There are a couple of very good reasons single-payer health-care advocates have chosen the slogan “Medicare for All.” The first is relatability: most Americans have heard of Medicare, and it’s perceived as being a lot easier to grasp than the Rube Goldberg Machine of Obamacare and other health-care proposals that build new systems altogether. The second is popularity: Medicare is one of the most popular government programs, and it is particularly popular among the older people who might otherwise be hostile to something as new-fangled, un-American, and socialistic-sounding as single-payer health care.
But it’s important to understand that “Medicare for All” is not a particularly accurate description of most single-payer proposals, notably that being promoted in the Senate by Bernie Sanders and by his supporters around the country. Medicare deploys both premiums and co-pays; one of the big selling points of single-payer is that it gets rid of both of those cost-sharing features. Medicare, like its first cousin, Social Security, depends heavily on lifetime contributions into a fund that pays for a sizable portion of benefits. By definition, single-payer is available to everyone, including people who haven’t paid a dime into the system. Medicare covers mostly acute care. Single-payer covers pretty much every medical service. And most of all, Medicare has a robust private-insurance component: about a third of the Medicare population gets its coverage through private Medicare Advantage plans. Single-payer proposals by and large abolish private health insurance: thus the name single payer.
So there is more than a bit of sleight of hand going on when single-payer fans try to borrow Medicare’s “brand” and popularity and suggest that any damn neoliberal who has doubts about “Medicare for All” is politically idiotic as well as reactionary. The underlying reality is that some of the very features that make Medicare different from single-payer are inseparable from the program.
A recent poll from Kaiser Family Foundation illustrates the point. It showed that 59 percent of Americans support “a national health-care plan, or Medicare-for-all, in which all Americans would get their insurance from a single government plan.” Sounds pretty strong, until you see that 75 percent support a “national Medicare-for-all plan open to anyone who wants it but people who currently have other coverage could keep what they have.” The first proposal is single-payer if you understand it. The second very clearly isn’t single-payer.
As non-single-payer health-coverage expansion programs come out that utilize or imitate Medicare, the potential for confusion is growing. Some interviews conducted by BuzzFeed with actual voters in Nebraska illustrates the problem:
[C]onversations with more than two dozen Omaha voters reveal a dynamic that polling, too, has begun to capture: When some moderate and left-leaning voters say “Medicare for All” sounds like a pretty good idea, they aren’t actually thinking about single-payer health care. Instead, they’re thinking about simply expanding the program to include more seniors or children, or offering a public option that people can buy into.
Pressed on the details of Medicare for All, many voters in Omaha expressed skepticism — or outright distaste — about the single-payer plan that [Bernie] Sanders has championed.
Some of these voters are very attracted to the “Medicare for All” stance of local congressional candidate Kara Eastman. But they might not like it if they understood it.
The lesson for progressives to grasp here is that associating any health-care proposal with Medicare may inflate its apparent popularity. But down the road, you’d best understand in some detail what voters actually want.