“Medicare for all” is a popular and politically effective slogan. Polls have shown that 70 percent of adults, and maybe more, say they’d support opening the federal health care program for the elderly to every American. This is all much to the delight Sen. Bernie Sanders, who managed to mainstream the idea during his 2016 presidential run, and has trumpeted those survey results in recent appearances.
One problem for Sanders is that when most Americans hear the words “Medicare for all,” they aren’t necessarily imagining the sort of single-payer system the Vermont senator has proposed. Worse yet, support for national health insurance seems to vacillate a great deal based on how pollsters couch the question. On Wednesday, for instance, the Kaiser Family Foundation published its latest tracking poll on public attitudes towards health care policy. Similar to its previous results, it found that 56 percent of Americans would support “a national health plan, sometimes called Medicare for all, in which American would get their insurance from a single government plan.” That’s not a bad outcome on its face. But many survey takers seemed to be confused about what Medicare for all, as it’s been formally proposed, would actually do. Among those under the age of 65 who had employer-sponsored coverage, 55 percent said they thought they would be able to keep their current health plan if Medicare for all were put in place.
That is not how Sanders’ single-payer bill would work. The legislation that Sanders has written, and that many of his colleagues and potential Democratic primary opponents endorsed, would expressly ban private insurance plans that compete with the government.
That turns out to be a fairly unpopular idea. According to Kaiser, support for Medicare for all drops to 37 percent if survey takers are told that the bill would eliminate private insurance companies, with 58 percent opposed.
In other words, Americans want access to government insurance, but they don’t want to be forced to use it—people prefer optionality. Kaiser finds that 73 percent of adults support “creating a national government administered health plan similar to Medicare open to anyone, but would allow people to keep the coverage they have.” This is an idea that, in health policy world, generally gets referred to as “Medicare for anyone.” The closest thing to it is probably a proposal produced by the Center for American Progress that would ban private insurers from competing on the individual market and would create strong incentives for employers to move their employees onto the federal plan.
This seems to be one of the two central hurdles for Sanders and other true single-payer advocates. They need to convince Americans that paying higher taxes won’t burden them, since they’ll no longer have to pay insurance premiums (60 percent of respondents to Kaiser said they’d oppose Medicare for all if it meant most Americans had to pay higher taxes). And they need to win over Americans who want to hold onto their current coverage, even if it may be less than perfect. Right now, the country seems a little more primed to accept a plan that gives them at least some semblance of choice—something that looks more like a mega public option.
All of that brings us back to political slogans. It’s obvious that one of the reasons that Medicare for all has become such a popular idea is that, despite the existence of Sanders’ bill, the concept is still pretty vague to most voters. People can clearly project what they want onto it, including the promise that they’ll be able to keep their old health plan. Meanwhile, Democratic candidates can stick it in their platforms without getting too hung up on details. And for the purposes of building broad political support for national insurance, that’s probably fine. Voters usually rally to broad, not granular, 10-point agendas (See: Green New Deal). But Democrats need to be aware that while Americans say they love Medicare for all, that doesn’t yet mean they love single payer.