The Democratic Split on Health Care

Countries that provide universal health care for citizens

The map shows (in green) countries that provide universal health care for its citizens. It’s from 2012, but I assume it’s still accurate. We are reminded that universal health care is not some pie-in-the-sky idea but is something many countries have accomplished. It’s also important to remember that this goal has been achieved in many different ways. I believe no two nations provide health care in exactly the same way. Many roads do get to the same place.

Currently the Democrats are split on two plans, Medicare for All — creating one single-payer system built on Medicare — and Medicare as a public option, sometimes called “Medicare for America.” Very basically, Medicare for All would replace the entire U.S. health insurance system with a Medicare-type program in which the government pays most medical bills directly. Medicare as a public option would allow people to keep their current insurance, including employee-based insurance, if they want that and their employers continue to provide it. Buying into Medicare would be a voluntary option, with substantial subsidies provided for lower- and middle-income people.

Maybe because I’m already on the standard Medicare for Geezers, I am not deeply and personally invested in one approach over the other. I agree with most progressives that Medicare for All, or something along those lines, is where we want to be. But I’ve also written that Medicare as a public option probably would be easier to sell to the public and would get us to the same place eventually.  See “The Many Roads to Universal Health Care” for those arguments.

Polling on these options has been confusing. An American Barometer Survey (whatever that is) came out last year saying that 70 percent of Americans support Medicare for All. But hold on, writes Nate Silver at FiveThirtyEight. More recent polling shows that the public option approach is much more popular than Medicare for All.

90 percent of Democrats thought a plan that provided for a public option was a good idea, as compared to 64 percent who supported a Sanders-style Medicare for All plan that would replace private health insurance. The popularity of the public option also carries over to independent voters: 70 percent support it, as compared to 39 percent for Medicare for All.

It’s possible that some of the positive polling for Medicare for All is muddied by confusion about what it means. See Eric Levitz, Polls: Voters Want Medicare for All — But Don’t Know What It Is.

A pair of new surveys confirm that the single-payer movement’s signature rallying cry is both broadly popular and widely misunderstood. In polls conducted by the Kaiser Family Foundation and Navigator Research, majorities of the public endorse the concept of “Medicare for All,” but evince ignorance about what such a policy would actually entail.

In Kaiser’s polling, most voters said that in a Medicare for All system, Americans would retain the option of keeping their current private insurance plans, and the obligation to pay premiums, co-pays, and deductibles.

In other words, what a lot of people polled are approving as Medicare for All is really the “public option” plan, not the single payer plan. Various polls also suggest that many people who really do prefer the single payer plan would be okay with the public option plan. And please do read all of Leavitz’s column; it’s from just last month and very informative.

Since either approach is popular with Democratic voters, it ought to be the case that Democratic presidential candidates who have chosen sides on this issue can advocate for one without trashing the other. But of course that’s not what is happening. “Centrist” Democratic candidates are using Republican talking points to trash Medicare for All. Paul Waldman writes,

The problem with what’s happening now is that some advocates of the public option approach are sounding a lot like, well, Republicans.

Their most common talking point when defending their plan is some variation of “We can’t kick 150 million people off their insurance,” referring to the number of people who are covered by employer plans:

    • “We should have universal health care, but it shouldn’t be the kind of health care that kicks 150 million Americans off their health care,” says John Delaney.
    • Beto O’Rourke says Medicare-for-all “would force 180 million Americans off their insurance.”
    • “I am simply concerned about kicking half of America off their health insurance within four years, which is what [Medicare-for-all] would do,” says Amy Klobuchar.

The generous interpretation of this line is that it’s warning about widespread disruption; the other interpretation is that it’s meant to stoke the fear that if you now have coverage and single payer passes, you could be left with no insurance at all, which is just false. If we passed single payer, you’d move from your current plan to a different plan, one that depending on how it’s constructed would probably offer as good or better coverage at a lower cost.

