By Sam Baker
Axios, October 31, 2018
When you hear candidates talk about “Medicare for All,” what do you think they are proposing?
52% – Single-payer, universal, government-run
21% – Competitive, optional, government-run
24% – Neither
Which of the following health care options do you prefer?
34% – Single-payer, universal, government-run
33% – Competitive, optional, government-run
30% – Neither
Data: Survey Monkey online poll conducted Oct. 24-26, 2018 among 2,949 U.S. adults. Total margin of error is ±2.5 percentage points.
By Don McCanne, M.D.
This new poll confirms that the label, “Medicare for All,” no longer refers exclusively to a single payer program that includes everyone, but, for many people, it refers to a competitive, multi-payer market of health plans that includes Medicare as an option (i.e., a public option). In fact, the polling indicates that just as many believe that they would prefer a competitive, multi-payer model of “Medicare for All” as would prefer a true single payer model of “Medicare for All” that actually includes absolutely everyone.
Single payer advocates understand the crucial distinction, though many of the public option advocates do not seem to understand the consequences of their choice. The single payer version of “Medicare for All” corrects the major deficiencies in health care financing, making health care equitable, accessible, and affordable for everyone. The public option version of “Medicare for All” perpetuates our highly dysfunctional, fragmented, inequitable, and often unaffordable health care financing system and merely adds one more option that increases the administrative complexity of our system. The differences are absolutely critical, but they are being glossed over by misuse of the “Medicare for All” label.
It is imperative that we educate the public as to the difference, but the labeling is a problem. “Single payer” is a somewhat wonkish term that often is still not well understood by everyone. In contrast, Medicare is a program that is almost revered, and most individuals can hardly wait until they are eligible to enroll in it. Although we have been using “Improved Medicare for All,” that does not distinguish it from a “Medicare for All” that supposedly has been improved by adding a public option.
Until there is a consensus on precisely how we should proceed, I would suggest in the interim the two following measures:
- We should keep the label simple, but to distinguish a bona fide single payer system, I would suggest calling it “Single Payer Medicare for All.”
- When others use “Medicare for All” when they mean only adding a public option, always call them on it. Insist that they label their model “Medicare for Some,” explaining that they are proposing Medicare for a few more but not for most of us who would still have to deal with the current dysfunctional system.
At the PNHP annual meeting November 9 & 10 in San Diego there will be a workshop on “Faux single-payer plans and legislative deficiencies,” presented by David Himmelstein and President-elect Adam Gaffney. Maybe we can reach a consensus on our strategy at that time.
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