Friday, June 13, 2014
Pew Research Center
June 12, 2014
Political Polarization in the American Public
Section 4: Political Compromise and Divisive Policy Debates
Government's Role in Health Care
The idea of a single-payer health care system – in which the government
pays for all health care costs – has long been a dream of many liberals.
But when Congress took up health care reform in 2009, Democrats united
behind a market-based proposal – what became the Affordable Care Act –
which was seen as more politically feasible.
The current survey finds that government involvement in the health care
system continues to draw extensive liberal support: Fully 89% of
consistent liberals say it is the responsibility of the federal
government to make sure all Americans have health care coverage. And
roughly half – 54% – think health insurance "should be provided through
a single national health insurance system run by the government."
Overall, the public is divided over how far the government should go in
providing health care. About half (47%) say the government has a
responsibility to make sure all Americans have health care coverage,
while 50% say that is not the responsibility of the federal government.
Those who believe the government does have a responsibility to ensure
health coverage were asked if health insurance should be provided
through a mix of private insurance companies and the government, or if
the government alone should provide insurance. The single-payer option
was supported by 21%, while about as many (23%) favor a mix of public
and private insurance.
On the other side of the issue, while half say it isn't the government's
responsibility to make sure all have health care coverage, relatively
few want the government to get out of the health care system entirely.
Rather, 43% say it's not the government's responsibility to ensure
health care coverage for all, but believe the government should
"continue programs like Medicare and Medicaid for seniors and the very
poor." Only 6% of Americans go so far as to say the government "should
not be involved in providing health insurance at all."
Even among consistent conservatives, there is minimal support for the
government having absolutely no role in providing health care.
Three-quarters of consistent conservatives (75%) say the government
should continue Medicare and Medicaid while just 20% think the
government should not be involved in providing health insurance.
Bar graph of poll results on government involvement in health care:
Table 4.7 Government Role in Health Care
Q121/a/b: Do you think it is the responsibility of the federal
government to make sure all Americans have health care coverage, or is
that not the responsibility of the federal government?
ASK IF GOV'T RESPONSIBILITY: Should health insurance (Be provided
through a single national health insurance system run by the government)
OR (Continue to be provided through a mix of private insurance companies
and government programs) [RANDOMIZE]?
ASK IF NOT GOV'T RESPONSIBILITY: Should the government (Not be involved
in providing health insurance at all) OR (Continue programs like
Medicare and Medicaid for seniors and the very poor) [RANDOMIZE]?
Table of results at this link:
Comment by Don McCanne
It is often said, based on many polls, that about 60 percent of
Americans support a single payer national health program. How solid is
that support? This important poll from Pew Research Center provides some
Those polled were split into two groups based on whether or not they
thought that it is the responsibility of the federal government to make
sure all Americans have health care coverage. They were split fairly
evenly - 47 percent believing that it is a government responsibility and
50 percent believing that it is not. But then the 50 percent who thought
it is not a government responsibility split into 43 percent of the total
believing that we should keep Medicare and Medicaid and only 6 percent
holding the position that government should not be involved at all.
This demonstrates a problem with polling. We tend to think that answers
to seemingly straightforward questions accurately represent the views of
the public. But against a background of rhetoric, memes, subliminal
persuasion, and the messages of controlled media (think Fox), simple
responses are not all that simple. The oft-repeated line, "Keep
government out of my Medicare," facetiously represents the complexity of
seemingly simple concepts. Fully half of people seem to believe that
they do not want the government to have the responsibility of making
sure that all Americans have health care coverage, yet actually only 6
percent do not want the government involved if it means eliminating
Medicare and Medicaid. That does not seem to be intuitive. People do
want the government involved, even though half said that health care
coverage wasn't the government's responsibility.
Single payer supporters likely will be troubled by the further responses
of the nearly one-half who do believe that the government should be
involved. Of those individuals ideologically classified as "Consistently
Liberal" 89 percent believe that it is a government responsibility, yet
only 54 percent believe that we should have a single national health
insurance system run by the government; 31 percent believe that we
should have a mix of private insurance and government programs. Of
"Consistently Conservative" 98 percent believe that the government
should not be involved, and zero percent support single payer (though
that 98 percent drops to 20 percent of the "consistently conservative"
when asked about Medicare and Medicaid).
Overall, only 21 percent of Americans in this poll seem to believe that
we should have a single national health insurance system run by the
Most single payer supporters find this difficult to believe. But the
view is quite malleable and subject to exposure to memes, rhetoric,
political advertising and whatever. As examples, California's
Proposition 186 and Oregon's Measure 23 - two single payer ballot
measures - had support in the polls early in their campaigns, yet
three-fourths of voters rejected Prop. 186, and four-fifths rejected
Measure 23. Late in each campaign, the insurance industry had very
little difficulty in taking advantage of the malleability of the views
on single payer.
How could the voters be so deceived? It's easy. It took only one more
question in this Pew poll to change opposition to government involvement
from 50 percent to 6 percent!
The lesson is that we cannot rest on believing that the 60 percent of
Americans who support single payer will eventually drive the political
process and bring us reform. That 60 percent is not an absolute - ask
single payer supporters in California and Oregon. People need to have a
much better understanding of health policy than they do. We need a solid
foundation that cannot be washed away by memes. That is a monumental
task, but that is what we are faced with.
We have a lot of educating to do. Get to work.
Addendum: The full Pew report represents a massive undertaking of
defining political polarization in America. It is important to
understand better this polarization if we hope to communicate our views
on a superior alternative for health care financing - a single payer
national health program (or, using malleable political rhetoric, "an
improved Medicare for all").
Political Polarization in the American Public:
I also want to thank Harvard Professor Robert Blendon for the help he
has given me in understanding political polling. Several years ago,
responding to my request to get the wording right on single payer in the
polls that Harvard and Kaiser Family Foundation were conducting, he sent
me a large package of material that amounted to a mini-course on
political polling. He convinced me how naive my view was that if we
could just phrase the poll questions appropriately, we could get a
stronger response supporting single payer and then use that to move the
political process. We may have many polls with a 60 percent favorable
response, but do we have single payer?
at 1:25 PM