National Exit Research Articles

Voters and Values in the 2004 Election

A poorly devised exit poll question undermined meaningful analysis of voters' concerns in the 2004 presidential election. Twenty-two percent of voters picked moral values from a list of issues describing what mattered most in their vote, more than selected any other item. Various commentators have misinterpreted this single data point to conclude that moral values are an ascendant political issue and to credit conservative Christian groups with turning George W. Bush's popular vote defeat in 2000 into his three million-vote margin of victory in 2004. We suggest, rather, that while morals and values are critical in informing political judgments, they represent personal characteristics and ill-defined policy preferences far more than any discrete political issue. First by conflating morals and values and then by further conflating characteristics and issues, the exit poll's issues list distorted our understanding of the 2004 election. In this article, we examine the flaws in the 2004 National Election Pool exit poll's most important issue question and explore the presumed rising electoral importance of moral values and the conservative Christians who overwhelmingly selected this item. Using national exit poll data from 1980 through 2004 and other national surveys, we find that the moral values item on the issues list cannot properly be viewed as a discrete issue or set of closely related issues; that its importance to voters has not grown over time; and that when controlled for other variables, it ranks low on the issues list in predicting 2004 vote choices. The aggregated exit poll data also show that the voting behavior of conservative Christians is relatively stable over time, and these voters were not primarily responsible for Bush's improvement in 2004 over 2000.

Health care in the 2004 presidential election.

We examined the importance for voters of health care as an issue in the presidential election of 2004, how this ranking compares with the importance of health care in past elections, and which issues voters regard as the most important health care issues in the months before the election. We studied data from 22 national opinion surveys, 9 of them conducted as telephone surveys during the 2004 presidential campaign, 10 conducted as telephone surveys during the previous three presidential elections, and 3 conducted as national exit polls of voters. Voters ranked health care as the fourth most important issue in deciding their vote for president in 2004. The top health care issues for voters were the costs of health care and prescription drugs, prescription-drug benefits for the elderly, the uninsured, and Medicare. Bioterrorism and abortion were also important issues for voters. The voters most concerned about health care were older persons and those who identified themselves as Democrats. Four issues less salient to voters were racial disparities in health care, aid to developing countries to prevent and treat human immunodeficiency virus infection and the acquired immunodeficiency syndrome, medical malpractice, and the quality of care. Although health care ranks higher in importance among voters than most other domestic issues, it is only fourth in importance in deciding their vote for president. The health care issues of greatest concern are the affordability of health care and health care insurance. Health care issues do not appear likely to play a decisive role in the presidential election in 2004, but they might make a difference in some swing states if the race is close.

STUDENTJAMA. Medical education in modern China.

