By Richard Morin and David S. Broder
Washington Post Staff Writers
Friday , July 28, 2000 ; A01

Health care has emerged as the most important issue this election year, but voters disagree on which health care problem the next president should work hardest to solve, according to a poll by The Washington Post, the Henry J. Kaiser Family Foundation and Harvard University.

The poll of registered voters found little appetite for major government reforms and diminishing levels of dissatisfaction with the health care system--but broad agreement that something must be done to address the nation's many health-related problems.

Together, this seemingly contradictory and potentially combustible mix of views underscores the difficulties the presidential candidates face as they begin to navigate the increasingly fractured terrain of health care politics.

Voters view the Democrats as best able to deal with health issues. But this new political environment offers opportunities for Republican George W. Bush on an issue traditionally favorable to Democrats, while posing risks for Vice President Gore, the Post/Kaiser/Harvard poll found.

Gone, at least for now, are the inflated passions that fueled the fierce battle seven years ago over President Clinton's health care reform plan. Between 1993 and January of this year, the proportion of Americans in Gallup polls who said they were "not at all satisfied" with the health care system fell from 45 percent to 27 percent.

The public's appetite for far-reaching reform also is vastly diminished, the poll found. Seven in 10 adults said the federal government should work to increase the number of Americans covered by health insurance. But only 38 percent were willing to pay additional taxes for a "major" government effort to cover all of the uninsured.

The clearest signal that the GOP is no longer content to cede health care voters to the Democrats will come Monday, on the first night of the Republican National Convention. The night's themes: improving education and expanding health care to "insure access to quality care for all Americans," according to the Republican National Committee.

Bush and the GOP still have far to go to win the health care vote, according to the poll. Democrats are more likely than Republicans to rate health care as a voting issue. That is one reason health care voters, by 55 percent to 30 percent, say Gore would do a better job on the issue than Bush. But among all voters, Gore's advantage melts away to 4 percentage points.

Thus the objective for Republicans may be simply to neutralize the health care issue and diminish the number of voters who make it the deciding factor in November.

That's an achievable goal for the GOP, said Robert Blendon of Harvard's School of Public Health, who worked on the poll. "It's clear that people are in a moderate mood on health care, and that Bush has a real chance to talk to health care voters," said Blendon. "The gap between Bush and Gore on this issue is now much narrower than it traditionally has been between Republicans and Democrats."

For Gore, the challenge is to clarify the differences between his proposals and Bush's. On paper, at least, it would seem easy for Gore to cement his standing with health care voters. According to the poll, the public prefers him to Bush on such key issues as covering the uninsured, prescription drugs and a patients' bill of rights.

The problem for Gore and the Democrats, Blendon said, is that "the history of health care as a political issue shows that it is extremely hard for candidates to explain their positions to voters in a way to get political gain. . . . The solutions all end up sounding like some very complex government plan that means higher taxes."

The public is already suspicious. A majority of voters say Gore's plan to cover more uninsured would lead to a "big" tax increase, and nearly as many say the same thing about Bush's plan. (In fact, neither Gore nor Bush suggests raising taxes: Both candidates plan to pay for new health care initiatives out of the budget surplus.)

The poll suggests that some of Gore's vulnerability on health care comes from an unexpected source: his own party. On issue after issue, Democrats said they trusted their party more than they trusted Gore to deal with specific health care concerns. At the same time, voters gave somewhat higher marks to Bush on health care than they did to the Republican Party.

"Yes, I'll go with Bush," said Andy Hill, an oil and gas distributor who lives on a farm outside Winston-Salem, N.C. Hill acknowledged that many health care problems need immediate attention, but he said he prefers Bush's modest proposals to Gore's more expansive plans.

"I'm a Democrat, don't get me wrong. To me, [Gore's] not what I consider my line of Democrats. I am a Terry Sanford Democrat," Hill said, referring to North Carolina's late governor and senator, who was known for his liberal views on social issues and more conservative views on the role of the federal government. "Of course Terry Sanford would rise out of his grave and kick my tail for supporting Bush."

