Americans Like Medicare for All, Not Medicare Only

Ask people if they like sunshine. 90%+ non-vampires will probably say yes.

Now ask them if they like sunshine on a day when it’s 90 degrees outside. Not as many people will favor it now. Ask if they like sunshine at a place where it’s 95 degrees out and the humidity is 97%. Even fewer people will be in favor of it.

Ask Americans what they think of salad as a healthy food item. Most would agree it is. That is, until you reveal to them that the cheese, croutons and the thick ranch dressing means their salad has more calories than a 12 oz rib-eye.

This is the current state of ‘debate’ around Medicare for All. It’s the sunshine of liberal politics, and it’s a feel-good term that attracts a lot of people. Medicare is a popular program, and Medicare for All, in the abstract, looks great. The problem is that we haven’t yet dropped from the warm and fuzzies to the details about exactly what it will look like. When proponents - especially “red rose” twitter - throw around claims that there’s well over a majority of the country who support Medicare for All, what they are really saying is that there is well over a majority of the country supports the words "Medicare for All.” It’s like being fond of sunshine. That is to say, the “support” is rather soft-underbellied and prone to collapse based on a number of factors.

A new Kaiser Family Foundation poll reveals exactly this dynamic. In the past 10 years or so, support for Medicare for All as a term has increased by 10 points, with 56% of Americans now supporting it. But support crashes through the floor when some of the key features of what in truth is Medicare-only is brought into focus. Even the much-celebrated feature among the Left, the elimination of health insurance companies, is opposed by six in 10 Americans.

The idea that a single payer system would ‘threaten’ the current Medicare program is spurious, but it would drastically change it. The ‘delays’ claim is actually accurate in many instances. In Canada, the wait time between a primary care visit and a specialist visit fell to 20 weeks last year. Of course, it is an explicit feature of a single-payer, Medicare-for-All system to raise taxes on most everybody, which taxes would replace the premiums, copays and deductibles currently paid by individuals, employers, and in cases of subsidized plans under Obamacare, the government. Eliminating insurance companies is always a crowd-pleaser at Sanders rallies.

Support increases, naturally, when people hear that single payer would eliminate premiums and out-of-pocket costs as well as guarantee health care for all.

And yet, all things considered, Americans are much more open to Medicare-as-an-option than to Medicare-only, across party lines. Nearly half of Republicans are for it, even, along with 91% of Democrats.

Taken together, the drop of support for a Medicare-only plan when people hear that such a plan would eliminate private insurance and the much-higher support of Medicare-as-an-option over Medicare-only points us to a singular conclusion: Americans like Medicare, but most people also like their own insurance and don’t want single-payer to be imposed as the only option. That conclusion is borne out by the survey as well. In fact, the widespread support for Medicare for All as a term is contingent on the false impression that people would be able keep their current insurance if they like it, and the proportion of people who think so is nearly identical to the overall support for Medicare for all, at 55%.

This survey reminded me of a quote from Howard Dean, who gained notoriety as a presidential candidate in 2004 with his opposition to the Iraq war, but whose trump card on policy really was health care. He once said that Americans never want as much change as they say they want. The excitement around Medicare for All is just such an example. As long as Medicare for All means an Medicare as an option for all, Americans are overwhelmingly in favor of it. But when it means Medicare only, the support collapses.

For those of us who support the idea that health care is a right, we cannot afford to turn this into a fight about Medicare-or-bust. When public sentiment is in favor of shoring up government involvement in health care - due, in part, to the Trump administration’s efforts to obliterate the Affordable Care Act - we cannot afford to gamble that sentiment away by insisting that the current system be immediately upended in favor of a single option. Americans like choices, even when the choices are illusionary. But Medicare as an option - or another public option - is a real choice.

Let people choose. And if that choice is truly the best choice, let Americans vote with their feet and their dollars. Let private industry compete, and if they can’t, go bankrupt. But let’s not give into the argument that if our ideas were truly good, we would not fear those competing with other options.

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