Just as all politics is local, all campaign issues may be local, if our survey this month on the presidential election is any indication. Local in the extreme sense, meaning that what matters most in your back yard becomes the most important issue in the election. Not surprising, then, that ophthalmologists, like most physicians, cite malpractice reform as their biggest concern. (See National Panel for other results.)

Medical malpractice is not an issue that's going to sway the national election, but just how important will health-care issues generally be this November?

The economy, terrorism and the war in Iraq hold the lead spots as voters rank key campaign issues. Assuming no major gains or setbacks in any of these areas in the next two months (a big assumption, yes), health care takes on far greater significance than may be apparent. Among strictly economic issues, nothing outpaces voters' concerns over rising health-care premiums. Premium costs rose 12.7 percent for the 12 months ending in spring 2002, compared with a 1.6 percent rise in general inflation and a 3.4 percent rise in wages, according to the Kaiser Foundation. On top of that, consumer satisfaction with the health-care system is at its lowest point in 12 years.

Prescription drug coverage for seniors, and the attendant quagmire  of drug reimportation, is receiving increasing attention, and that's not a positive development for the incumbent. Surveys show that a majority of Americans don't even know that a Medicare Prescription Drug Bill was passed: 16 percent believe it wasn't passed, 31 percent say it was, and 54 percent just don't know. When asked who would benefit from this legislation, most respondents name the drug companies and insurers, while just 13 percent say seniors.

Many have called this the most important election in a generation. Some have joked that it will be decided by six voters in Ohio. That it will be razor-close is fairly certain. That the two parties have very different plans for the future of health-care financing issues seems pretty clear. If we're fortunate enough to reach November without outside forces intervening to impact the outcome, let's hope those six voters in Ohio and the rest of us treat this decision with the gravity that it deserves.