Hopping over the Electoral Hurdles of Health Care

Sometimes the remedy is worse than the disease.     

-Francis Bacon

 

Canadians like their health care.

Not only do they like it - they pay attention to it and they really (I mean really) don’t want government to cut spending on it.

Not as much as they used to though.

The Canadian Election Study asked voters a number of interesting questions measuring their attitudes and opinions towards the topic of health care.

There are a million different ways you could analyze views towards health care given it’s sacred place in Canadian society, however, I thought the following would be interesting to look into:

  • Whether voters thought government should spend more, less or about the same as now (in 2015) on health care and how those views have changed over time (if at all).

  • How much attention voters paid to health care in relation to other major public policy issues such as crime, immigration or the environment as well as who was paying the most/least attention.

  • Which voters were satisfied with then Prime Minister Stephen Harper’s handling of health care and to what extent were they satisfied (spoiler alert: satisfaction went beyond the Tory base).

  • How voters perceived the state of Canada’s health care system and to what extent they thought it was good/poor.

So let’s pull out our stethoscope and get to the heart of healthcare.

Source: Canadian Election Study

Source: Canadian Election Study

Support for increased government spending has dropped significantly over the past fifteen years.  Almost all of the increase in support for status quo spending came at the expense of those who want spending increased.

One way to read the data is that voters are more likely to believe that government shouldn’t spend any more money on healthcare as opposed to spending less on it.

If I were a healthcare policy analyst or lobbyist for health care services I would take interest in the above because it means that requesting government funding for health services would become increasingly difficult. My client or organization’s funding would be increasingly more likely to come from another health entity that was receiving government funding.

Having said that, the good news for a lobbyist is that no government would ever want to advocate for decreased spending on healthcare due to its massive unpopularity.

Remember: in politics there’s one pie. Every increase or decrease in the size of your slice came from somebody else’s.

Source: Canadian Election Study

Source: Canadian Election Study

Region is a significant variable that helps explain the increase in support for status quo spending. We see voters from Alberta to Ontario being more likely to support the status quo while Quebec and the two coasts are more likely to believe the government should spend more. Women were more likely to believe that the government should spend more while men were more likely to support the status quo.  

An interesting finding from the above is the percentage of voters 25-34 who were more likely to believe in increased government spending than any other age group. Analysis a few charts below shows that those over the age of sixty five paid the most attention to healthcare but lacked the intensity of support for government spending than those 25-34 had.

Source: Canadian Election Study

Source: Canadian Election Study

Strong majorities of within every demographic measured in this analysis believe the government should spend more on health care. However, as the top ten graph above shows, some demographics are less intense in their support than others.

Source: Canadian Election Study

Source: Canadian Election Study

I used the above chart in my first article to show where immigration stacked up in relation to other major public policy realms. We see that healthcare was paid attention to more than any other issue during the 2015 election and any politician that wanted to get the attention of voters was more likely to get it with healthcare than on matters of defence or even crime.

Source: Canadian Election Study

Source: Canadian Election Study

It’s unfortunate that we aren’t able to see how much attention health care received over the years like we do government spending.  However, we do see some change over a four year period. There was a six point drop (roughly one in twenty voters) in the percentage of voters who said they pay a lot of attention to health care while the percentage of people who said they were paying at least some attention grew by six percent.  

Source: Canadian Election Study

Source: Canadian Election Study

Conservatives take note: Quebec and BQ voters paid the highest level of attention to health care followed by those who are over the age of sixty five. As noted in a few graphs above, those 25-34 were more likely than any other age bracket to believe in increased government spending but didn’t make the top ten demographics that paid attention to health care.

Source: Canadian Election Study

Source: Canadian Election Study

The above shows that it’s not whether people pay attention to health care, it’s to what extent they care about it. Those 25-34 paid the least amount of attention to health care and were more likely to say they paid at least some attention to it.

Source: Canadian Election Study

Source: Canadian Election Study

Incumbents face a different set of electoral challenges than their opposition counterparts. Incumbents generally run on their record from their time in office and will tout the progress they’ve made as a reason to be re-elected.

Historically, voters often use the economy as a metric by which the electorate decides whether to reward or punish incumbent governments. However, we see that health care is a massive priority for voters and it would make sense to see to what extent voters were satisfied with then Prime Minister Stephen Harper’s handling of health care.

We see that half of voters overall were satisfied with Harper’s management of health care. All things considered, this isn’t half bad: Harper became increasingly unpopular during his tenure and policy issues are often seen with a partisan lens. As a Conservative strategist or staffer at Health Canada, I would have taken some satisfaction to know that even though only one-third of the electorate voted Conservative; half of the electorate were satisfied with Harper’s handling of health care. His performance cut through partisan lines.  

Source: Canadian Election Study

Source: Canadian Election Study

I don’t think it would come as a surprise to readers that those who voted Conservative and those in Alberta (a highly conservative region of the country) were most satisfied with Harper’s management of health care.

What’s really interesting to note is how much satisfaction younger voters 18-24 had. Generally speaking, this demographic is very unlikely to vote Conservative and had far-from enthusiastic views about Stephen Harper during his time in office.

As noted earlier, policy matters are often viewed through a partisan lens. We see left-of-centre voters having the greatest level of dissatisfaction with Harper’s management of health care while those in households earning <$60k/year also exhibited moderately high levels of dissatisfaction. This is important because middle-class voters are a key demographic all parties needed to win over.

Performance of Stephen Harper - health care - all demographics.png

A few graphs above we saw that half of the electorate was satisfied. We see to what extent that (dis)satisfaction was distributed among different demographics. Among partisan lines, Green party voters had the second highest level of satisfaction with Harper’s handling of health care.

the state of the Canadian health care system - 2011 vs 2015.png

From the above we see minor shifts in increased satisfaction towards the state of Canada’s health care system. This may help contextualize why demand for government spending decreased in the lead up to the 2015 election.

Source: Canadian Election Study

Source: Canadian Election Study

When we look at the amount of confidence voters had in the state of Canada’s health care system we see that those over the age of fifty five, those in Ontario and those in Alberta were most confident.

The good news for health policy analysts is that fewer than one in five of each of the top ten demographics were critical of the health care system.

Source: Canadian Election Study

Source: Canadian Election Study

While some demographics were more critical than others, voters overall had a great deal of confidence in the Canadian health care system. Those who held the harshest criticisms about the state of Canadian health care were marginal at best.

A left-of-centre party would most likely benefit from promising more money for healthcare on the campaign trail. Why?

  • Increased government spending is very popular overall.

  • Increased government spending on health care appeals to the demographics that are least likely to vote Conservative.

Considering that the NDP and Liberals are both going after the same demographics I would imagine both parties to step up their spending game. Just recently we saw the NDP promise free dental care for households earning <$70k/year is an example of this.

Not a bad move.

The problem both the NDP and the Liberals have is: who is seen as more credible and more likely to deliver on those health care promises?

If I were a Conservative, I sure as hell wouldn’t want to announce that I was going to cut health care spending. What I would try and do is find out which aspects of healthcare voters prioritize the most and transfer funding from areas that don’t need as much funding and put it into areas that (the public believes) do. You would be able to tell voters that you wouldn’t be reducing spending and that you were trying to get them more value for their dollar.

 

Adrian Macaulay