Health Care Could Be Pivotal Issue in Swing States

September 22, 2004 08:47:40 PM PDT , HealthDay

By Karen Pallarito
HealthDay Reporter

WEDNESDAY, Sept. 22 (HealthDayNews) -- Health care may not be the defining issue in this fall's presidential race, but it could become critical in some "swing states," new research suggests.

"It depends on how close the election is," said Robert J. Blendon, a professor of health policy and management at the Harvard School of Public Health, and lead author of a new study examining public opinion survey results.

The report, co-authored with Kaiser Family Foundation President and Chief Executive Officer Drew E. Altman and his colleagues, appears in the Sept. 23 issue of the New England Journal of Medicine.

Health care ranks as a top domestic issue, ahead of education and Social Security, the study found. Asked to describe in their own words which health-care issues would be most important in deciding their vote for president, voters most frequently mentioned the cost of health care and prescription drugs, and Medicare and health care for the elderly.

Yet voters say they're more concerned about the economy and jobs, the war in Iraq and terrorism, the survey revealed. These same issues remain dominant themes in the candidates' pre-election stump speeches and will likely frame the three upcoming debates between President George W. Bush and Sen. John Kerry.

If it's a tight race, the candidates may look for an issue on which they might "hit a home run," Blendon said, and that could put health care on the playing field. "I think after the first week in October, we'll see if the candidates think it's really worth battling it out," he said.

Gail Shearer, director of health policy analysis for Consumers Union in Washington, D.C., sees health care playing a more pivotal role in the election than its fourth-place ranking in the new survey might indicate. "To me, I read into this that health care could be very important," she said.

If the election is close, then the swing states will be critical in deciding the election, Shearer said. And, she added, because most Americans get health insurance coverage through the workplace, it's difficult to separate the impact of the economy and job creation -- voters' No. 1 election issue -- from their concern about rising health-care costs.

To test the importance of health care as an issue in the election, health-care researchers examined data from 22 national opinion polls, including two surveys designed specifically for the new study.

In all of the surveys, voters were given a list of issues to help them recall the ones they considered most important. The results of the surveys were statistically re-weighted to reflect the composition of the U.S. population.

Democrats were more likely to cite health care as the single most important issue for deciding their vote for president. The issue gained top billing among 19 percent of Democrats, vs. 13 percent of independents and 9 percent of Republicans.

Likewise, the issue gained more traction among Americans aged 65 and older than younger adults.

Asked to rate the importance of 11 specific health-care issues, most voters said the cost of health care and health insurance, the cost of prescription drugs, prescription drug benefits for the elderly, and the uninsured would be most important in deciding their vote for president.

Only 1 percent of voters cited quality of health care. "It isn't that they're not concerned about quality issues, but they don't see candidates as solving this problem," Blendon reasoned. "They don't think that either Kerry or Bush is going to make the doctor better."

One-third of voters -- particularly white males -- do not regard health care as an important election issue, the study found. For them, none of the 11 health issues was deemed critical to deciding their vote.

"It's not important to them that health care be a big issue to the top leader of the country," Blendon said.

What's important to older voters, however, may be a different story. The survey revealed deep divisions over the Medicare prescription drug law backed by the Bush administration last year. Forty-eight percent of those polled have an unfavorable impression of the law, and only 27 percent view it favorably.

"I think that could be a major issue for many voters," Shearer said.

More information

The Kaiser Family Foundation can help you compare the presidential candidates' health policy positions.

Steroid Tames Mild Cases of Croup

September 22, 2004 02:02:31 PM PDT , HealthDay

By Serena Gordon
HealthDay Reporter

WEDNESDAY, Sept. 22 (HealthDayNews) -- It's the middle of the night and your child, who's been sick with a cold, is making the strangest noises you've ever heard; it almost sounds like a seal barking.

That sound is the hallmark of croup, a catchall term used to describe common symptoms that can occur with a number of respiratory viruses.

And a new study finds that treating mild cases of the disease with the steroid dexamethasone offers some benefits.

Most cases of croup are mild, and get better on their own in a couple of days. But, that's little comfort to a parent who's been up for hours in the middle of the night with a constantly coughing child.

That's why Canadian researchers conducted a trial to see if treatment with dexamethasone could help children with mild cases of croup.

They found that a one-time oral dose of dexamethasone, which is used to treat more severe cases of the croup, showed "small, but important clinical and economic benefits."

"Both as a primary-care physician and as a mother, I was glad to see someone looking seriously at the milder form of the disease," said Dr. Perri Klass, who wrote an editorial accompanying the study in the Sept. 23 issue of the New England Journal of Medicine. She is an associate professor of pediatrics at Boston University School of Medicine.

"Often we don't seriously think about the stress and anxiety of the mild forms of the disease," she said. "Before you think about using some kind of intervention, you need to know if it will make a measurable difference."

While croup is possible any time during the year, according to the National Institutes of Health, the disorder is most common in the northern hemisphere October through March. Children between 3 months and 5 years old tend to be the ones most affected, and some children have it more than once in any given year.

In the new study, the researchers treated 720 children who had mild croup with either a single dose of dexamethasone or a placebo. The children were recruited from four different pediatric hospitals across Canada.

Doctors grade croup on a scale from zero to 17, and to be eligible for the study children had to have a score of less than two, the researchers said.

The researchers followed the children to see if they had to return to their health-care provider for additional treatment, and also assessed symptoms on days one, two and three after treatment. They also calculated economic costs, parental stress and the number of hours of sleep lost by the child.

Fifteen percent of the untreated group had to return to their doctor for follow-up care within seven days, while only 7.3 percent of the treated group needed additional care.

The researchers also calculated economic costs to society ( Canada has government-sponsored health care), and found treatment saved an average of $21 per child.

Children who were treated with dexamethasone lost slightly less sleep than those who didn't receive medication, and their parents reported slightly less stress.

Dr. Frank McGeorge, program director for emergency medicine at Beaumont Hospital in Royal Oak, Mich., said the cases in the study were very, very mild cases of croup. "The question is whether or not this is even a disease that needs to be treated at all. You're talking about a group that most pediatricians would consider not at a particular risk of worsening, and would be highly likely to improve if left alone," he said.

McGeorge pointed out, however, that giving a dose of dexamethasone for croup is already fairly standard practice in emergency medicine.

"If they're sick enough to show up in the ER, their illness is probably severe enough that treatment will be of benefit," McGeorge said. He added that while this study probably won't change his practice much, it might make him consider giving a dose of dexamethasone in milder cases.

Because it's just a one-time dose, neither Klass nor McGeorge expressed concern about side effects from the medication. But both pointed out, as do the authors of the study, that no long-term studies have been done to see if there are any long-term effects.

If you're worried about your child's cough or concerned about his or her breathing, Klass added, "I don't think you can say this too many times -- anything that seems to be compromising a child's airway is extremely serious and should be watched. It's never a bad idea to check in with your doctor if you're worried about a young child's breathing."

More information

To learn more about croup, visit the National Library of Medicine.