Democrats are all for expanded access; Republicans dread tax increases to expand access, and are more concerned with managing costs (downard). This rift is described, in some detail, by Bob Blendon et. al. in an important analysis published this week in the New England Journal of Medicine.

NEJM feels so strongly about this content that they’ve made it freely available to all comers. I urge all of you who are tracking health politics this year to read this document.

Blendon’s politically savvy team analyzed polling surveys from a variety of sources, so this is a sort of meta-analysis of voters’ feelings in the key primary states. They analyzed many aspects of health care in America, including but not limited to support for universal coverage, concerns about rising health care costs, desire to radically or marginally reform the system, and opinions about the quality of health care received in the U.S.

There are a few areas where roughly the same proportion of Democrats and Republicans agree: that the health system has some good things, but requires some fundamental changes (agreed by about one-half of voters from each party); and, roughly the same proportion of Dems and Republications are worried about the economy (about 20% from each party).

Otherwise, across-the-board of health issues, there are striking differences based on deep philosophical rifts that have typically split the two parties: individual responsibility (that would be a deeply held Republican value) versus support for government intervention (which would tend to be a Democratic core belief). This chasm, which is the classic face-off between the individual vs. the collective, filters across all of the health issues polled. Take “the problem that Americans do not have health insurance.” 94% of Democrats find this a “very serious” problem, compared to 55% of Republicans. Consider a mandate that every American have health insurance: 79% of Democrats favor this versus 44% of Republicans — a nearly 2:1 ratio in favor of such a mandate.

Health Populi’s Hot Points: Kaiser Family Foundation has been tracking health issues for many months with an eye toward November 2008. Their latest data from December 2007 demonstrate that voters’ key issues right now are Iraq, health care, and the economy — which has been ticking up in citizens’ minds with the advent of the sub-prime mortgage crisis, rising prices at the gas pump, and sticker shock at the grocery store check-out. Where health care ultimately sits in the minds of voters will determine how the ever-dwindling cadre of Presidential candidates weight health care in their priorities. As the economy slips further into recession (which Merrill Lynch and Goldman Sachs assert we’re already in), both the economy and the health line items will weigh heavier on voters’ minds. Stay tuned to the Kaiser poll, which I will continue to monitor on behalf of Health Populi readers.