C. WILF
952
structures eith er di sagree or are neutral.
Statement 3.
Health care is a luxury, just like living in a nice neighbor-
hood or driving a nice car (fb).
Factor scores: –4 –1 –3 –4 0
Statement 1.
Health care is socialism, and socialism is not an American
value (fb).
Factor scores: –3 –4 0 –4 0
Statement 3 emphasizes the universal prioritization of health
care common to all belief structures, and even the Libertarians
do not reject this position. The statement on socialism, included
so as to make the domain as comprehensive as possible, is also
either strongly rejected or ignored. The health care debate has
often been infused with inflammatory ideology to advance po-
litical agendas. However the analysis reveals an inverse asso-
ciation or indeed no association between health care and an
alternative societal paradigm. It is also significant that both
statements are fact types or lower order statements. All belief
structures show a common position at this most basic level, and
do not involve higher order goals or methods for their attain-
ment.
Conclusion
Q Methodology reveals a set of distinct belief structures that
go beyond differences found in political polls. Five belief
structures were derived from the analysis and indicate that un-
derlying ideas and concerns about health care reform cover a
more complex range than previously indicated. While labels
and hence ideologies such as liberal or conservative have been
repeatedly applied to the health care debate, Q Methodology
shows that these labels are simplistic at best, and potentially
misleading. It may seem, for example, that the conservative
label might equally apply to the Status Quo Advocates and the
Anti-Government Libertarians. But a review of their defining
statements indicates important differences between them. Con-
sider Statement 29:
We need to address the economic inequity that underlies our
ability to achieve health care outcomes that other societies
have achieved (cw).
Factor scores: 1 1 –4 2 2
The Status Quo Advocates are adamantly opposed since this
involves change, while the Libertarians take a position more
like the Welfare State Activists, the Future Cost Alarmists and
the Uncertain Interventionists, who could hardly be considered
conservatives. Yet one could argue that the Libertarians react
positively to this statement because in their belief structure it
represents an imperative for individual self-sufficiency on this
issue, just as self-sufficiency drives their other responses.
Equally important, Q Methodology has shown that despite
deep differences in underlying belief structures, there is a
common policy space that can serve as a practical starting point
for discussing health care service delivery. Protection from
catastrophic financial loss, a concern for accelerating business
health care expenditures, and a belief that access to health care
is a basic necessity are fundamental premises that every belief
structure, from Welfare State Activists to Anti-Government
Libertarians can support. As the health care debate continues
and likely intensifies as challenges to the Affordable Care Act
are presented, policy prescriptions that begin with these few
reliminary yet politically acceptable ideas may have a better
likelihood of generating meaningful and permanent health care
reform than more comprehensive programs that put opposing
belief structures against each other.
p
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