The latest polling on healthcare issues shows Medicare for All is a political loser. Its tenuous support evaporates as soon as pollsters mention it raises taxes or eliminates private insurance.
There’s no doubt a tax-based universal system that covered everyone would be administratively simpler and reduce the gross disparities produced by current arrangements. But the time to pass came just after World War II, when President Harry Truman proposed a national, tax-supported health insurance plan in a country where just 1 in 7 people had hospital coverage.
That effort was doomed when the American Medical Association, American Hospital Association and U.S. Chamber of Commerce opposed it with the false charge that it was “socialized medicine.” While their reasoning has changed, those same groups are joining the insurance industry now in fighting Medicare for All.
Major American unions, facing political gridlock, opted to negotiate for tax-advantaged health insurance benefits, even as they gave lip service to the superiority of a universal plan. By 1958, 75% of Americans had health insurance and unions were heavily invested in protecting those benefits. Most unions remain ambivalent about Medicare for All.
“There’s no question that ultimately we need to establish a single-payer system, but there has to be a role for those hard-fought-for, high-quality plans that we’ve negotiated,” AFL-CIO President Richard Trumka said recently.
The additions since 1965 of Medicare, Medicaid, the Children’s Health Insurance Program and the Affordable Care Act gave us the hot, sticky mess we have today—an administratively complex and overly expensive system where 1 in 10 persons are still uninsured and a growing number of people struggle to pay their out-of-pocket costs.
Would that we could in one fell swoop cut through that Gordian knot.
It is theoretically possible to design a universal, tax-based, single-payer system that would cost middle-class families less, add benefits and leave private sector provider arrangements largely intact. But as Sen. Bernie Sanders (but not Sen. Elizabeth Warren) admitted on the Democratic Party debate stage, that would require a major tax overhaul.
There’s reason for her caginess. Public support for Medicare for All drops from 51% to 37% when people are told it would raise taxes, according to the latest Kaiser Family Foundation tracking poll.
Every objection raised by moderate Democrats and Republicans has a similar impact. When told Medicare for All would end private insurance, lead to treatment delays or pose a threat to traditional Medicare, public support falls dramatically.
The primary reason why a bare majority still supports Medicare for All is that it provides universal coverage and eliminates out-of-pocket costs. We don’t have to upend the entire insurance system to accomplish those goals.
The Commonwealth Fund and Urban Institute just analyzed competing approaches to expanding coverage. They concluded improving the ACA and creating a public option alternative would cover 98% of Americans at a tenth the cost of Medicare for All.
As the intraparty debate rages, the Democratic-controlled House is moving to lower household spending on healthcare. Its legislation to curb drug industry pricing power on high-cost drugs would also set limits on Medicare beneficiaries’ total out-of-pocket costs.
They need to go much further. They should improve the ACA so that it achieves near universal coverage. They should put strict limits on out-of-pocket spending in all health and drug plans. They should cap individual drug co-pays at a level that doesn’t prevent people from filling their prescriptions. They should ban balance billing.
What most Americans want are pragmatic solutions to their immediate healthcare cost problems, not a dramatic overhaul of the entire system. In a political season when the latest Gallup poll ranks “the government/poor leadership” far ahead of “healthcare” as the main concern, pragmatism will put Democrats on much sounder political footing than pushing Medicare for All.