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Americans agree on reforming health care but undecided on how

February 14, 2020

Topics: Quote of the Day

Public Agenda, February 5, 2020

The main findings from this research are:

1. Americans across political affiliations are calling for substantial changes to the health care system, including those who are satisfied with their current insurance.

2. Americans across the political spectrum share many of the same goals for health care, beginning with making it more affordable for ordinary people — perhaps because half of Americans have experienced serious financial difficulties due to health care or know someone who has. Other important shared goals include covering pre-existing conditions and covering long-term care.

3. The survey asked people to consider four approaches to health care reform. Of those, a public option-type plan is supported by a majority of Democrats while Republicans are split on it. A Medicare for All-type plan is also popular with Democrats but opposed by most Republicans. A market-based approach appeals to about half of Republicans and a plurality of Democrats. Giving states more responsibility for health care garners the least support overall.

4. As people grapple with the four approaches, common ground on protecting people with pre-existing conditions emerges strongly. Democrats are more comfortable with using tax increases to fund health care and with a larger role for the federal government than Republicans are, while Republicans particularly value consumer choice.

The data also suggest that the opinions of many Americans on health care are not set in stone. A quarter of Americans say they do not yet know enough to have an opinion about the various plans tested in this survey. Furthermore, we found that people themselves say that their support for various health care reform plans may change as they consider the implications of those plans. This signals substantial room for people’s views to evolve as they learn and deliberate, suggesting a crucial role for the news media in bringing forth the best evidence on what works to achieve America’s shared health care goals.


As you may know, there are several proposals to make changes to the nation’s health care system. In general, which of the following comes closest to your opinion about the country’s current health care system overall?

Make major changes or redesign it completely
60 – Republican
64 – Democrat
65 – Independent

In order to improve health care in the United States, how important are the following to you?

Lowering the cost of prescription drugs
91 – Republican
98 – Democrat
96 – Independent

Improving the quality of health care
83 – Republican
95 – Democrat
90 – Independent

Making sure all Americans have health insurance coverage
72 – Republican
95 – Democrat
83 – Independent

Making sure all communities have access to enough doctors and hospitals
89 – Republican
97 – Democrat
93 – Independent

Covering treatment for mental health and addiction services
82 – Republican
98 – Democrat
88 – Independent

Covering long-term care for the elderly and disabled
91 – Republican
98 – Democrat
94 – Independent

Making sure people with pre-existing medical conditions can get affordable health insurance
90 – Republican
98 – Democrat
95 – Independent

Making health care more affordable for ordinary Americans
92 – Republican
98 – Democrat
97 – Independent

Making sure that lower-income people have about the same quality of basic care as higher-income people
84 – Republican
97 – Democrat
87 – Independent

One idea would create a new federal health insurance program that gives people a new option beyond what’s currently available in the private insurance marketplace. Any adult could buy into the program on a sliding scale (those with less money pay less, those with more money pay more).
Which of the following comes closest to how you feel about this idea?

I would support it or probably support it
37 – Republican
61 – Democrat
46 – Independent

Another idea would create a single federal health insurance program that automatically covers all Americans, replacing all private and employer-provided insurance. This program would be completely free for individuals and families; instead, it would be paid for through taxes.

I would support it or probably support it
22 – Republican
65 – Democrat
38 – Independent

Another idea would use tax incentives to encourage people to save money for their health needs. It would also require doctors and hospitals to post prices clearly so people can shop for the best deal, and it would deregulate insurance companies to spur development of new, low-cost options like short-term, minimal-coverage, or high deductible policies.

I would support it or probably support it
55 – Republican
41 – Democrat
51 – Independent

Another idea would shift more responsibility, resources and authority for health care reform from the federal government to the states. State policymakers could then decide on the reforms that would make the most sense for their residents.

I would support it or probably support it
46 – Republican
37 – Democrat
34 – Independent




By Don McCanne, M.D.

This survey provides very convincing evidence that Americans across the political spectrum are in strong agreement that our health care system needs changes. They agree especially on making care more affordable, making sure all Americans have health insurance coverage, lowering the cost of prescription drugs, ensuring access to doctors and hospitals, covering mental health and addiction services, covering long-term care, guaranteeing coverage for pre-existing disorders, and making sure that lower-income people have the same quality of basic care as higher-income people.

In contrast, of four basic models of reform – public option, national single payer, private consumer-driven health care, and state-based reform – there is no uniform support across the political spectrum. The strongest support is that 65 percent of Democrats support national single payer. Also, 61 percent of Democrats support a public option, while 55 percent of Republicans and 51 percent of Independents support consumer-driven health care.

There is a problem with these numbers. Though there is a division on which model of reform should be supported, there is only one model that would achieve the specific reform on which there is very strong agreement. That model, of course, is single payer. Single payer could also be established at the state level with enabling federal legislation, but state solutions have the weakest support.

About one-fourth of respondents indicated that they did not have enough information to make a decision on these models (Topline link above). Many indicated that they could change their mind based on various potential policy impacts. Also there is the perennial problem that people may know what they know, but they frequently do not know what they don’t know, and that is especially true when considering the complexities of health policy.

The public does need to be better informed on policies that would actually work to bring us the high performance health care system that they desire. Our task is made more difficult in this day in which obfuscation and deception have seemed to become the norm for the opponents of health care justice for all. We need a fact-based national dialogue on reform, and we need it now. Otherwise we’re in for more of the same.

Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.

About the Commentator, Don McCanne

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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