Health and Care: what the public prioritizes and why it is hard to measure

Health and Care, one of the ten provisional subjects in My Vote Forward, covers health services, public health, caregiving and mental health. In the United States, health spending reached $5.3 trillion in 2024, or 18.0% of the economy, according to federal estimates, yet the subject ranks very differently in surveys depending on how the question is asked. A high priority for health and care tells you people want attention paid to it; it does not tell you whether they want more government, less government, lower prices, more access or different rules.

In plain words

Almost everyone uses health care at some point. Many people also care for a parent, a child or a partner. So it is no surprise that health and care matters to people.

But “health care should be a priority” can mean very different things. One person means “my insurance costs too much.” Another means “my mother cannot find a nursing aide.” A third means “the government should stay out of my medical decisions.” All three might rank this subject first.

This page explains what surveys show, why they disagree, and what choices sit underneath the subject. Two companion pages explain who decides and what the evidence shows.

Defined terms

Health and Care (as a My Vote Forward subject). Health services, public health, caregiving and mental health, as scoped in the demo’s provisional subject list. See Subjects.

National health expenditure (NHE). The federal estimate of all spending on health care and related activity in the United States, published by the Centers for Medicare and Medicaid Services (CMS).

Coverage. Having health insurance, whether private (through an employer or bought directly) or public (Medicare, Medicaid, military and veterans’ programs).

Access. Whether a person can actually obtain needed care at a reasonable time, distance and cost. Coverage does not guarantee access.

Public health. Population-level activity such as disease surveillance, vaccination programs, sanitation and outbreak response, as distinct from treating individual patients.

Caregiving. Unpaid help given by family members or friends, and paid long-term services and supports, to people who need assistance with daily activities.

Priority versus proposal. A priority says the subject deserves attention. A proposal is a specific action, with an authority, a cost and a funding source. See Proposals.

Evidence: what the public says about health and care

Health and care looks marginal or central depending on the survey method. In Gallup’s open-ended question, “What do you think is the most important problem facing this country today?”, 3% of adults named healthcare in September 2026, compared with 30% who named government or poor leadership and 13% who named the high cost of living or inflation.⁠¹ Gallup interviewed about 1,000 adults by telephone from September 1 to 17, 2026, with a margin of error of ±4 percentage points.⁠¹

A closed list produces a different picture. In Pew Research Center’s January 2024 survey of 5,140 adults about priorities for the president and Congress, about six in ten adults in every age group said reducing health care costs should be a top priority.⁠² The difference is not a contradiction. People who would rate health costs as important when asked about them directly may still name something else as the single most pressing national problem. See Subjects for a fuller discussion of open and closed questions.

Questions about the role of government divide people more sharply than questions about importance. In a Pew survey of 10,357 adults conducted November 17 to 30, 2025, 66% said the federal government has a responsibility to make sure all Americans have health care coverage, and 33% said it does not.⁠³ Among Democrats and those leaning Democratic, 90% said the government has that responsibility; among Republicans and Republican leaners, 41% did.⁠³ Within the whole sample, 35% favored a single national government program and 31% a mix of government and private programs, while among those who said the government is not responsible, 26% of all adults said Medicare and Medicaid should continue and 7% said the government should not be involved at all.⁠³

These numbers show why a ranking of subjects cannot be read as a policy instruction. Two people who rank health and care first may hold opposite answers to Pew’s question.

Why health and care is hard to measure as a priority

Health and care is hard to measure as a priority for five reasons.

It bundles different problems. The demo’s scope joins medical services, public health, caregiving and mental health. Someone worried about vaccine mandates, someone worried about drug prices and someone caring for a parent with dementia are all inside one subject. The Comparative Agendas Project, which codes policy activity across countries, treats health as one major topic but separates social welfare and other areas that touch caregiving (see Subjects).

It overlaps other subjects. Health insurance is tied to jobs for many Americans, which places part of the concern inside Economy and Work. Homelessness and mental illness overlap with Housing and Communities. A person must decide where to put a concern that belongs in two places, and different people will decide differently.

Personal experience changes salience. Health concerns spike when a person or a family member is sick. A ranking taken in one month may describe the participants’ recent experiences more than a stable view.

Cost and quality are often confused. “Health care is a problem” may mean the system costs too much, or that it delivers too little, or both. Survey questions that ask about “health care” without distinguishing cost, coverage, access and quality cannot tell these apart. See Question design.

Participants are not the public. Anyone who chooses to take part in My Vote Forward is self-selected. People with serious illness or heavy caregiving duties may have the strongest views and the least time to participate. See Measurement.

The real tradeoffs in health and care

Health and care involves tradeoffs that no ranking resolves. Each one has serious defenders on more than one side.

Spending versus everything else. CMS estimates that national health expenditure reached $5.3 trillion in 2024, or $15,474 per person and 18.0% of gross domestic product, and it projects health spending to rise to 20.6% of GDP by 2034.⁠⁴ Every additional dollar spent on health care is a dollar that households, employers and governments do not spend on wages, schools or other goods. Some argue the spending buys real value; others argue much of it is waste or high prices. The evidence page reviews what is known.

Who pays. CMS reports that in 2024 the federal government financed 31% of national health spending, households 28%, private businesses 18%, and state and local governments 16%.⁠⁵ Shifting costs among these payers does not make them disappear. Lower premiums for one group may mean higher taxes for another.

