Health care has proven to be an early flashpoint in the Democratic presidential primary, as progressives champion a single-payer, “Medicare for All” program and centrists favor reforms to the Affordable Care Act.
If the findings from the Henry J. Kaiser Family Foundation’s health tracking poll published Tuesday are any indication, the less-ambitious plans from candidates like former Vice President Joe Biden and Sen. Kamala Harris (D-Calif.) may be on to something.
First, the poll makes clear why health care has featured so prominently in the primary campaign: 83% of Democratic voters view the issue as “very important,” more than any other issue, including climate change (76%) and immigration (69%).
And while 72% of Democratic voters told the pollsters this month that they support Medicare for All, that’s down from 80% in April. But when asked to choose between Medicare for All and proposals that augment the Affordable Care Act, 36% of Democrats chose Medicare for All and 57% preferred plans that build upon Obamacare.
That’s key to understanding the intra-party debate about how to approach health care reform.
Sen. Bernie Sanders (I-Vt.) and other backers of single-payer, Medicare for All plans maintain that eliminating the for-profit health insurance industry and guaranteeing all U.S. residents generous, lifelong health coverage is the best and most equitable way to ensure that everyone has access to doctors, hospitals, and prescription drugs at minimal out-of-pocket cost.
To achieve this result, these plans would require everyone in the United States to give up their current sources of coverage, whether it’s private health insurance purchased on the exchanges set up by the Affordable Care Act, job-based health benefits or already-existing government programs like Medicare and Medicaid.
Biden, Harris, and other Democrats who are fearful that this disruption would anger the public — and who are also more accepting of the profit-seeking nature of the health care industry — have introduced policies that would leave most of the system untouched, while also creating a public option health care plan that would compete with private insurers.
To Medicare for All supporters, these compromise plans are inadequate because they retain too much of the status quo, in which even Americans who have health insurance struggle to pay for medical expenses.
To most Democratic voters, however, this public-private hybrid enjoys strong support, the poll shows: 85% of respondents support a public option.
As other surveys have shown over the years, support for single-payer health care and for the public option is malleable and can vary depending on how questions are asked and what arguments for or against are included.
For example, in earlier Kaiser Family Foundation polls, 65% of Democrats, Republicans and independents combined said they favor a public option. That support rose to 75% when respondents were told the program could save money, but fell to 53% when respondents were told the public option would reduce how much doctors and hospitals are paid.
Another worrisome sign for proponents of Medicare for All is that Americans, despite the many documented shortcomings of private health insurance, continue to rate it positively.
Among Democrats surveyed, 68% have favorable views of job-based private health insurance, which is the most common form of coverage for working-age adults and their dependents. Support for private insurance from the exchanges is lower among Democrats at 47%. Notably, Medicaid and Medicare are the highest-rated forms of insurance, with 85% and 84% (respectively) of Democrats having favorable views of the programs.
Whichever approach to health care reform ― and whichever candidate ― ultimately prevails, one thing is clear: Democratic candidates and voters alike agree the American health care system is flawed, and the government should play a big role in fixing it.