By Bradley Jones
Pew Research Center, September 29, 2020
A majority of Americans continue to say the federal government has a responsibility to make sure all Americans have health care coverage.
And since last year, there has been an increase – especially among Democrats – in the share saying health insurance should be provided by a single national program run by the government.
Among the public overall, 63% of U.S. adults say the government has the responsibility to provide health care coverage for all, up slightly from 59% last year. Roughly a third (37%) say this is not the responsibility of the federal government, according to a Pew Research Center survey conducted July 27 to Aug. 2 among 11,001 adults.
When asked how the government should provide health insurance coverage, 36% of Americans say it should be provided through a single national government program, while 26% say it should continue to be provided through a mix of private insurance companies and government programs. This is a change from about a year ago, when nearly equal shares supported a “single payer” health insurance program (30%) and a mix of government programs and private insurers (28%).
Most of the increase has come among Democrats and Democratic-leaning independents. A 54% majority of Democrats and Democratic leaners now favor a single national government program to provide health insurance, up from 44% last year. Support for single payer health coverage has increased among most groups of Democrats, including those who describe their political views as very liberal (up from 66% to 77%), liberal (50% to 61%) and conservative or moderate (35% to 43%).
Among Republicans and Republican leaners, a 66% majority says the government does not have the responsibility to make sure all Americans have health care coverage. Among the one-third of Republicans who say the government does have this responsibility, opinion is divided over whether or not it should be provided through a single government program or a mix of private and government programs.
Although most Republicans say it is not the government’s responsibility to ensure health coverage for all, a 54% majority says the government “should continue to provide programs like Medicare and Medicaid for seniors and the very poor.” Only 11% of Republicans say the government should not be involved at all in providing health insurance.
While divisions remain within the Democratic Party about the best way to provide health insurance, increasing shares across most demographic and ideological groups support a single national government program.
Very liberal Democrats, who in 2019 constituted 15% of Democratic registered voters, are far more likely than liberal Democrats (32% of Democrats) and moderates and conservatives (51%) to say that health insurance should be provided by a single government program.
White Democrats remain more likely than those of other races and ethnicities to support a single national program, but White, Black and Hispanic Democrats have each increased their support for a single national program by about 10 percentage points since last year.
A similar pattern emerges with age: Younger Democrats are still more supportive than older Democrats, but Democrats of all ages have increased their support over the past year.
By Don McCanne, M.D.
The Pew American Trends Panel survey tends to provide results demonstrating lower percentages of support for a single national government program to provide health care coverage than do other polls on the topic, but that is likely due to the design of the Pew polling questionnaire.
The Pew poll asks a two part question. First they ask if it is the federal government’s responsibility to make sure all Americans have health care coverage. In the most recent poll, 63% say that it is. Then only those who say it is are asked if health insurance should be provided through a single national health insurance system run by the government or should it continue to be provided through a mix of private insurance companies and government programs. The other 37% are not asked this question but rather are asked whether or not programs like Medicare and Medicaid for seniors and the very poor should be continued. Thus if everyone who said that it was the responsibility of government to make sure that all Americans have health insurance coverage chose a single national health insurance system over a mix of private insurers and government programs, then the maximum would be only 63%, since the other 37% weren’t asked the single payer question. In the current poll, 36% chose a single national health insurance system, but that is 57% of those who were actually asked.
Compared to one year ago, about the same percentage say that health coverage should be a government responsibility, but the percentage supporting a single national program has increased over those supporting a mix of government and private programs. This would suggest that people are becoming even less satisfied with the private sector which would include employer-sponsored plans and private individual plans. This may have been precipitated by disappointment with plans that failed individuals during the coronavirus pandemic. The government is a more reliable provider of health care coverage than is the private sector, and more people are realizing that.
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