Medical Device Daily Executive Editor

If you're a Republican, you are likely to prefer Sen. John McCain's position on U.S. healthcare — that it simply needs some improving, and with expanded private-sector health insurance coverage.

If you're a Democrat, you probably are leaning toward Sen. Barack Obama and Sen. Hillary Clinton's positions — that radical changes in the system are needed, with a broadened governmental healthcare insurance system.

These are the conclusions that can be drawn from a survey just released by the Harvard School of Public Health (HSPH; Cambridge) and Harris Interactive, (Rochester, New York) as part of their ongoing series, "Debating Health: Election 2008.”

The survey indicates that Americans are sharply split on the quality of U.S. healthcare.

In the survey, 45% believe the U.S. has the best system in the world, while 39% believe other countries have better systems (15% don't know or declined to respond).

And there is a significant divide along party lines. Nearly seven-in-10 Republicans (68%) believe the U.S. healthcare system is the best in the world, compared to just three in 10 (32%) Democrats and four in 10 (40%) Independents who feel the U.S. system is the best.

Harris said that the poll was conducted during a period of debate over the comparative merits of the U.S. system and the healthcare systems in other countries. President Bush and other political figures — along with conservative media talkers — that the U.S. has the best system in the world.

However, the World Health Organization (Geneva) and other organizations rank the U.S. below many other countries. And Michael Moore's movie Sicko helped to underline some of the U.S. healthcare system's negatives.

So how might this issue impact how Americans vote in the upcoming presidential election?

• When asked if they would be more likely to support or oppose a presidential candidate who advocates making the U.S. healthcare system more like health systems in other countries, specifically Canada, France, and Great Britain, only one in five (19%) Republicans say they would be more likely to support such a candidate. This is compared to more than half (56%) of Democrats and more than a third of Independents (37%) who say they would be more likely to support such a candidate.

• Though many Americans view the healthcare systems of other countries as better than the U.S. in general, the survey shows that they do not identify as better those countries that have been most frequently compared to the U.S.

In head-to-head comparisons with Canada, France and Great Britain, a large percentage of Americans are not sure how the U.S. compares overall.

• Over half (53%) of Americans say they don't know how the U.S. compares to France and four in 10 (40%) say they don't know if the U.S. system is better or worse than Great Britain's. A quarter (26%) is not sure how the U.S healthcare system compares to the Canadian system.

The view that U.S. healthcare lags behind other countries appears to be driven by the view that the U.S. is behind in controlling healthcare costs and providing affordable access to everyone.

• In comparing how the U.S. compares to other countries in specific areas, a slim majority of Americans believe that the U.S. healthcare system is better in terms of the quality of patient care patients (55% saying the U.S. is better than other countries) and shorter waiting times to see specialists or be admitted to the hospital (53% believe the U.S. is better than other countries).

• However, few believe that the U.S. has the edge when it comes to providing affordable access to everyone (26% believe the U.S. is better than other countries) and controlling healthcare costs (21% believe the U.S. is better than other countries).

Once again, there are sharp differences between Republicans, Democrats and Independents in the survey.

• Four-in-10 (40%) Republicans believe the U.S healthcare system is better than other countries when it comes to making sure everyone can get affordable healthcare, compared to just one-in-five Democrats (19%) and Independents (22%) who share that belief.

• On each of the four elements tested, Independents are within a few percentage points of agreement with Democrats, and both are significantly separated from Republicans.

"The healthcare debate in this election involves starkly different views of the U.S. health care system,” said Robert J. Blendon, Professor of Health Policy and Political Analysis at the Harvard School of Public Health. "One party sees it as lagging [behind] other countries across a broad range of problem areas, while the other party sees the system as the best in the world with a more limited range of problems.”

The survey design team includes Professor Robert Blendon, Tami Buhr, John Benson and Kathleen Weldon of the Harvard School of Public Health; and Humphrey Taylor, Scott Hawkins and Justin Greeves of Harris Interactive.

Harris says that the survey was conducted by telephone, among a cross section of U.S. adults age 18 and over, March 5-8, among a representative sample of 1,026 respondents.