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Support for a public option is increasing as single payer sinks

October 15, 2019

Topics: Quote of the Day

By Lunna Lopes, Liz Hamel, Audrey Kearney, and Mollyann Brodie
KFF, October 15, 2019

Support for Medicare-for-all has narrowed in recent months, with 51% now saying they favor a national health plan and 47% opposed. At the same time, support for a public option has inched up since July, with 73% now saying they favor a government plan that would compete with private health care plans and 24% opposed.

Q: Do you favor or oppose having a national health plan, sometimes called Medicare-for-all, in which all Americans would get their insurance from a single government plan?

51% – Favor
47% – Oppose

71% – Favor
28% – Oppose

28% – Favor
61% – Oppose

51% – Favor
48% – Oppose

Q: Do you favor or oppose having a government-administered health plan, sometimes called a public option, that would compete with private health insurance plans and be available to all Americans?

73% – Favor
24% – Oppose

73% – Favor
24% – Oppose

58% – Favor
38% – Oppose

74% – Favor
24% – Oppose



By Don McCanne, M.D.

In recent years there has been increasing support for a single national health program that would cover everyone – a single payer model of Medicare for All. However, in this political season, the spinmeisters have been effective in reducing that support so that now the nation is fairly evenly divided with a majority of Democrats favoring it, a majority of Republicans opposed, and Independents are split.

The message that has gained traction is that people would like to be able to enroll in Medicare as long as they can also keep their option of choosing private health insurance, especially those plans offered by their employers. Close to three-fourths of those polled favor this approach, including well over half of the Republicans.

It does seem intuitive that the best option would be to allow anyone to enroll in Medicare if preferred, while at the same time preserving the right to enroll in a plan offered by the employer or one offered in the marketplace. You can participate in Medicare for All if you want to, but you don’t have to.

The fallacy of this argument is that the single payer model of Medicare for All is a highly efficient model that recovers half a trillion dollars in administrative waste while improving allocation of our health care resources and funding the system equitably making health care affordable for everyone. In contrast, adding another individual plan as an option to purchase, even if that plan is labeled Medicare, does not correct the profound, costly dysfunctions in our fragmented system of financing health care that leaves care unaffordable for far too many while leaving many more out of the system entirely. Thus merely being able to buy yet another plan that happens to be labeled Medicare leaves our overpriced, highly dysfunctional and extremely inefficient financing infrastructure in place, when it needs to be replaced with an efficient, effective, equitable, affordable system that takes care of all of us.

Health policy is complicated. It is important to understand the nuances since they can make the difference between personal solvency and bankruptcy, health and sickness, and even life and death. To understand the profound difference between Single Payer Medicare for All and the Medicare Public Option, it is highly recommended that you read the article in The Nation by David Himmelstein and Steffie Woolhandler (a recent Quote of the Day) and share it with as many people as possible. Everyone must understand why private commercial plans, private Medicare Advantage plans, and a Medicare public option cannot possibly repair the defects that make our health care financing system the most expensive and the most dysfunctional of all.

The Nation, “The ‘Public Option’ on Health Care Is a Poison Pill,” by David Himmelstein and Steffie Woolhandler:

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About the Commentator, Don McCanne

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Don McCanne is a retired family practitioner who dedicated the 2nd phase of his career to speaking and writing extensively on single payer and related issues. He served as Physicians for a National Health Program president in 2002 and 2003, then as Senior Health Policy Fellow. For two decades, Don wrote "Quote of the Day", a daily health policy update which inspired HJM.

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