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The number of Americans who want "radical change" in the U.S. healthcare system has reached 36 percent, focusing intense national attention on the issue, says Republican pollster Bill McInturff, who has tracked the question since 1992.
"Every time we have gotten into the mid-30s or higher (percentage-wise), we have had a huge debate," he says.
Healthcare reform efforts, both the rhetoric and the substance, are strongly shaped by what pollsters find in their surveys.
Mr. McInturff says other spikes in the desire for change have stimulated debate, but also countervailing forces that have blocked substantive change. Small business led much of the opposition to healthcare reform during the Clinton administration, but that dynamic seems to have changed, he says.
"Among the people who say they want change are small business owners (43 percent) and people who work at companies of less than 10 employees (48 percent)," Mr. McInturff tells Dermatology Times.
In 1995, almost two-thirds of Americans said they wanted government to do less. Former Speaker of the House Newt Gingrich tapped into that sensibility to lead a Republican revolution in Congress in the 1990s.
But there has been "a gradual shift over the last decade so that a comfortable majority, 55 percent, now say they want government to do more," Mr. McInturff says.
Another trend he has identified is "public anger" over the extraordinary cost of the U.S. involvement in Iraq and the money being spent there, which many contend could be spent at home. He says an economic dialogue over Iraq "was not plausible" in 2004, but has become so now.
Countering this to some extent is the more recent and growing concern with the economy: job security, the imploding housing market and the rising cost of gasoline and food. Economic worries have replaced healthcare as the leading concern of voters, and that is likely to influence political priorities during the next session of Congress, Mr. McInturff says.
Ms. Lake agrees. She says that for voters, particularly females, "Healthcare is not just an issue, it is a value. Voters overwhelmingly believe that healthcare is a right. ... It is not accidental that all of the Democratic (presidential) candidates came out immediately with comprehensive healthcare reform plans."
Embedded within Americans' sense of a right to healthcare is a constellation of other values and perceived responsibilities that influence how programs will be discussed and shaped.
Chief among them is the idea of personal responsibility, Ms. Lake says.
"Everyone should play a role here. If you don't tap into that, you often find that people start differentiating between the 'deserving' and the 'undeserving,'" she says.
One form it takes is support of co-payments for medical services. The word "prevention" is tests well with focus groups, but "wellness" does not.
"It sounds like you have to change your lifestyle," Lake says. "People are furious about insurance practice of pre-existing conditions."
Choice is another paramount value, particularly for people who already have health insurance coverage; they want to be able to keep their own doctor, she says.