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Public Education Needed on the Advantages of Public Insurance

February 11, 2023

Summary: US adults are fed up with health insurance costs and coverage, eager for real reform. Most favor a government guarantee of coverage, and a plurality (38%) support single payer. Yet 53% prefer a system of private insurance, despite its failings. We need to further educate the public.

The Challenge of Healthcare Reform
January 27, 2023
By Frank Newport

Gallup data show that Americans’ current ratings of their personal healthcare situations are on the positive side of the majority line, including a 72% excellent or good rating for personal healthcare quality, a 66% excellent or good rating for personal healthcare coverage, and 56% who are satisfied with personal healthcare costs.

Americans are clearly more negative when asked about healthcare “out there” across the country. For example, 76% of Americans are dissatisfied with the cost of healthcare in the U.S.; only 32% rate healthcare coverage in the U.S. as excellent or good; and the new low of 48% of Americans rate the quality of healthcare in the country positively.

One seemingly simple solution for healthcare problems is the single-payer, “Medicare for All” program advanced by such leaders as Sen. Bernie Sanders. We don’t find strong support for this remedy from the public, although the public’s attitudes are complex (and interesting to study).

A 57% majority of U.S. adults believe that the federal government should ensure all Americans have healthcare coverage. Yet nearly as many, 53%, prefer that the U.S. healthcare system be based on private insurance rather than run by the government.

Putting responses to these two questions together, we find that only 38% of Americans adopt the position Sanders espouses — that the government’s role is to ensure that everyone has healthcare coverage and that the government should run the system. Another 35% of Americans adopt the opposite views, believing both that the nation should use a private insurance system and that it is not the government’s role to ensure healthcare for all to begin with. And 18% of Americans believe that the government should ensure that everyone has insurance, but that this should be accomplished through private insurance, not a government-run system.

The takeaway here: The majority of Americans recognize that government has a role in expanding health insurance coverage, but many are ambivalent about fulfilling that role with a government-run system.

Comment by: Don McCanne

The Gallup data confirms that Americans are increasingly concerned with cost and coverage of healthcare in the nation, though they rate their own personal situation more positively than they do for the nation generally. This lack of pressing personal concern combined with everyone’s concern about taxes likely explains why many are reluctant to support comprehensive healthcare reform at this time.

Another important finding confirmed here is that there is a clear preference for the insurance system to be run by the private sector rather than by the government. This probably represents a relative satisfaction with employer-sponsored plans, contrasted with problems with Medicaid and some other safety net health programs, as well as other experiences with government bureaucracies. This is heavily reinforced with positive marketing campaigns from the private industry and negative propaganda campaigns from right-wing advocacy organizations.

This preference for private plans would be very unlikely if the public at large truly understood the clear advantages of a well-designed single payer system over a market of private plans: universal, comprehensive, accessible, affordable, equitable, high quality health care for everyone. Indeed poll questions that describe single payer’s universal comprehensive coverage with lower costs often yield 2/3 support.

We’ve long said that we need to educate the public on these advantages. We’ve also been trying to educate them on the deficiencies of the private plans (medical debt and bankruptcies are now growing rapidly amongst the privately insured!). Even our President doesn’t get the message. Frank Newport writes, “The Joe Biden administration certainly feels the ACA has been a success,” when we have the most expensive system that barely qualifies as being mediocre.

There is a message here. We have to become much more effective at delivering it.

Response from Kip Sullivan:

I want to call attention to bias in the question Gallup asked. Pollsters frequently confuse respondents by asking how they feel about “government-run health care” or similar, rather than a more accurate phrase such as “government insurance like Medicare.” I tried to download the questions Gallup asked and was allowed to see only one. Here it is:

Which of the following approaches for providing healthcare in the United States would you prefer? * Government-run health systems * System based mostly on private insurance. 

Single-payer bills would not, as we all know, require the “government to provide health care.”

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