The further danger is that that kind of talk inevitably leads one toward the promise that got Barack Obama into such trouble, “If you like your plan, you can keep it.” In fact, here’s O’Rourke saying that under his plan, “For those who have private, employer-sponsored insurance or members of unions who have fought for health care plans … they’ll be able to keep that.” And here’s Biden saying much the same thing: “If you like your health care plan, your employer-based plan, you can keep it. If in fact you have private insurance, you can keep it.”

Haven’t they learned anything?

Of course not. The issue is, of course, that the public option plan wouldn’t directly cause you to lose your employee or private health insurance, but you could still lose it in the same ways people lose insurance now; for example, if you employer simply chooses to stop offering the plan you like as an employee benefit. Which happens all the time.

Waldman is also critical of a campaign ad Joe Biden released last week showing a woman thanking her union for fighting for her health insurance plan. “Apart from the praise of the Affordable Care Act, this video could almost have been scripted by the Republican National Committee, with its paeans to private health insurance,” Waldman writes. Health care is framed as something one earns through decades of hard work, not as a universal right.

Stuff like this reinforces my opinion that Biden is not the guy we want as the nominee. Of course I’ll vote for him if he is, but in the long run he’s going to hurt the future of the Democratic Party — by keeping it stuck in the mushy past — more than help it.

I do also run into people who are completely committed to Medicare for All and consider the public option route a betrayal. I respect that opinion, but at this point I think the one stand all Democrats should be taking is that health care is a universal right, period, not something that it’s okay to withhold from people who haven’t “earned” it. Beyond that, I can live with differences of opinion as to  how that will be achieved.

4 thoughts on “The Democratic Split on Health Care

  1. Thailand, btw, also has universal healthcare for its citizens.  

    As for what way to go in healthcare, I'd say go for any of the Western European, Canadian, Australian, or Japanese methods.**  They're all far cheaper than ours (because the clout of the purchaser is greatly multiplied the more people purchasing as a group).  And that means any problems (for instance, the overstated but sometimes true problem with wait times in Canada) could be erased simply by increasing the funding (it'd take between a 50-75% increase for Canada to be paying, per capital, what we pay*).

    * and actually, that's true of what we paid federally BEFORE the ACA.

    ** if it was my choice to impose, I think I'd adopt the French system, but any of them would be an enormous improvement over what we have, which in turn is a big improvement over what we had pre-ACA.


    Can we D's find a few health care plans – maybe like, oh say, about a half-dozen – that we can shop around to people, INSTEAD OF 20+ DIFFERENT OPTIONS?!?!?!?!

    All of this crap would confuse the shit out of Einstein!!!

    Those of who've been keeping-up with the proposed health care options already have some knowledge of them, and maybe opinions.  Those of us who don't, can't, or won't bother to follow, will wait until there's some distillation of the proposals down to 3 or 6 (speaking of distillation, I could use some adult beverages to get over watching good D candidates at each others throats this early!).

    Hopefully, some of the candidates will drop out after this week's debates – like down to about a dozen, or less.

    Meanwhile, for a bunch of you, I know you have to get your shots in at the others this week, but can you not form a circular firing squad get those shots in?

    Thank you.




  3. I wonder if there's any way to break a poll of satisfied private insurance customers down into those who have had to actually use that insurance for an expensive serious illness and those who haven't.  

  4. The anti-social system we have now, unfortunately, has supporters, and they too do not even know what they support.  Zoomer is right on needing a poll showing those who have had to use private insurance for any kind of a serious illness.  The ground level reality of such an experience  will probably  keep you on anti anxiety medicine you can ill afford.  It you can afford the medication you probably can't get or afford to find  any medical professional qualified and experienced enough to monitor the medicines effectiveness much less it's side effects.  

    Democrats need to set their sights high and their expectations low.  We do need medicine that is more social.  We need a floor of support especially for that which comes from the anti-social.  For example, someone injured at a garlic festival from an irate shooter needs a pool of money available for even free cosmetic surgery if needed, wanted, and desired.  You can probably guess what I would suggest taxing to establish that pool of money.  Let's just say we could start with the guns and ammo popular with the anti-social types of people, some of which become mass shooters.  That just makes good sense.   I would say common sense but that is an oxymoron.  If it was common, more people would have it.  If it had sense, it would know it is not that common.

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