By Drew Altman
Axios, June 3, 2019
There’s a big disconnect between the health care debates that dominate Washington, the campaigns and the politically active — where all of the talk is about sweeping changes like Medicare for All or health care block grants — and what the voters are actually thinking about.
The big picture: In our focus groups with independent, Republican, and Democratic voters in several swing states and districts, the voters were only dimly aware of candidates’ and elected officials’ health proposals. They did not see them as relevant to their own struggles paying their medical bills or navigating the health system.
Details: We conducted six focus groups in three states (Texas, Florida, and Pennsylvania), facilitated by Liz Hamel, the Kaiser Family Foundation’s Director of Polling and Survey Research. Each one had eight to 10 people who vote regularly and said health care will be important in their presidential vote in 2020.
- These voters are not tuned into the details — or even the broad outlines — of the health policy debates going on in Washington and the campaign, even though they say health care will be at least somewhat important to their vote.
- Many had never heard the term “Medicare for all,” and very few had heard about Medicare or Medicaid buy-in proposals, or Medicaid and Affordable Care Act state block grant plans like the one included in President Trump’s proposed budget.
- When asked what they knew about Medicare for all, few offered any description beyond “everyone gets Medicare,” and almost no one associated the term with a single-payer system or national health plan.
- When asked about ACA repeal, participants almost universally felt that Republicans did not have a plan to replace the law.
- When voters in the groups were read even basic descriptions of some proposals to expand government coverage, many thought they sounded complicated and like a lot of red tape.
- They also worried about how such plans might strain the current system and threaten their own ability to keep seeing providers they like and trust.
Between the lines: Most voters in these groups don’t seem to see the current health reform proposals on either side of the aisle as solutions to their top problems: paying for care or navigating the health insurance system and red tape.
- That, combined with a general distrust of politicians, can make these voters wary of any plan that sounds just a little too good to be true to them.
The bottom line: For most voters, the debate will be more meaningful when they see stark differences on health between the Democratic nominee and President Trump in the general election. Then they may be able to focus more on what differences on health reform mean for the country and their daily lives.
By Don McCanne, M.D.
Although we should be cautious about trying to draw Great Truths from half a dozen focus groups, we should be concerned about what these groups revealed about their understanding of the basis of the problems that they experience with our health care system.
They see problems with navigating the health care system and with paying their medical bills. But when offered solutions for these problems they show little understanding of even basic health policy, and they seem to be influenced more by political memes expressing a distrust of government, complexity of public solutions, and government interference with their interactions with the health care system.
A particularly important example of this is, “When asked what they knew about Medicare for all…almost no one associated the term with a single-payer system or national health plan.”
This lack of sophistication leaves them unaware that the government Medicare program is far more deserving of our trust than the private insurers (“surprise medical bills” anyone?), that a government program that includes everyone though a publicly funded universal risk pool is far less complex than a multitude of private insurers with various complex rules for accessing and paying for care, and that a single payer system interferes less since the patient has free choices in health care whereas the private plans are more restrictive of benefits while limiting coverage to their contracted provider lists (a minute fraction of the physicians and hospitals available throughout the nation).
Health policy is complicated, but the message for single payer Medicare for All need not be: enrollment for life, free choice of physicians and hospitals and other health care professionals and institutions, and automatic payment by our own public program. The focus groups already understand that the Republicans do not have a replacement plan, but what they do not understand is that only the single payer model of Medicare for All meets these goals whereas the ACA/public option Medicare for Some often leaves them exposed to the access and affordability issues they already face.
Again, single payer Medicare for All means:
- Never have to change insurers.
- Free choice always of doctors and hospitals.
- No medical bills since care has been prepaid through our taxes.
None of these are features of either the Republican proposals or the Democratic ACA/public option proposals. It’s a simple message. Let’s do our best to see that the American voter understands it.
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