qotd: Lessons from Kaiser poll on single payer

Kaiser Family Foundation
February 25, 2016
Kaiser Health Tracking Poll: February 2016
By Bianca DiJulio, Jamie Firth, Ashley Kirzinger, and Mollyann Brodie

The February Kaiser Health Tracking Poll asked the public about broad
options for changing the health system that are currently being
discussed and finds more Americans (36 percent) say policymakers should
build on the existing law to improve affordability and access to care
than any other option presented. Sixteen percent say they would like to
see the health care law repealed and not replaced, 13 percent say it
should be repealed and replaced with a Republican-sponsored alternative,
and 24 percent say the U.S. should establish guaranteed universal
coverage through a single government plan.

As debate continues over the idea of universal coverage through a single
government plan, the survey finds the public divided, with half saying
they favor the idea and 43 percent saying they oppose it, and some
opinions swayed after hearing counterarguments. In addition, majorities
of Democrats and independents favor the idea, compared to just 20
percent of Republicans. Most Americans think that if guaranteed
universal coverage through a single government plan was put into place,
uninsured and low-income people would be better off, but there is little
consensus among the public about how it would impact their care personally.

This month's poll also explores the public's reaction to a few terms
used to describe the idea of expanding health insurance coverage to all
Americans. Majorities say they have a positive reaction to the terms
"Medicare-for-all" and "guaranteed universal health coverage" and fewer
say the same for "single payer health insurance system" and "socialized
medicine." About half (53 percent) of Democrats say they have a very
positive reaction to "Medicare-for-all" compared with 21 percent who say
the same for "single payer health insurance system."

Next Steps for the Health Care System

While health care ranks fourth as an important voting issue,
presidential hopefuls have proposed a range of visions for the future of
the health care system, from the full repeal of the Affordable Care Act
(ACA) to the adoption of a universal government plan. The survey finds
that when given four broad approaches for the future of the health care
system that are currently being discussed, Americans opinions are split
with the largest share reporting that they favor building on the ACA and
the existing system. Overall, 36 percent say lawmakers should build on
the existing law to improve affordability and access to care, 24 percent
say the U.S. should establish guaranteed universal coverage through a
single government plan, 16 percent say they would like to see the health
care law repealed and not replaced, and 13 percent say it should be
repealed and replaced with Republican-sponsored alternative.

A closer look at views across parties shows that a third of Democrats
(33 percent) favor the idea of universal coverage through a single
government plan but more Democrats (54 percent) say they would prefer to
build on the existing health care law. A roughly similar share of
independents (26 percent) say the U.S. should establish guaranteed
universal coverage through a single government plan, and 36 percent say
lawmakers should build on the existing health care law. The majority of
Republicans (60 percent) say they would like to repeal the health care
law whether it's replaced or not, although 21 percent say they would
like to build on the existing law and 9 percent say they would like
universal coverage through a government plan.

How Malleable are Americans' Opinions of Guaranteed Health Coverage From
a Government Plan?

Although half of the public says they favor having guaranteed health
insurance coverage through a single government health plan, some can be
swayed by counterarguments made by critics. For instance, 20 percent
overall shift their opinion from favor to oppose after hearing that
guaranteed coverage through a single government plan would "require many
Americans to pay more in taxes," 20 percent say they now oppose the idea
after hearing that it would "give the government too much control over
health care," and 14 percent say they now oppose it after hearing that
it would "eliminate or replace the current health care law." On the
other side of the debate, those who originally said they opposed the
idea were also persuaded by arguments, although fewer changed their
opinions after hearing the arguments. About one in 10 changed their
stance from oppose to favor after hearing that guaranteed coverage would
"ensure that all Americans have health insurance as a basic right" (13
percent), that it would "reduce health insurance administrative costs"
(11 percent), and that it would "eliminate all private health insurance
premiums, co-pays, and deductibles paid by employers and individuals"
(11 percent).

Impact of Coverage Through Single Government Plan

Most Americans think that if guaranteed universal coverage through a
single government plan was put into place, uninsured and low-income
people would be better off (60 percent and 57 percent, respectively).
Fewer say that middle class people (34 percent) and people like them (31
percent) would be better off, which is roughly similar to the shares who
say these same groups will be worse of or not be impacted much at all.
Most (63 percent) say it would not have much impact on wealthy people,
just 14 percent say they would be better off and 18 percent say they
would be worse off. Democrats and independents are more likely than
Republicans to report that all people would be better off through a
single government plan.

The country has not had a substantial public debate about single payer
legislation recently and there is little consensus among the public
about how enacting guaranteed universal coverage through a single
government plan would impact their personal health care. Roughly four in
10 say that they think the cost, quality, availability of health care
treatments, and choice of doctors and hospitals would stay about the
same as it is under the current health care system. About a third say
these measures would get worse if universal coverage was put into place
and around two in 10 think these measures would get better. Not
surprising considering their stances on the idea of guaranteed universal
coverage, majorities of Republicans say each measure would likely get
worse if such a plan was enacted, while at least half of Democrats say
each would likely stay about the same. Additionally, those under age 50,
Black and Hispanic Americans, and those with lower incomes are more
likely than their counterparts to say that these measures will get better.