A total of 1,183 self-described registered voters were interviewed, including 614 voters who said health care or Medicare was an important issue in deciding their presidential vote. The margin of sampling error for the overall results is plus or minus 3 percentage points, and plus or minus 4 percentage points for the health care voters.

Health care, including Medicare, has emerged as the top voting issue for 44 percent of all voters this election year, surpassing the economy, crime, jobs, the budget and even education on the public's list of priorities, according to the poll.

But which health care issue? The poll found no consensus on which is the most pressing problem. Equal proportions of Americans named patients' rights, the cost of prescription drugs for the elderly and spotty health insurance coverage as their biggest worry. Three other concerns were chosen by nearly as many health care voters, virtually a six-way tie.

"It's unbelievable, the cost of prescription drugs and hospital stays and doctor's visits," said Donna Foster, 49, a sales manager for a radio station in Ardmore, Okla. "And I'm worried about people who don't have health insurance."

The experiences of her mother have shown her the difficulties seniors have obtaining affordable medications. "Right now she doesn't have to make a choice between food and drugs. But if things keep up, we might," said Foster, who plans to vote for Gore.

Other voters are sharply focused on a single issue, which also complicates the politics of health care. While politicians talk interchangeably about health care and Medicare as if they were complementary issues, they are not. Voters most concerned about Medicare, the poll suggests, are often indifferent and occasionally hostile to other health care concerns.

"If someone is going to take care of Medicare and keep it strong, I'd be for them," said Weldon Keller, 70, a semi-retired carpenter in Hico, Tex. But other proposed reforms leave him cold. "I don't think government needs to try to do everything, and they can't afford to do everything."

Most Americans support an active but limited role for government in ensuring the safety and quality of medical products and services. Today, what voters want is not major change but incremental solutions to specific problems.

For example, 58 percent reject a single-payer plan, similar to Britain's and Canada's, in which all citizens would get health insurance through the government. By contrast, 68 percent say the government should ensure that retirees over 65 can obtain the prescription drugs they need. By a large margin, 57 percent to 36 percent, they endorse the Clinton-Gore administration proposal to make drug benefits part of Medicare over the Bush-Republican congressional alternative of providing government subsidies for the purchase of private drug insurance plans.

Even a narrow majority of GOP voters say they prefer expanding Medicare to include prescription drugs--a finding that underlines Democrats' belief that this is a potentially important issue for them.

"It has to be a modest effort," said Bob Pasquarelli, 48, a sales representative in Castleberry, Fla., outside Orlando who plans to vote for Gore. "It has to be a marriage between private enterprise and government. . . . Government wants to get involved in too many things, and doesn't do them well."

But those polled rejected reforms or measures that would significantly raise taxes. Seventy-two percent say the government should try to reduce the number of uninsured--but support drops to 38 percent if a tax increase is part of the plan.

The poll also suggests that some popular health care initiatives may not be quite as popular as many politicians believe. Eight in 10 health care voters, for example, support a patients' bill of rights, including the right to sue health plans--a lopsided consensus irresistible to some politicians.

But nothing in the politics of health care is quite so simple. Support falls by more than 30 percentage points when supporters are asked if they would still support a patients' bill of rights if it meant that "some companies might stop offering health care plans to their workers"--an argument raised by opponents of patients' rights provisions that allow workers to sue their health plans.

In this cautious and comfortable political climate, the poll suggests that both presidential candidates have picked health care proposals that are popular with the public.

Three-fourths favor expanding state government programs for low-income people, which are favored by Gore, and about two-thirds favor offering uninsured Americans income tax deductions, tax credits, or other financial assistance to help them purchase private health insurance on their own, which Bush supports.

Assistant director of polling Claudia Deane contributed to this report.

2000 The Washington Post Company