According to a recent survey from The Commonwealth Fund, a whopping 82 percent of Americans think the health care system “should be fundamentally changed or completely rebuilt.” But in almost every election poll, health care trails the economy and the war in Iraq. Americans agree that the system is broken, but they’re not asking the candidates to address the problem; voter dissatisfaction has not translated into electoral demand.

In fact, even as health care costs have more than doubled since the 90s, fewer Americans consider health care “one of the two important issues for government to address” than did during President Clinton’s reform efforts:

So why are Americans paying more, but caring less? The answer may lie in presidential leadership, or lack thereof. As Clinton prioritized health care reform in his first term and educated the public about the consequences of allowing health care costs to spiral out of control, support for government action peaked. But his failure to secure reform and the Bush administration’s dearth of solutions to the health care crisis took the health issue off the table and out of the political consciousness.

The trend highlights the role of the president in shaping the political debate and helping voters “get behind solutions to big problems.” As Faiz Shakir points out, “voters could get behind solutions to big problems” if leaders would “help them divine what they are.”

Yesterday, during an NPR segment about the impact of Sen. John McCain’s (R-AZ) proposal to allow insurance companies to sell policies across state lines, Michael Cannon of CATO and Rep. John Shadegg (R-AZ) both repeated the false claim that benefit mandates significantly increase the costs of health insurance:

CANNON: [Some states require that a health plan] includes chiropractic coverage, in vitro fertilization, which is very expensive and a lot of people find morally objectionable but a lot of states require that.

SHADEGG: You’re going to allow them [insurance companies] to bring a policy into your state that is going to cover basic services but might not cover hair prostheses, might not cover aroma therapy, might not cover acupuncture. That means that policy will cost less money and enable people to afford it.

Very few states actually cover hair prostheses (10), in vitro fertilization (13) and acupuncturists (11). In fact, after the second presidential debate, in which McCain also suggested hair prostheses drive-up health care costs, the Wall Street Journal Health Blog contacted William Parsley, “a dermatologist who is president of the International Society of Hair Restoration Surgery, a nonprofit group of about 700 hair-restoration doctors world-wide.” According to Parsley, “insurance payment for cosmetic hair is the real joke. Parsley said that only hair restoration as part of reconstructive surgery necessitated by severe burns, serious injuries and accidents is customarily covered by insurance“:

Such reconstructive surgeries account for about 1 to 2% of hair transplants performed, he said. What about the gold-plated health insurance, we asked. Ever see any of that? Yes, he said, twice in 34 years of practice that insurers paid for a patients’ cosmetic hair transplant. The most recent instance was two decades ago, though.

Are we alone in withholding payment for hair loss? Parsley says no, cosmetic hair transplants aren’t covered in countries with government-run health systems. “They don’t even offer that in Canada,” he said.

What’s more, conservative claims that benefit mandates significantly increase the cost of health insurance fly in the face of fact. According to state experiences and an exhaustive study by the Congressional Budget Office, “eliminating some of the most expensive mandates — maternity, mental health, and preventive care for children — would bring” only a small reduction to health care premiums. The CBO report found that “the impact in the small group market is no more than five percent of premiums” while California’s Health Benefit Review Program “determined that eliminting all 44 of California’s mandates would reduce premiums by no more than 4.8 percent.”

In short, insurance companies lose money by insuring sick people, not though benefit mandates.