Ability
to keep current hospital and doctor, enroll voluntarily would sway most
opponents
As some leading
Democrats push a bolder vision for delivering on the party’s decades-long
aspiration of universal health care, intraparty dissonance threatens to derail
that effort before it has even begun, with establishment Democrats and
progressives sparring over how to satiate the appetite for dramatic overhaul
without alienating Americans fearful of disruption.
Support for “Medicare
for All” has fallen since the 2018 midterm
elections, as Republicans have gone on the offensive, branding it as an embrace
of socialism and a government takeover of health care.
The underpinnings of
much of the discourse surrounding the controversial policy are rooted in
genuine debate surrounding what “Medicare for All” means in the first place —
and muddled definitions have left Americans relying more on what they’d like to
see in the plan than on what’s truly there as they build their outlook.
Democratic presidential aspirants, eager to please steadfast believers, wary
optimists and skeptics alike, appear to be in no rush to alleviate the
ambiguity.
And when it comes to
making a case to Americans, a new Morning Consult survey probing public
opinion on Medicare for All — defined as a system where all Americans are
automatically enrolled in a government-run health plan that replaces all
duplicative private coverage — indicates language will go a long way.
The survey of 6,600 U.S. adults found that
both supporters and opponents are highly susceptible to messaging, shedding
light on why candidates, in the early stages of curating their policy
platforms, are casting nets wide enough to accommodate convictions in flux and
the reality that the eventual legislation will be some hybrid of the different
proposals currently on the table.
The poll found that
despite the abyss between partisans on health reform, most people want the same
thing: a system in which everyone has health insurance, and the right to choose
where they get it from, without going bankrupt. And with many months ahead to
litigate the merits of Medicare for All, the data suggests the proposal’s
proponents are on more fertile ground than its detractors to bring the public
to their side.
Respondents were
asked about different policies that would expand health care coverage: Medicare
for All; a public option system in which Americans choose coverage either from
the government or private market; a single-payer system in which one entity
(usually the government) covers the costs of health care; a Medicare buy-in
system in which adults ages 50-64 could buy coverage through Medicare and
private insurance is still available; and a Medicaid buy-in system in which all
adults could buy coverage through Medicaid.
The public option and
buy-in plans fared best, with 62 percent of adults saying they support the
public option and 62 percent and 61 percent backing Medicaid and Medicare
buy-in systems, respectively. A single-payer health system barely garnered
majority support (51 percent) while Medicare for All fell short of a majority,
at 47 percent.
At this stage, it
appears dubious that the public will coalesce around one proposal by 2020. The
coalition challenging the power of industry stakeholders in the health care
system and heralding Sen. Bernie Sanders’ (I-Vt.) legislation as the silver bullet solution
has frustrated establishment Democrats, and still
faces an uphill battle in winning over the public.
But a Medicare for
All approach perceived as slightly less disruptive could have tremendous
potential, at least on the pathway to eventual single-payer, as there is much
more common ground between supporters and opponents than initially meets the
eye. In fact, most skeptics can warm quickly to Medicare for All — especially
if it takes a page or two from the public option.
ALL OPPONENTS DEMOCRATS REPUBLICANS INDEPENDENTS EMPLOYER COVERAGE SELF-PURCHASE MEDICARE
Voluntary enrollment
is alluring: Three in 5 Medicare for All opponents say it would increase their
likelihood of supporting Medicare for All. In the same vein, 56 percent of
opponents are more likely to support a plan that maintains a role for the
private market.
While Democratic
presidential candidates in the Senate, such as Elizabeth Warren of
Massachusetts, Kirsten Gillibrand of New York, Cory Booker of New Jersey and
Kamala Harris of California, have endorsed Sanders’ bill, they’ve otherwise
treaded carefully on textbook single-payer. However, their support for a plan
guaranteeing universal coverage without nixing employer-sponsored plans has
been unwavering.
“Medicare for America,” introduced in the 115th
Congress by Democratic Reps. Rosa DeLauro of Connecticut and Jan Schakowsky of
Illinois, who plan to bring forward the revised legislation within weeks, vows
to do just that, and it has scored an early endorsement from another 2020
candidate, former Texas Rep. Beto O’Rourke.
Topher Spiro, a lead
author of the Center for American Progress’ “Medicare Extra” plan (the bedrock
for the DeLauro and Schakowsky bill), said the Morning Consult poll confirms
that this approach – that is, Medicare for All for those who want it – is
extremely popular not only with Democrats, but the broader electorate.
The poll also
revealed some of the hesitation toward Medicare for All may be driven by lack
of information.
