By Ashley Kirzinger, Cailey Muñana, Lunna Lopes, Liz Hamel, and Mollyann Brodie
Kaiser Family Foundation, June 18, 2019
The most recent KFF Health Tracking Poll finds majorities across partisans think taxes for most people would increase under a national health plan, sometimes called Medicare-for-all (78 percent), and about half (53 percent) think private health insurance companies would no longer be the primary way Americans would get health coverage under such a plan. However, when it comes to other key changes that the leading Medicare-for-all bills introduced by Sen. Bernie Sanders and Rep. Pramila Jayapal would bring, large shares are unaware of how the current health care system may be affected. For example, majorities say people would continue to pay deductibles and co-pays (69 percent) and continue to pay premiums (54 percent) under a Medicare-for-all plan. Likewise, majorities say people with employer-sponsored or self-purchased insurance would be able to keep their plans (55 percent each) under a Medicare-for-all plan.
Though lowering costs and increasing access emerge as the top issues that Democrats and Democratic-leaning independents want to hear presidential candidates talk about, there are some notable differences between liberals and moderates. One-fourth of liberal Democrats and Democratic-leaning independents (23 percent) offer implementing a single-payer or Medicare-for-all system when asked what health care issue they want to hear the candidates discuss, making it among the top health care issues offered by this group along with increasing access (27 percent) and lowering the amount people pay for health care (24 percent). Among moderate Democrats and Democratic-leaning independents, more than three times as many offer lowering the amount people pay for health care (34 percent) than implementing a Medicare-for-all system (9 percent).
A National Health Plan or Medicare-for-all
Eight in ten (78 percent) think that under a national health plan, sometimes called Medicare-for-all, taxes for most people would increase. Majorities of Democrats (71 percent), independents (80 percent), and Republicans (85 percent) say that taxes for most Americans would increase under a national health plan.
In addition, about half of Americans (53 percent) – including half of Democrats and independents (52 percent each) and most Republicans (57 percent) – think that under a national health plan, private health insurances would no longer be the primary way Americans would get health coverage. Still, a substantial four in ten of the public believe that under such a plan, private health insurance companies would still be the primary source of coverage for most Americans and an additional seven percent say they do not know what would happen under a national health plan.
In focus groups, many participants expressed skepticism about the idea that private insurance companies would cease to exist under a Medicare-for-all plan. Some thought these companies were just too powerful, and others thought they would continue to exist for people who want to buy extra coverage beyond what a national plan would offer.
When it comes to other potential impacts of a national health plan, many Americans say most aspects of the current health care system would remain unchanged. Majorities of Democrats, independents, and Republicans say people would continue to pay deductibles and co-pays when they use health care services (71 percent, 68 percent, and 68 percent, respectively). In addition, majorities of both Democrats and independents also believe people with employer-sponsored insurance would be able to keep their current coverage (68 percent and 53 percent), people who purchase their own plans would be able to keep their current coverage (65 percent and 55 percent), and individuals and employers would continue to pay health insurance premiums (61 percent and 53 percent). At least four in ten Republicans also say each of these things would happen under a national health plan. Small shares of the public overall say they don’t know whether each of these things would happen under such a plan (4 percent say they don’t know if people would continue to pay deductibles and co-pays, 7 percent say they don’t know for the other changes included).
Navigating the Medicare Debate
Navigator, June 17, 2019
The simple ideas of protecting and expanding Medicare are more popular than any branded program.
The most popular Medicare ideas among the public are also the simplest – the ideas of “protecting Medicare” and “expanding Medicare.” Both ideas are popular and have low negative ratings. “Medicare for All” as a brand shows promise, as it’s more popular than not (51% say it’s a good idea versus just 33% saying it’s a bad idea), though, as noted below, there is also clear confusion about the program. Proposals using more prescriptive language (e.g., “buy-in” or “single-payer”) score less positively, mostly due to a lack of knowledge as indicated by higher “don’t know” ratings.
Confusion: Medicare for… All who want it?
Only one in five Americans are very confident they know what “Medicare for All” would mean for our health care system (18% very confident) or their personal health care (20% very confident). When asked to characterize what “Medicare for All” means to them, respondents are divided: 40% think “Medicare for All” would eliminate the private insurance market and require everyone to switch to Medicare, while 60% think it would let anyone buy Medicare who wants to, while allowing others to stay on their private insurance. Perhaps most fascinating: Democrats are most likely to think “Medicare for All” is a “buy-in” program, while Republicans are much more likely to believe it will eliminate private insurance.
And those different interpretations of “Medicare for All” have dramatic consequences on the program’s support.
When respondents are asked whether they support “Medicare for All” – described as a buy-in program – 73% support it. However, when respondents are asked whether they would support “Medicare for All” – described as eliminating private health insurance – support drops significantly, with 47% saying they support it. This illustrates how support for Medicare for All is driven more by branding with the term “Medicare” than by specific knowledge of the program.
Concerns about Medicare for All center on costs.
Americans are most concerned that “Medicare for All” will raise taxes, cost too much, and increase the deficit. Given Americans’ top health care concern is cost, progressives should take serious note of and grapple with these cost concerns.
(Note that the KFF poll is designed to be neutral, whereas the Navigator poll is designed to inform the progressive community.)
By Don McCanne, M.D.
Unfortunately, these polls demonstrate that Americans are not well informed on the single payer model of Medicare for All. There are two important factors that have contributed to the confusion: 1) Moderate Democrats who support adding a public option the current system under the Affordable Care Act have confused the public by using the label “Medicare for All” or variations of it when their proposals are actually only Medicare for some, and 2) the conservatives have been much more effective in disseminating negative messages about Medicare for All including threats of having their employer-sponsored plans taken away from them and having to pay egregiously high taxes.
Regarding the effectiveness of messaging, it is interesting that more Republicans believe that Medicare for All will eliminate private insurance (correct except for supplemental coverage of non-essential services), whereas more Democrats believe that Medicare for All is a buy-in (public option) preserving current private insurance (incorrect, except for the Medicare for some copycats) – Question 133X in the Navigator toplines.
Our message is quite straightforward, but it has not gained enough traction. We should probably specify Single Payer Medicare for All to distinguish it from the Medicare for Some models, and then keep the message simple:
Single Payer Medicare for All
- Universal (everyone in)
- Affordable (no medical bills; prepaid through equitable taxes)
- Comprehensive (including drug, dental, eye, hearing and long-term care)
- Free choice of doctors and hospitals (no insurer provider lists)
- Accessible (regional planning)
- Efficient (eliminate private insurance and administrative waste)
- Portable (care throughout the United States)
- Permanent (throughout life)
President Trump once again is promising us, within the next two months, “something terrific” to overhaul the nation’s health care system. Let’s see him match this list.
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