Kaiser Health Tracking Poll: February 2016

By Bianca DiJulio, Jamie Firth, Ashley Kirzinger, and Mollyann Brodie
Kaiser Family Foundation, February 25, 2016

The February Kaiser Health Tracking Poll asked the public about broad options for changing the health system that are currently being discussed and finds more Americans (36 percent) say policymakers should build on the existing law to improve affordability and access to care than any other option presented.  Sixteen percent say they would like to see the health care law repealed and not replaced, 13 percent say it should be repealed and replaced with a Republican-sponsored alternative, and 24 percent say the U.S. should establish guaranteed universal coverage through a single government plan.

As debate continues over the idea of universal coverage through a single government plan, the survey finds the public divided, with half saying they favor the idea and 43 percent saying they oppose it, and some opinions swayed after hearing counterarguments. In addition, majorities of Democrats and independents favor the idea, compared to just 20 percent of Republicans. Most Americans think that if guaranteed universal coverage through a single government plan was put into place, uninsured and low-income people would be better off, but there is little consensus among the public about how it would impact their care personally.

This month’s poll also explores the public’s reaction to a few terms used to describe the idea of expanding health insurance coverage to all Americans. Majorities say they have a positive reaction to the terms “Medicare-for-all” and “guaranteed universal health coverage” and fewer say the same for “single payer health insurance system” and “socialized medicine.”  About half (53 percent) of Democrats say they have a very positive reaction to “Medicare-for-all” compared with 21 percent who say the same for “single payer health insurance system.”

Next Steps for the Health Care System

While health care ranks fourth as an important voting issue, presidential hopefuls have proposed a range of visions for the future of the health care system, from the full repeal of the Affordable Care Act (ACA) to the adoption of a universal government plan. The survey finds that when given four broad approaches for the future of the health care system that are currently being discussed, Americans opinions are split with the largest share reporting that they favor building on the ACA and the existing system. Overall, 36 percent say lawmakers should build on the existing law to improve affordability and access to care, 24 percent say the U.S. should establish guaranteed universal coverage through a single government plan, 16 percent say they would like to see the health care law repealed and not replaced, and 13 percent say it should be repealed and replaced with Republican-sponsored alternative.

A closer look at views across parties shows that a third of Democrats (33 percent) favor the idea of universal coverage through a single government plan but more Democrats (54 percent) say they would prefer to build on the existing health care law. A roughly similar share of independents (26 percent) say the U.S. should establish guaranteed universal coverage through a single government plan, and 36 percent say lawmakers should build on the existing health care law. The majority of Republicans (60 percent) say they would like to repeal the health care law whether it’s replaced or not, although 21 percent say they would like to build on the existing law and 9 percent say they would like universal coverage through a government plan.

How Malleable are Americans’ Opinions of Guaranteed Health Coverage From a Government Plan?

Although half of the public says they favor having guaranteed health insurance coverage through a single government health plan, some can be swayed by counterarguments made by critics. For instance, 20 percent overall shift their opinion from favor to oppose after hearing that guaranteed coverage through a single government plan would “require many Americans to pay more in taxes,” 20 percent say they now oppose the idea after hearing that it would “give the government too much control over health care,” and 14 percent say they now oppose it after hearing that it would “eliminate or replace the current health care law.” On the other side of the debate, those who originally said they opposed the idea were also persuaded by arguments, although fewer changed their opinions after hearing the arguments. About one in 10 changed their stance from oppose to favor after hearing that guaranteed coverage would “ensure that all Americans have health insurance as a basic right” (13 percent), that it would “reduce health insurance administrative costs” (11 percent), and that it would “eliminate all private health insurance premiums, co-pays, and deductibles paid by employers and individuals” (11 percent).

Impact of Coverage Through Single Government Plan

Most Americans think that if guaranteed universal coverage through a single government plan was put into place, uninsured and low-income people would be better off (60 percent and 57 percent, respectively). Fewer say that middle class people (34 percent) and people like them (31 percent) would be better off, which is roughly similar to the shares who say these same groups will be worse of or not be impacted much at all. Most (63 percent) say it would not have much impact on wealthy people, just 14 percent say they would be better off and 18 percent say they would be worse off. Democrats and independents are more likely than Republicans to report that all people would be better off through a single government plan.

The country has not had a substantial public debate about single payer legislation recently and there is little consensus among the public about how enacting guaranteed universal coverage through a single government plan would impact their personal health care. Roughly four in 10 say that they think the cost, quality, availability of health care treatments, and choice of doctors and hospitals would stay about the same as it is under the current health care system. About a third say these measures would get worse if universal coverage was put into place and around two in 10 think these measures would get better. Not surprising considering their stances on the idea of guaranteed universal coverage, majorities of Republicans say each measure would likely get worse if such a plan was enacted, while at least half of Democrats say each would likely stay about the same. Additionally, those under age 50, Black and Hispanic Americans, and those with lower incomes are more likely than their counterparts to say that these measures will get better.