Federal versus state budgets. Medicaid is jointly financed. KFF reports that total Medicaid spending was $919 billion in federal fiscal year 2024, of which the federal government paid $594 billion (65%) and states $325 billion (35%).⁠⁶ Because states must balance their budgets and the federal government does not, decisions about Medicaid eligibility and payment rates in one capital ripple into the other.

Present versus future commitments. The 2025 Medicare Trustees Report projects that the Hospital Insurance trust fund, which pays for Medicare Part A, will be depleted in 2033, three years earlier than projected the year before, after which incoming revenue would cover 89% of costs.⁠⁷ Options to close the gap include higher payroll taxes, lower payments to providers, changes to benefits or eligibility, or general revenue transfers. Each falls on a different group.

Unpaid care versus paid care. AARP and the National Alliance for Caregiving estimated in 2025 that 63 million Americans are family caregivers, nearly 50% more than in 2015; half reported a negative financial impact and seven in ten were employed.⁠⁸ Public support for paid care reduces the burden on families but costs money and requires a workforce. Relying on families keeps public costs lower but concentrates costs on caregivers, most of whom, in the AARP survey, were also employed.⁠⁸

Individual liberty versus collective protection. Public health measures such as vaccination requirements and quarantine rest on state police power. The Supreme Court upheld a compulsory smallpox vaccination law in Jacobson v. Massachusetts (1905), stating that liberty “does not import an absolute right in each person to be, at all times and in all circumstances, wholly freed from restraint”.⁠⁹ The same opinion said courts could intervene if a rule were applied in an arbitrary or oppressive way.⁠⁹ Where that line falls remains contested.

Strongest arguments across perspectives

The strongest arguments about health and care do not line up neatly on one axis. Each of the following is held by serious people and has evidence that supporters cite.

Universal public coverage. Advocates of a single national program argue that the United States spends more per person than peer countries (an analysis of OECD data put 2024 U.S. spending at $14,775 per person against a peer average of $7,860⁠¹⁰) while leaving millions uninsured, and that a single payer could use its bargaining power to lower prices and administrative costs. They point to other high-income countries that cover everyone at lower cost. Critics answer that those systems ration care through waiting lists and budgets, and that transition costs and tax increases would be large.

A mixed public and private system. Supporters of the current mix, or of expanding it through subsidies and public options, argue that it preserves choice for the majority who have private coverage while filling gaps. Critics on one side say it leaves too many people underinsured; critics on the other say subsidies raise prices and crowd out private markets.

Market competition and consumer choice. Market-oriented reformers argue that health care costs are high because patients rarely see prices, regulation limits supply, and third-party payment removes incentives to economize. They support price transparency, health savings accounts, repeal of certificate-of-need laws and broader scope of practice for nurse practitioners. Critics answer that patients cannot shop well during emergencies and that markets can leave the sick and poor without coverage.

State and local control. Federalists argue that states differ in demography, costs and values, and that Medicaid, insurance regulation and public health work best when decided closer to home. Critics argue that state control produces unequal coverage based on where a person lives, as the split between expansion and non-expansion states shows. See Who decides.

Prevention and social conditions. Public health advocates argue that the largest gains come from outside the clinic: reducing smoking, overdoses and injuries, improving housing and nutrition. Critics caution that such programs are hard to evaluate and can become paternalistic or open-ended.

Family and community care. Some argue that caregiving should be supported through tax credits, paid leave and respite services that keep care within families. Others argue that relying on families is inequitable and that a professional long-term care system is needed. Both views treat caregiving as a public concern, which is itself a change from treating it as purely private.

Competing interpretations

Health and care priorities can be read in at least three ways, and each reading leads somewhere different.

A cost reading. The consistent concern in surveys is about cost, which suggests a high priority mostly reflects household financial strain. On this reading, the public wants lower bills and is less concerned with the structure that produces them.

A security reading. Another reading holds that people want assurance that they will not lose coverage or be ruined by illness. Pew’s finding that two thirds see a federal responsibility for coverage⁠³ fits this reading, though the same survey shows deep disagreement about the means.

A distrust reading. A third reading, prominent since the COVID-19 pandemic, holds that health has become partly a question of trust in institutions and of personal autonomy. On this reading, a high priority may mean “government has overreached” as often as “government should do more.”

My Vote Forward does not choose among these readings. A subject ranking cannot distinguish them, which is why opinions on specific proposals are asked separately with specific wording. See Opinions.

Application to this framework

• Priority. A participant can rank Health and Care against the other nine subjects. The result says how much attention participants think the subject deserves, nothing more. See Priorities.
• Opinion. Views on a specific proposal, such as a hypothetical county mental health levy, are a separate step with exact wording and voluntary sharing. See Opinions.
• Vote. If a health measure reaches an official ballot, the vote happens through the official election, not through My Vote Forward. See Private voting.
• Authority. Because health and care decisions are split among federal, state and local bodies, the framework points each concern toward the body that can act. See Who decides.
• Tradeoffs. Ranking health above other subjects is not the same as allocating money to it. See Tradeoffs.

Hypothetical example: in a city where participants rank Health and Care first, the published result would say that, with the denominator and method. It would not say participants favor any particular program. A county health board considering a new clinic could see the priority, but would still need to consult on the specific proposal.

Unresolved questions

• Should caregiving and mental health be separate subjects, given how different they are from medical services and insurance?
• How should a participant classify a concern that spans subjects, such as employer-based insurance or homelessness among people with mental illness?
• Can a priority question be designed to distinguish cost concerns from access and quality concerns without becoming a policy question? See Question design.
• How much do recent personal health events shift rankings, and should results report that volatility?
• How should local priorities for health be reported when most health financing decisions are federal or state?