Wording Matters

Politicians and pundits use a variety of terms to describe the idea of
expanding health insurance coverage to all Americans and this month's
poll explores the public's reaction to a few of these terms. Nearly
two-thirds (64 percent) of Americans say they have a positive reaction
to the term "Medicare-for-all" and more than half (57 percent) say they
have a positive reaction to the term "guaranteed universal health
coverage." Less than half of Americans report a positive association
with the phrases "single payer health insurance system" (44 percent) and
"socialized medicine" (38 percent).

Similar to the public at large, more Democrats report having a positive
reaction to "Medicare-for-all" and "guaranteed universal health
coverage" than say the same about "socialized medicine" or "single payer
health insurance system." Additionally, more Democrats have positive
reactions to all of the terms than Republicans and independents do.
Around half of Democrats report a very positive reaction to
"Medicare-for-all" (53 percent) and "guaranteed universal health
coverage" (44 percent), while fewer Republicans say the same for each
(17 percent and 9 percent, respectively). Two in 10 Democrats report
very positive reactions to "socialized medicine" (22 percent) and
"single payer health insurance system" (21 percent), while fewer than
one in 10 Republicans do.


Topline

4. Which of the following comes closest to your view of the future of
the US health care system?

16% The health care law should be repealed and NOT replaced

13% The health care law should be repealed and replaced with a
Republican-sponsored alternative
36% Lawmakers should build on the existing health care law to
improve affordability and access to care

24% The U.S. should establish guaranteed universal coverage through
a single government plan

6% None of these/Something else

4% Don't know/refused


5. Do you favor or oppose having guaranteed health insurance coverage
in which all Americans would get their insurance through a single
government health plan?

50% Favor
27% Strongly favor
23% Somewhat favor

43% Oppose
13% Somewhat oppose
30% Strongly oppose

7% Don't know/Refused


19. I am going to read you a list of terms. Please tell me if you have
a positive or negative reaction to each term.

a. Socialized Medicine

38% Positive
15% Very positive
23% Somewhat positive

49% Negative
19% Somewhat negative
30% Very negative

12% Other

b. Medicare-for-all

64% Positive
36% Very positive
27% Somewhat positive

29% Negative
15% Somewhat negative
14% Very negative

6% Other

c. Single payer health insurance system

44% Positive
15% Very positive
29% Somewhat positive

40% Negative
21% Somewhat negative
19% Very negative

17% Other

d. Guaranteed universal health coverage

57% Positive
28% Very positive
29% Somewhat positive

38% Negative
15% Somewhat negative
22% Very negative

6% Other



Report:
http://kff.org/health-reform/poll-finding/kaiser-health-tracking-poll-february-2016/

Topline:
http://files.kff.org/attachment/topline-methodology-kaiser-health-tracking-poll-february-2016

***


Comment by Don McCanne

About half of Americans would prefer a single government health plan for
everyone, according to this poll. However, when offered several choices,
more would prefer to build on the current system (36%) than would prefer
to establish a single government plan (24%). Also, followup questions
show that the opinions of a single government plan are quite malleable,
depending whether the query has a positive or negative slant.

The malleability of opinion and the poor understanding of the benefits
of single payer demonstrate that the public still has a relatively weak
understanding of precisely what a single payer system is. We need to
intensify our educational efforts.

Perhaps more disconcerting is that more people would prefer to build on
the Affordable Care Act than to establish a single government plan. The
message of the incrementalists seems to be carrying the day. People
believe that we can simply tweak the current system and achieve the same
goals as single payer.

What people haven't grasped are the fundamental differences between the
financing infrastructures of our fragmented multi-payer system and a
well designed single payer system. Recent Quote of the Day messages
describing some of the flaws in our current system have asked the
question, "What incremental change would fix this particular problem?"
The answers don't come easy.

It's easy to say that we can build on the Affordable Care Act by
gradually covering more people and by controlling spending by
eliminating waste, but these are wishes, not policies. In most
instances, there is no simple patch that would work, but rather most
changes increase the administrative complexity, add significantly to the
costs, and fall short of fully correcting the specific problems addressed.

This is a very important message that we have to deliver. Our current
financing infrastructure is not particularly amenable to incremental
patches. It is imperative that we replace our flawed infrastructure with
one that automatically addresses the problems that we still face in
health care financing. Single payer would do that.

This poll also tested labels for a single payer system. Close to
two-thirds had a positive reaction to the term, "Medicare-for-all."
People also had a positive reaction to "guaranteed universal health
coverage," but that doesn't mean much and has been misused as a label
for systems that are neither guaranteed nor universal. Yet people seem
to be split or confused by the term, "single payer health insurance system."

"Medicare-for-all" does seem to be preferred, but some opponents are
quick to point out the deficiencies in our Medicare program. Adding
"improved," as in "Improved Medicare for All," defuses that challenge.

So do not let people get away with saying that we'll simply build on the
system we have. Demand that they define the precise incremental steps
and how each would move us significantly closer to truly affordable care
for absolutely everyone. If you keep pushing them they'll eventually
have to describe a single payer system because patches to our current
system just won't get us there.