By Julie Appleby
USA TODAY
Universal health insurance — the idea that every resident would have medical coverage from birth to death — has been labeled everything from a communist plot to the only thing that will solve America’s growing problem of the uninsured.
Presidents from Harry Truman to Richard Nixon and, most recently, Bill Clinton, have proposed various plans for universal coverage, but all have been defeated.
Still, Americans consistently tell pollsters they embrace such an idea.
“We have always seen strong support for the goal of universal coverage but never seen consensus on how to get there or a willingness to pay the price,” says Drew Altman, president of the Kaiser Family Foundation.
That division was reflected in a wide-ranging poll of 1,201 Americans’ views on the nation’s health system sponsored by USA TODAY, ABC News and the Kaiser Family Foundation. The nationally representative sample has a margin of error of plus or minus 3 percentage points.
Fifty-six percent say they would prefer universal coverage to the current system, which relies on a mix of voluntary efforts by employers to offer insurance and a mix of government and private insurance options for those who don’t get coverage through work. The latest Census Bureau data estimate 46.6 million are uninsured.
“Universal coverage would make it possible for everyone to get the proper medical care,” says Theresa Harris, 36, of Middlesex County, Conn., one of those surveyed in the poll. Harris and her husband run their own business, so they buy their own health insurance, which costs $1,100 a month.
In the survey, 68% said providing coverage for everyone is more important than keeping taxes down.
Another poll respondent, Vince Ruck, 55, says he would expect a slight increase in taxes under such a proposal, but he would support that.
“Universal would be better,” says Ruck, who recently lost his health insurance when he was laid off from his customer service job after eight years. “Under the system we have, if employers don’t want to make any effort to provide benefits, such as health care, then the employee is basically left out.”
Proponents of universal care say it’s the only way to guarantee health coverage to all, would end fears by the middle class that they could go bankrupt if they fall ill, and take the burden off of employers to provide health insurance.
“It would bring comprehensive, affordable care to absolutely everyone,” says Don McCanne, president of Physicians for a National Health Program. “No other reform model can promise that. They all fall short.”
But opponents say a universal program might still require employers to pay, could mean higher taxes and longer waits for some medical services. “You can’t make the burden of health spending go away,” says Michael Cannon, director of health policy studies at the Cato Institute. “If you take it off of employers in the form of insurance premiums, you’ll just load it back on in the form of taxes.”
Rejecting trade-offs
When survey respondents were asked about possible trade-offs that might come with a universal program, positive responses plummeted. The poll found:
76% would oppose universal coverage if it meant some medical treatments currently covered by insurance would no longer be covered.
68% would be against it if it led to limits on the choice of doctors.
60% said they would be opposed if it led to higher payments, either through taxes or health premiums.
“I don’t think we can afford $6-a-gallon gas to pay for health care,” says poll respondent Richard Baker, 64, of Long Island, N.Y., who has insurance through his wife’s job.
Some Americans also express skepticism about the role government would play.
There are a wide range of options for how such a program could work, from a so-called single-payer model under which the government pays all the bills and oversees the health system to one where the government is responsible for paying the bills but channels payments to a largely private medical system.
“Government programs are great and necessary,” says Daniel Brown, 40, a pastor in Hazelwood, Mo., and a poll respondent. “I’m not opposed to helping people who need help. But I don’t want to live in a place where the government has ultimate control and tells you what to do.”
Brown says he runs an Internet marketing business and a travel company, in part to help pay $1,200 a month in health insurance costs to cover his family.
Baker, a retired billing specialist, says, “I don’t want government to handle anything about health care.”
But the government is increasingly involved in health care, already footing about 45% of the nation’s $2.2 trillion spending on medical care.
Medicare, which is paid for through tax dollars, covers about 43 million disabled Americans and senior citizens in a program that is as close as the USA gets to a universal system. Medicaid, which is administered jointly by the states and the federal government, provides health care services for more than 50 million Americans, including poor children and their parents and senior citizens in nursing homes.
Survey respondents liked the idea of expanding Medicare: 75% said they support allowing uninsured people 55 to 64 to join the program.
States lead in trying universal plans
While there has been little interest in Washington in universal health coverage, some experiments are occurring in the states. Massachusetts has passed a law requiring everyone to buy insurance and offering subsidies for low-income residents. Employers, too, must offer coverage or pay into a fund. Illinois has expanded children’s health programs and made them available to all, not just the low-income.
Vermont is working to expand its ability to provide care to the chronically ill and will focus on efforts to stem the epidemic of obesity, which can lead to costly health problems. Its plan aims not only to cover more uninsured, but also control the rate of growth of insurance premiums for the insured.
Kenneth Thorpe, professor of health policy at Emory University, says that reform efforts must focus on providing assistance to both the insured and uninsured. Thorpe served as an adviser to health reform proponents in Vermont, an experience he says led him to embrace a different approach to rallying public support for change.
“As soon as people hear ‘cover the uninsured,’ they think they’ll get taxed, pay more and get less,” Thorpe says. “But if … reform is focused on making health care more affordable and better quality for the 85% of people that have insurance, you get the insured people engaged in a debate in a way where they see there is something in it for them.”