Wording Matters

Politicians and pundits use a variety of terms to describe the idea of expanding health insurance coverage to all Americans and this month’s poll explores the public’s reaction to a few of these terms. Nearly two-thirds (64 percent) of Americans say they have a positive reaction to the term “Medicare-for-all” and more than half (57 percent) say they have a positive reaction to the term “guaranteed universal health coverage.” Less than half of Americans report a positive association with the phrases “single payer health insurance system” (44 percent) and “socialized medicine” (38 percent).

Similar to the public at large, more Democrats report having a positive reaction to “Medicare-for-all” and “guaranteed universal health coverage” than say the same about “socialized medicine” or “single payer health insurance system.” Additionally, more Democrats have positive reactions to all of the terms than Republicans and independents do. Around half of Democrats report a very positive reaction to “Medicare-for-all” (53 percent) and “guaranteed universal health coverage” (44 percent), while fewer Republicans say the same for each (17 percent and 9 percent, respectively). Two in 10 Democrats report very positive reactions to “socialized medicine” (22 percent) and “single payer health insurance system” (21 percent), while fewer than one in 10 Republicans do.

Topline

4.  Which of the following comes closest to your view of the future of the US health care system?

16%  The health care law should be repealed and NOT replaced

13%  The health care law should be repealed and replaced with a Republican-sponsored alternative

36%  Lawmakers should build on the existing health care law to improve affordability and access to care

24%  The U.S. should establish guaranteed universal coverage through a single government plan

6%  None of these/Something else

4%  Don’t know/refused

5.  Do you favor or oppose having guaranteed health insurance coverage in which all Americans would get their insurance through a single government health plan?

50%  Favor
27%  Strongly favor
23%  Somewhat favor

43%  Oppose
13%  Somewhat oppose
30%  Strongly oppose

7%   Don’t know/Refused

19.  I am going to read you a list of terms. Please tell me if you have a positive or negative reaction to each term.

a.  Socialized Medicine

38%  Positive
15%  Very positive
23%  Somewhat positive

49%  Negative
19%  Somewhat negative
30%  Very negative

12%  Other

b.  Medicare-for-all

64%  Positive
36%  Very positive
27%  Somewhat positive

29%  Negative
15%  Somewhat negative
14%  Very negative

6%   Other

c.  Single payer health insurance system

44%  Positive
15%  Very positive
29%  Somewhat positive

40%  Negative
21%  Somewhat negative
19%  Very negative

17%  Other

d.  Guaranteed universal health coverage

57%  Positive
28%  Very positive
29%  Somewhat positive

38%  Negative
15%  Somewhat negative
22%  Very negative

6%   Other

Report:
http://kff.org/health-reform/poll-finding/kaiser-health-tracking-poll-february-2016/

Topline:

http://files.kff.org/attachment/topline-methodology-kaiser-health-tracking-poll-february-2016

About half of Americans would prefer a single government health plan for everyone, according to this poll. However, when offered several choices, more would prefer to build on the current system (36%) than would prefer to establish a single government plan (24%). Also, followup questions show that the opinions of a single government plan are quite malleable, depending whether the query has a positive or negative slant.

The malleability of opinion and the poor understanding of the benefits of single payer demonstrate that the public still has a relatively weak understanding of precisely what a single payer system is. We need to intensify our educational efforts.

Perhaps more disconcerting is that more people would prefer to build on the Affordable Care Act than to establish a single government plan. The message of the incrementalists seems to be carrying the day. People believe that we can simply tweak the current system and achieve the same goals as single payer.

What people haven’t grasped are the fundamental differences between the financing infrastructures of our fragmented multi-payer system and a well designed single payer system. Recent Quote of the Day messages describing some of the flaws in our current system have asked the question, “What incremental change would fix this particular problem?” The answers don’t come easy.

It’s easy to say that we can build on the Affordable Care Act by gradually covering more people and by controlling spending by eliminating waste, but these are wishes, not policies. In most instances, there is no simple patch that would work, but rather most changes increase the administrative complexity, add significantly to the costs, and fall short of fully correcting the specific problems addressed.

This is a very important message that we have to deliver. Our current financing infrastructure is not particularly amenable to incremental patches. It is imperative that we replace our flawed infrastructure with one that automatically addresses the problems that we still face in health care financing. Single payer would do that.

This poll also tested labels for a single payer system. Close to two-thirds had a positive reaction to the term, “Medicare-for-all.” People also had a positive reaction to “guaranteed universal health coverage,” but that doesn’t mean much and has been misused as a label for systems that are neither guaranteed nor universal. Yet people seem to be split or confused by the term, “single payer health insurance system.”

“Medicare-for-all” does seem to be preferred, but some opponents are quick to point out the deficiencies in our Medicare program. Adding “improved,” as in “Improved Medicare for All,” defuses that challenge.

So do not let people get away with saying that we’ll simply build on the system we have. Demand that they define the precise incremental steps and how each would move us significantly closer to truly affordable care for absolutely everyone. If you keep pushing them they’ll eventually have to describe a single payer system because patches to our current system just won’t get us there.