Voters believe that Medicare for All would raise their taxes without eliminating their premiums, co-pays, or deductibles. And most voters think that sounds great.
A pair of new surveys confirm that the single-payer movement’s signature rallying cry is both broadly popular and widely misunderstood. In polls conducted by the Kaiser Family Foundation and Navigator Research, majorities of the public endorse the concept of “Medicare for All,” but evince ignorance about what such a policy would actually entail.
In Kaiser’s polling, most voters said that in a Medicare for All system, Americans would retain the option of keeping their current private insurance plans, and the obligation to pay premiums, co-pays, and deductibles.
As Axios helpfully illustrates:
In other words: When the median voter hears Medicare for All, she ostensibly pictures a health-care system similar to our current one, except that Americans of all ages would gain the opportunity to buy into a Medicare-like public health-insurance program (i.e., one that would require beneficiaries to make various cost-sharing payments, just as the already-existing Medicare does).
This isn’t the first Kaiser poll to produce such a result (although it offers more detail about voters’ conceptions of Medicare for All than the foundation’s previous polls). And Navigator Research affirms Kaiser’s findings. In Navigator’s survey, 60 percent of voters said that Medicare for All was best described as “a health care plan that lets anyone buy Medicare instead of their current private insurance, if they want to.”
Of course, Medicare for All’s champions in Congress beg to differ. Both Bernie Sanders’s Senate proposal and Representative Pramila Jayapal’s House bill would make health care “free at the point of service,” meaning that Americans would no longer have to deal with medical bills or cost-sharing payments of any kind. Premiums, co-pays, and deductibles would become abominable anachronisms, joining the iron maiden, manacles, and other misbegotten instruments of torture in the ash heap of history. Instead, all health-care financing would be done through the tax code. Meanwhile, Sanders and Jayapal would also outlaw all private insurance, except for supplemental plans that cover the few services (such as cosmetic plastic surgery) that their national public plan wouldn’t. This is a critical component of their vision, as they expect the abolition of private insurance to eliminate redundant administrative costs, and thus make universal, free, point-of-service health care more fiscally sustainable.
Ironically, in both new polls, Republican voters evinced a much clearer understanding of what Medicare for All actually means than Democrats or independents did (at least in the view of the advocates and politicians who popularized the phrase).
This result is likely a product of the GOP’s (demagogic) messaging on health care, which has taken pains to emphasize that Medicare for All is not “Medicare for anyone who wants it.” And it isn’t hard to see why Republicans have been so eager to emphasize that point. In both Kaiser and Navigator’s polling, Medicare for All is much more popular when it is defined as a public option:
But the polls also suggest that voters are unaware of single-payer’s most popular features. When Navigator asked respondents to pick their top three priorities for health-care policy, reducing out-of-pocket costs, premiums, deductibles, and drug prices were by far the most commonly cited. Meanwhile, “ensuring that you can keep your existing insurance coverage” ranked next to last:
Which is to say, voters ostensibly care a lot more about cutting their costs than they do about avoiding changes to their existing coverage (note that even keeping one’s current doctors did not rank as a high priority).
Americans support making coverage universal. But for the large majority who already have some form of insurance, this does not seem to rank as a high priority. The reason why health care is now a perennial top issue for American voters is that the costs of maintaining coverage and utilizing care are rising every year. The fact that our nation’s insanely inefficient and grotesquely corrupt health-care system is commandeering an ever-higher share of GDP hurts virtually everyone in the United States, not just the sick and the poor. Even healthy, middle-class Americans with “good” coverage are burdened by rising premiums. Costs are the salient issue. And single-payer promises to eliminate them.
Given all this, it seems likely that Sanders’s version of Medicare for All would poll better if voters understood that it would abolish premiums and deductibles and bring down overall health-care costs. The fact that Medicare for All still attracted majority support in Kaiser’s poll — even as a majority of voters said that the policy would raise middle-class taxes without eliminating monthly premiums — suggests that voters might welcome the actual trade-offs offered by single-payer. (Although, even if voters are willing to pay more in taxes to receive stable, free, point-of-service health care, it is unclear exactly how much more they are willing to pay. And Sanders has yet to provide much detail about how middle-class tax rates would change under his proposal.)
On the other hand, many public-option plans wouldn’t require middle-class tax increases of any kind. In fact, depending on how such a plan is structured, the Congressional Budget Office could actually score a public option as deficit reducing, as enrolling middle-income Americans into a program like Medicaid is cheaper than providing them with subsidies to purchase private insurance, at least in the manner that the Affordable Care Act did. It’s conceivable that support for a public option would be even higher than 73 percent if voters understood that such a benefit would not require significant tax hikes for middle-income people.
Of course, one can also imagine that a perfectly informed electorate — which understood the unique efficiencies and cost reductions that a properly designed single-payer plan could yield — would ultimately favor the abolition of private insurance, restrictive provider networks, and payment at the point of service over a mere Medicare buy-in.
Regardless, the health-care industry’s very well-informed rentiers have made it clear that they will vigorously oppose any attempt to expand public insurance. Considering how much money and influence the pharmaceutical, insurance, hospital, and physicians’ lobbies collectively command — and how small any hypothetical Democratic Senate majority is likely to be for the foreseeable future — it’s hard to see any significant health-care reform passing Congress in the absence of overwhelming public support.
Polls suggest that single-payer could plausibly command that kind of support eventually. But they also clearly show that the policy is not overwhelmingly popular today. Accepting that fact is a precondition for changing it.