What Do Voters Want? A Clean Bill Of Health
By Geoffrey Colvin

(FORTUNE Magazine) – You'd never guess it from watching TV news or reading the papers, but the biggest concern of voters this year isn't WMDs or the economy or Howard Dean's howl or whether President Bush went to his National Guard meetings. It's health care. Ask real, lever-pulling voters what they worry about most, as pollsters do, and the answer is clear. The leap in interest is sudden and dramatic, which is great news--the issue demands all this attention and more. Now the bad news: As a nation, we are still not even close to getting real about health care.

If health care were a candidate, its surge would be the talk of every coffee shop and TV gabfest: Only 5% of Americans named it as a top concern two years ago; then last year the number more than doubled, to 11%, and this year it almost doubled again, to 19%. Why such a rush of worry? We could all cook up plausible explanations involving the aging of the population, enactment of the Medicare drug benefit, cutbacks in employer medical coverage, and other factors, and we'd all be more or less right. The key fact is that for whatever reason, Americans seem finally in a mood to confront a huge issue we've absolutely hated confronting for years. And it's going to hurt like hell.

The process we have to get through is what Daniel Yankelovich, the great pollster, has called the journey from public opinion to public judgment. Once an issue makes it onto our agenda, we demand action--and our demands are at first unrealistic, wishful thinking, insistently ignoring the hard tradeoffs of real life. That's where we are with health care. As a hospital administrator told me recently, the attitude of most patients is still, "I want the best possible care, immediately, for free."

Well you can't have it. Nobody can. That's reality. To gauge your own progress in getting real about health care, think about a few simple questions:

If you're an employee or retiree who receives company-paid medical coverage, do you have any idea how much it costs the company? Do you know what it would cost you to buy the same coverage on your own, rather than through the company? Because of your age or a preexisting condition, might you be unable to get coverage?

Do you know who owns your local hospital? Do you know if the owner is a for-profit or not-for-profit organization? Is your doctor a part owner of a hospital, and would that affect his medical advice?

If your spouse, parents, or children had to be rushed to an emergency room, do you know where you would want them taken? Many people don't, which is a metaphor for the fantasyland view of health care: Others know better; others are paying, so they'll decide.

For a real mind-bender, try this: Why are surging revenues seen as admirable and exciting in every industry except health care, where they're seen as a grave national problem? Think hard before you answer, for this turns out to be a deep question. Nobody says, "America's semiconductor costs are out of control," or "This country's broadband Internet access costs are becoming a crisis," though what we spend on those things is growing much faster than medical costs.

Could the difference be that we can live without semiconductors and broadband, but we literally cannot live without medical care? Okay, but how much care do we need? Here's a thought experiment: There's a very small chance you'll have a catastrophic health event this year and could be saved by a medicine or medical product or medical procedure that didn't exist a year ago. It probably won't happen, of course. But it could. Is that worth a 14% increase in your medical insurance premium (last year's average premium increase)? To put it another way: Would you like to save the 14% increase and in return agree not to be treated with any medical advances achieved since 2002? Just think, a level premium--keep paying 2002 prices, keep getting 2002 medicine. If you could do it, would you?

Such questions scarcely begin to suggest what we all have to think through. And while it's terrific that voters are urgently interested, the candidates won't lead us through the process; it's just too painful. The wrestling with hard reality that leads to what Yankelovich calls "full resolution--moral, emotional, and intellectual" is work we'll have to do mostly on our own. Now that we've started, let's not stop.

GEOFFREY COLVIN, senior editor at large of FORTUNE, can be reached at gcolvin@fortunemail.com. Watch him on Wall $treet Week With FORTUNE, Friday evenings on PBS.