On Tuesday, yet another poll found that a supermajority of the American people — and a slim majority of Republican voters — want big government to get its hands on their health care.
Specifically, 70 percent of voters — and 52 percent of self-proclaimed Republicans — told a team of pollsters from Hill.TV and HarrisX that they would “support providing Medicare to every American.” In late August, a Reuters/Ipsos poll produced nearly identical numbers, when it asked voters whether they supported “Medicare for All” — a term that the survey declined to define.
There is little question, then, that voters like the general idea of letting everyone in on Grandma’s government health care — which is no small thing, considering that Republicans have been arguing for years that we can barely afford to preserve Medicare for the elderly, and that any attempt to expand eligibility would result in “Medicare for none.”
But there is some ambiguity about whether this means that voters are prepared to support the abolition of the private health insurance industry, and a significant increase in middle-class taxes (in exchange for the elimination of their monthly premiums, and free health care at the point of service), which is what Medicare for All’s most ardent supporters mean when they use that phrase.
In its polling of the issue, the Kaiser Family Foundation (KFF) has found that about 53 percent of Americans approve of “a national health plan in which all Americans would get their insurance from a single government plan” — but, oddly, that a significant portion of that 55 percent believes that they would be able to keep their private health coverage under such a policy. Further, KFF has found that voters’ views on single-payer and Medicare for All are highly malleable. In a June 2017 survey, the pollster presented respondents who had initially expressed support for single-payer with right-wing counterarguments — and 20 percent of switched to opposing it. On the other hand, when Kaiser exposed respondents who initially opposed single-payer to left-wing talking points, 17 percent came around to Bernie Sanders’s point of view.
This uncertainty about what voters mean when they say they support “Medicare for All” — and how firm that support really is — has led to some hand-wringing on the left side of the aisle. As Elisabeth Rosenthal and Shefali Luthra recently wrote for the New York Times Sunday Review:
[S]ome worry the terms “Medicare for all” and “single-payer” are at risk of becoming empty campaign slogans … For every candidate with a clear proposal in mind, another uses the phrases as a proxy for voter frustration. The risk, some critics say, is that “Medicare for all” could become a Democratic version of the Republican “repeal and replace” slogan — a vote-getter that does not translate to political action because there is neither agreement about what it means nor a viable plan.
But this analogy is preposterous — and the immense popularity of Medicare for All is great news for Democrats, even if voters don’t know exactly what it means.
Republicans didn’t struggle to translate “repeal and replace” into legislation because they had neglected to unanimously campaign on a single, detailed health-care plan. Rather, they struggled to do so because they’d campaigned on bald-faced lies about their general intentions for health-care policy, out of recognition that their actual goals were deeply unpopular.
Donald Trump ran for president on promises to replace Obamacare with a health-care plan that would “take care of everybody,” and to oppose any and all cuts to Medicaid. Meanwhile, Congressional Republicans routinely suggested that their problem with Obamacare was that it had done too little to deliver universal access to affordable health insurance. “There are 25 million Americans who aren’t covered now,” Mitch McConnell told Meet the Press in January 2017. “And many Americans who actually did get insurance when they did not have it before have really bad insurance that they have to pay for, and the deductibles are so high that it’s really not worth much to them.”
So it’s hardly surprising that when Americans learned that “repeal and replace” did not mean “everybody gets better coverage and lower deductibles,” but rather, “24 million people lose insurance, Medicaid gets cut by $800 billion, and people with preexisting conditions get abandoned to their fate,” they soured on the idea.
By contrast, there is no confusion about the direction in which Democrats want to move health-care policy. Voters (and Democratic officeholders) might have different definitions of Medicare for All — but nobody thinks that it means reducing the federal spending on health care, restricting access to publicly-funded health insurance, and giving Medicare to fewer Americans.
Now, it’s true that some details of a genuine single-payer health plan would almost certainly prove controversial. When single-payer champions began trying to put taxpayer money where their mouths were in Colorado and Vermont, they proved unable to retain the public’s support in the face of a well-funded opposition. And beyond taxes, any attempt to kill off the insurance industry — and impose (badly needed) cost controls on hospitals and physician pay — will provoke a furious counter-mobilization among those constituencies.
But in all probability, none of this will actually matter if Democrats take power in 2021. Put simply: Either single-payer supporters will assemble a social movement so massive and militant, it fundamentally transforms political reality in the U.S. — or else, moderate Democrats will kill a single-payer bill the moment it arrives in Congress (even if president Bernie Sanders is the one who sends it there).
It’s possible that a blue wave election this November — and another strong showing in 2020 — will allow Democrats to win control of both chambers of Congress. But because the Senate’s malapportionment gives disproportionate power to voters in more conservative parts of the country, Team Blue’s legislative majorities will live and die on the whims of right-leaning Democratic senators like Joe Manchin, Jon Tester, and Joe Donnelly — who, in his latest campaign ad, pledges that if “socialists want to turn health care over to the government” they’ll have to do so “over my dead body.”
Which is to say that by the time a (genuine) single-payer health care plan becomes remotely viable in the Senate, the policy will, necessarily, have become overwhelmingly popular with voters. Unless the American public becomes unmistakably, enthusiastically on board with higher taxes, and the elimination of private health insurance, Joe Donnelly will not defy the entire health insurance industry, the hospital lobby, the American Medical Association, the conservative media apparatus — and his own campaign promises — in order to vote for single-payer health care.
Assuming, for the moment, that the Democratic Socialists of America do not transform our politics between now and 2021, then the endgame of a legislative fight over single-payer will be some kind of public option plan, possibly one that would automatically cover children, the poor, and the uninsured; in other words, less Medicare for All then “a relatively low-cost public health insurance plan for anyone who wants or needs it.” And Democrats have put forward a variety of highly detailed proposals for programs like that.
Some minority of single-payer activists might prefer Congress to pass no health-care legislation, than to see it enact a public option. But no progressive Democrats in Congress feel that way. Bernie Sanders voted for the Affordable Care Act in 2009, and has praised various public option proposals that his colleagues have put forward over the past year and a half. There is little reason to doubt that a Democratic Congress would be able to reach some kind of consensus on health-care policy; after all, unlike congressional Republicans, they agree with each other — and with the American public — about what direction policy should move in.
The only question is how progressive that consensus will be. Even a public option would be sure to attract massive industry opposition, and some grumbling from the Joe Manchin’s of the world. Thus, a militant single-payer movement — that’s powerful enough to make a strong public option (i.e., one that threatens the long-term viability of the private insurance industry) look like milquetoast moderation — would probably make it easier for Democrats to pass a progressive health-care compromise, not more difficult.
And if Democrats did end up settling on public option, all available survey data suggests it would be wildly popular: When the Kaiser Family Foundation defined Medicare for All as a government health-insurance plan that is “open to anyone who wants it but people who currently have other coverage could keep what they have,” 75 percent of respondents endorsed the proposal — including 64 percent of Republican voters.