Sixty-two percent of
opponents said they were more likely to support a plan that allows them to keep
their hospital and doctor (under Sanders’ plan, they could). Nearly an equal
share (59 percent) said the same if the Medicare for All plan included dental,
vision and long-term care coverage (Sanders’ plan does).
A majority of
Medicare for All opponents are enticed when told the plan would eliminate
prescription drug co-pays (54 percent), stop corporations and the
pharmaceutical industry from profiting off ill Americans (59 percent) and
uphold coverage quality for current Medicare beneficiaries (58 percent).
Only one argument —
that Medicare for All would extend federal funding for abortion — kept a
majority of opponents steadfast in their opposition.
By contrast, a
majority of supporters stood their ground in the face of every argument tested
except one: The possibility that Medicare for All would denigrate coverage for
seniors caused 54 percent of proponents to sour on the plan.
ALL SUPPORTERS DEMOCRATS REPUBLICANS INDEPENDENTS EMPLOYER
COVERAGE SELF-PURCHASE MEDICARE
Many conservative
arguments against Medicare for All, such as the contention that the system
would increase income taxes, do not faze the majority of supporters. Forty-one
percent of proponents are not only undeterred by a spike in income taxes, but
say it increases their likelihood of support. Another 11 percent say it makes
no difference, while 38 percent say it raises their likelihood of opposition.
Upwards of 60 percent
of advocates stand by Medicare for All if it requires government spending cuts
(71 percent), mandates enrollment (68 percent), eliminates the Affordable Care
Act (53 percent) or covers abortion (62 percent).
Health care industry
groups have characterized Medicare for All and any plan expanding Medicare as
perilous for doctors and hospitals, but their leading lines of attacks — that
the plan would reduce providers’ revenue and slash physician salaries — land
softly, moving a third or fewer supporters to think twice.
Scott Jennings, a
former political appointee of President George W. Bush and a founding partner
of RunSwitch Public Relations, said Republicans and Democrats alike miss “being
straight with people about what drives costs.” Given that a small slice of the
population is responsible for the lion’s share of health care costs, “the true
question is whether we should have a system that takes care of those folks
while leaving the private market intact and affordable for the vast majority of
the American people who spend very little,” he said.
Advocates of
universal coverage are now tasked with marrying the ideological spirit of
Medicare for All with the choice and practicality that Americans, including
most Democrats, are unwilling to sacrifice.
Adversaries on
Capitol Hill and within the industry have homed in on the elimination of
job-based insurance to weaken support for Medicare for All, and the question
about the role of the private market has inflamed a simmering rift between establishment
Democrats and a progressive coalition challenging how much power insurers and
corporations exert over the health system.
Consequently, some
candidates are billing a public option as a short-term compromise. For example,
Pete Buttigieg, the mayor of South Bend, Ind., said in an April 15 interview with MSNBC’s Rachel Maddow that
he supports moving toward Medicare for All by first making it available on the
exchange for people to opt into.
Among Medicare for
All supporters, 74 percent approve of an approach that does not eliminate the
private market but allows more people to enroll in Medicare or Medicaid, as a
compromise in the short-term on the path to universal coverage. Striking down
the private market turns off about a third of supporters.
Charles Gaba, a
progressive health care analyst who runs ACAsignups.net, cautioned against
writing off more politically palatable iterations of Medicare for All as
“incremental.” Even the Affordable Care Act, which few would consider a “baby
step,” was intended as a step on the pathway to universal coverage, he said.
Proposals like
“Medicare for America,” Gaba said, “make the new government program mandatory
for the half of the country that is least likely to object, but completely
optional for the half most likely to object.”
Jesse Ferguson, a
Democratic strategist, questioned whether Medicare for All necessarily
eliminates employer-sponsored coverage. Though the party has unfinished work in
defining the terms of its internal health care debate, Ferguson said,
disagreement on the best path forward does not undermine the fact that
Democrats’ commitment is to guaranteeing health care for all, not striking down
the private market.
The survey finds
people are split between whether Medicare for All exclusively refers to the
policy championed by congressional progressives, which eliminates duplicative
private insurance, or broadly encapsulates the fight for universal coverage. In
the latter case, the Sanders bill, which explicitly replaces private insurance,
is just one of several approaches.
Less than a third of
adults describe Medicare for All as laid out in Sanders’ plan, while 32 percent
say it offers everyone insurance through the government or the private market.
A 39 percent plurality of those who back Medicare for All believe the plan
leaves employer-sponsored plans on the table.
Warren said by email
that “there are multiple proposals on the table right now that would layer
coverage expansions that add up over time, but the aim has to be very clear:
Make sure every single person in this country has health care coverage.” The
other presidential candidates signed onto Sanders’ legislation did not respond
to requests for comment.
No comments:
Post a Comment