Public support for single-payer health care is growing—in fact, a Kaiser Family Foundation poll in July found a majority of Americans support it—but that increase comes with an important caveat. Most Americans only want government-run health care until they find out that it means the government will run their health care.
I thought about that this morning while reading J.D. Tuccille's excellent piece asking, "Are You Sure You Want Medicare For All?" He walks through the various ways government-run health care seems to be appealing—it means families no longer have to bear the cost of heartbreaking medical disasters on their own, for example—and the far greater number of reasons why government-run health care would be a fiscal, political, and medical disaster:
Jumping through bureaucratic hurdles for the privilege of accepting substandard compensation isn't as attractive as it might seem. That may be why a growing number of physicians refuse to see Medicare patients, others limit the number they'll accept, and more balk all the time.
Under a single-payer system, options for medical providers may be more limited than they are now—there probably wouldn't be any better-paying private insurers to take by preference to the government system. But there also wouldn't be any private insurers to effectively subsidize Medicare patients. In the case of a single-payer transition, doctors who find the terms of Medicare for All unacceptable may switch entirely to private-pay (if that's still permitted), while some percentage will leave medicine entirely. Considering the potential for switching over to single-payer in The Atlantic, Olga Khazan predicts "Hospitals would shut down, and waits for major procedures would extend from a few weeks to several months."
Are you sure that's what you want in your health care system? Progressives seem willing to bet on it, as Tuccille notes, with such figures as Sen. Bernie Sanders (I-Vt.) and Sen. Elizabeth Warren (D-Mass.) getting ready to unveil a Medicare-for-all scheme. Expect that issue to feature prominently in the 2018 midterm election as Democrats try to win back control of Congress.
Republicans have botched their efforts to repeal and replace Obamacare so badly that the threat of single-payer is real, and growing. But this is a debate that can be won with facts. That July Kaiser survey suggests that Americans aren't actually ready to jump on the single-payer train. (The Sander/Warren "Medicare-for-all" plan would not be a true national single-payer system, but would amount to putting more Americans into government-run health plans. Kaiser's poll used both "single-payer" and "Medicare-for-all" interchangeably.)
This chart is the crucial one:
While 55 percent of Americans say they want a single-payer/Medicaid-for-all plan, those in favor tend to change their minds when they hear that it means giving the government more control over health care, or that Americans would have to pay more in taxes.
That tracks with other polling on the issue. A May poll from the nonpartisan Public Policy Institute of California found support for single-payer state healthcare at 65 percent statewide, but that number dropped to 42 percent when respondents were told at least $50 billion in new taxes would be required to pay for it. That's a pretty optimistic view of the taxes that would be required to pay for single-payer in California; the actual cost would be well over $100 billion annually.
Are you sure you want government-run health care? Many Americans don't seem to understand the question. But once they do, the answer is "no."
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