Medicare for some (more)

“Medicare for all” sounds really good and just that phrase definitely polls well.  But, both the policy reality of universal health care and the political reality of how we can there are far more complicated.  Great piece from Slate’s Jordan Weissman  looking at the latest health care polling and how complicated this really all is:

“Medicare for all” is a popular and politically effective slogan. Polls have shown that 70 percent of adults, and maybe more, say they’d support opening the federal health care program for the elderly to every American. This is all much to the delight Sen. Bernie Sanders, who managed to mainstream the idea during his 2016 presidential run, and has trumpeted those survey results in recent appearances.

One problem for Sanders is that when most Americans hear the words “Medicare for all,” they aren’t necessarily imagining the sort of single-payer system the Vermont senator has proposed. Worse yet, support for national health insurance seems to vacillate a great deal based on how pollsters couch the question. On Wednesday, for instance, the Kaiser Family Foundation published its latest tracking poll on public attitudes towards health care policy. Similar to its previous results, it found that 56 percent of Americans would support “a national health plan, sometimes called Medicare for all, in which American would get their insurance from a single government plan.” That’s not a bad outcome on its face. But many survey takers seemed to be confused about what Medicare for all, as it’s been formally proposed, would actually do. Among those under the age of 65 who had employer-sponsored coverage, 55 percent said they thought they would be able to keep their current health plan if Medicare for all were put in place.

That is not how Sanders’ single-payer bill would work. The legislation that Sanders has written, and that many of his colleagues and potential Democratic primary opponents endorsed, would expressly ban private insurance plans that compete with the government.

That turns out to be a fairly unpopular idea. According to Kaiser, support for Medicare for all drops to 37 percent if survey takers are told that the bill would eliminate private insurance companies, with 58 percent opposed.

In other words, Americans want access to government insurance, but they don’t want to be forced to use it—people prefer optionality.  Kaiser finds that 73 percent of adults support “creating a national government administered health plan similar to Medicare open to anyone, but would allow people to keep the coverage they have.” This is an idea that, in health policy world, generally gets referred to as “Medicare for anyone.” The closest thing to it is probably a proposal produced by the Center for American Progress that would ban private insurers from competing on the individual market and would create strong incentives for employers to move their employees onto the federal plan. [emphasis mine]

This seems to be one of the two central hurdles for Sanders and other true single-payer advocates. They need to convince Americans that paying higher taxes won’t burden them, since they’ll no longer have to pay insurance premiums (60 percent of respondents to Kaiser said they’d oppose Medicare for all if it meant most Americans had to pay higher taxes). And they need to win over Americans who want to hold onto their current coverage, even if it may be less than perfect. Right now, the country seems a little more primed to accept a plan that gives them at least some semblance of choice—something that looks more like a mega public option.

As it turns out, Steve Greene prefers optionality, too.  Not because I think it is necessarily better policy than true single payer, but because I think it is way better than the status quo and faces dramatically fewer political hurdles than a true single payer.  And, there’s some really good ideas out there, like the plan from CAP.  In addition to interesting ideas on Medicaid buy-in as well.  Major reform that results in getting all Americans decent, affordable health care will be really, really hard.  But I do think path dependence being what it is, we are far more likely to achieve this with a system that does have more optionality.  And, there’s plenty of examples of this in other advanced democracies that show it can work really well.  Single payer is far from the only way to deliver more affordable, universal health care.

Paul Waldman is also on the case regarding the intra-Democratic fight to come:

There are even some on the left, in their passion for replacing our current mess of a system with a version of the universal systems in place in every other industrialized country, who are prey to the belief that it will be simple to do so. But it won’t.

The good news is that we’ve hit the ground running on a real debate on how to go about getting from where we are now to a system of universal coverage. And this is going to be one of the most important parts of the upcoming race for the Democratic presidential nomination, because when one candidate wins, their health care plan will form the basis for the next attempt at reform. So the stakes are extraordinarily high…

advocates were seeking, which was a bit unfortunate because there are many models of universal coverage that aren’t single-payer (in which there is only one insurer, the government). But single-payer has now, for better or worse, been replaced by “Medicare for all.”

Every Democrat running for president has embraced Medicare-for-all as a broad idea. But the truth is that they mean different things when they say it…

But there’s much stronger support — up to three-quarters of the public, including many Republicans — for optional plans whereby Medicare or Medicaid would be opened up to people who don’t have insurance now or would just prefer to get their coverage from the government. We might call this Medicare for All (Who Want It).

Here’s a graph that summarizes that:

But what happens when you introduce people to arguments against the idea? Not too surprisingly, support plummets:

That doesn’t mean it’s doomed, any more than strong support for the idea in the abstract means that the public loves Medicare-for-all and always will. What it means is that people are persuadable in either direction, and a lot will depend on what kind of debate we have…

And about that debate, make no mistake: The GOP will fight optional plans with just as much fury as they will a true Medicare-for-all — even those plans that now get plenty of support from Republicans. That’s because they oppose any expansion of social programs, especially the ones that are effective and popular. Medicaid and Medicare are already a living rebuke to the conservative philosophy that says government can’t do anything right and shouldn’t even try. The last thing they’ll stand for is an attempt to expand them and make more Americans protective of their government benefits.

In general, I feel pretty favorably disposed towards most of the Democrats running/expected to be running for 2020.  As for who I ultimately actually support, how smart and sophisticated they are on both the politics and policy of health care reform is going to be big.  This is too important to mess up.

About Steve Greene
Professor of Political Science at NC State

3 Responses to Medicare for some (more)

  1. R. Jenrette says:

    The Democrats need to hurry up and get a good health care bill out. Maybe we could start with improving the Affordable Care Act and adding a public option. That would make for a smoother change from the “plan” that is now in effect.
    I’m no detail person on health care policy but I sure would be putting the experts to work now. The most effective act the Democrats could take to solidify the current support from the public is to present such a plan. If they don’t do it, the public will see it as just another amorphous campaign promise, like Trump’s.

  2. Nicole K. says:

    Well, you have to consider the huge power of the American Medical Association, hospitals, the drug companies, durable medical equipment manufacturers. They are very organized and spend huge amounts of money to get what they want. Obamacare was successful because they brought all those players in and got their input on what they wanted. And they are all universally opposed to any sort of a public option. They’ve killed it every single time it’s been proposed since the Truman administration, and they will kill it again should it be proposed again. It’s just not going to happen in this country.

    As Dr Greene said, there’s other ways to get everyone affordable health care that doesn’t require that it be provided directly by the government.

    • R. Jenrette says:

      Which ever health plan works best is fine with me. I’m saying that the Democrats must have a plan and quickly to keep their credibility with the public.

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