MODERN CHINESE MEDICAL EDUCATION HAS RECENTLY UNdergone 3 distinct periods of development—before, during, and after the 1966-1976 Cultural Revolution—driven largely by extra-academic political forces. In 1965 in China, there were 298 secondary medicalpharmaceutical schools with a 3to 4-year curriculum, which admitted students with a junior high (9-year) education; 92 medical-pharmaceutical universities, usually with a 5-year curriculum, which admitted students after high school; and 21 colleges of traditional Chinese medicine. The curriculum of the secondary medical schools at the time often included general education in language, literature, mathematics, and science, as well as specific vocational training in medicine. The medical university curriculum included 3 years of basic science lectures, 1 year of clinical didactics, and a 1-year practicum (similar to an internship year in the United States). University graduates were eligible to practice with no further training, whereas secondary school graduates were usually required to complete a practical internship first. With the onset of the Cultural Revolution, medical education essentially ceased; between 1966 and 1970, no new students were admitted and no formal instruction was given to those already enrolled. In 1970, Chinese medical schools and universities were reopened but with a new philosophy of training peer-chosen “worker-peasant-soldier” students in a curriculum emphasizing political ideology and practical training over basic science. Entrance examinations, as well as degrees and diplomas, were abolished, and a limited 3-year curriculum was instituted, even at the upperlevel medical universities. Approximately one fourth of the curriculum was devoted to political science, and students were required to complete several weeks of agricultural and factory labor each year. Priority for admission was given to peasants, factory workers, or those in the liberation army, and students were not required to have finished high school. In fact, because of the disruptions during the initial period of the Cultural Revolution, many students began medical school with no more than a junior high education. Universities themselves had limited input, and, while in theory students were chosen by communities and coworkers whom they would return to serve, in practice they were also often chosen by Communist party officials. The end of the Cultural Revolution brought the reinstitution of a national entrance examination in 1977, and by 1980, university admission was highly competitive, with an admission rate of less than 10%. Many graduates of the 1970s were recalled from their jobs for remedial coursework. The 1980s also brought attempts to reform extrauniversity medical education, such as that of the “barefoot doctors.” Begun decades prior to and expanded during the Cultural Revolution, this program gave young agricultural or factory workers a few weeks to a year of training in preventive and practical medicine. They then provided medical care in the countryside, in factories, or in urban health stations and usually continued to work alongside those they treated. They numbered in the millions, and in all, fewer than 10% of “doctors” in 1972 China were college-educated in medicine. Similar to the way that many of the worker-peasantsoldier graduates were recalled in the post-Revolution period, so were many of the barefoot doctors: most took a written examination in 1980, and by 1984, one third had been retrained to secondary school level. Overall, though, the restored university curriculum looked much like the pre-Revolution curriculum, with some expansion of the time spent in clinical clerkships and the practicum. In 1988, a national conference sponsored by the World Bank and the World Health Organization suggested several reforms, including the introduction of problem-based, less didactic learning and a focus on prevention and rural health needs. Then as now, the majority of physicians in China were educated within secondary schools rather than universities, and further reform of 3-year secondary medical education and barefoot doctor programs were discussed as a means of meeting the needs of the increasingly elderly rural Chinese population. As of 1996, there were 550 secondary medicalpharmaceutical schools, 123 medical-pharmaceutical universities, and 30 colleges of traditional Chinese medicine in China. Medical curricula vary greatly, from 3 years at secondary schools to 5 to 8 years at universities. The most common course of study is 5 years and has changed little since the late 1970s. Students are placed based on the results of national entrance examinations, but there is still no national exit examination, nor is there a central accreditation body for medical schools and universities. It remains to be seen whether recent regional and global attempts to set universal standards for medical education will be incorporated in China.

Technical Critique of the Multimedia, Multipathway, Multireceptor Risk Assessment Model

The U.S. Environmental Protection Agency (USEPA) is developing the Multimedia, Multipathway, Multireceptor Risk Assessment (3MRA) model to evaluate potential human and ecological risks associated with the disposal of solid wastes designated as hazardous wastes in nonhazardous waste management units. USEPA intends to use the 3MRA model to determine national exit levels that will allow solid wastes that theoretically pose acceptable human and ecological risks to be safely managed in Subtitle D nonhazardous waste management units. We critically evaluated the 3MRA model to determine whether the methodology, interim modules, and input parameters are appropriate and scientifically defensible. Overall, our review of the 3MRA model indicates that it contains many conservative assumptions that may limit the validity of the model results and its use as a national model adequate for making regulatory decisions. Many of the assumptions and data inputs used to model the pathways involved in the transport of chemicals from a waste management unit are flawed. Other specific concerns include the lack of model validation, incompatibility of data between modules, and overestimation of potential human and ecological exposures. Before using the 3MRA model, we recommend that USEPA consider whether the 3MRA model is either an appropriate or accurate tool for evaluating the disposal of hazardous wastes nationwide.

The 1996 election: older voters and implications for policies on aging.

Aggregate national exit poll data from the 1996 presidential election suggest that voters aged 60 and older were not influenced by age-related policy issues, such as Medicare, any more than younger voters were. Yet, state-level data provide a basis for conjecture (although not a conclusion) that such issues may have influenced the voting decisions of some older voters in 14 states. If so, however, the impact was in Clinton's favor in some states and Dole's favor in others. Now that the election is over, the short-term problem of Medicare Part A will be dealt with swiftly, but a bipartisan commission to deal with the program's long-term issues is problematic. The establishment of such a commission on Social Security is more likely. The President's response to the push by governors and congressional Republicans to turn Medicaid into a block grant program will indicate whether he will move at all to the left of the centrist political position that he assumed throughout 1996.