Democratic Voters Don't Actually Understand 'Medicare For All,' New Report Says

They have some pretty important misconceptions, though the political implications aren't clear.

A new poll about “Medicare for All” should make you think twice before trusting polls on Medicare for All.

Yes, that sounds a little weird. But it’s the biggest takeaway from the new survey, one designed specifically to measure the public’s understanding of how Medicare for All would actually work.

It turns out that a lot of people don’t really get it.

That lack of awareness could have big implications for the debate over Medicare for All, an idea that has already figured prominently in the Democratic 2020 presidential primaries and is sure to get attention at next week’s candidate debates in Miami.

Of course, figuring out exactly what those implications are isn’t easy. It’s possible that, as people learn more about Medicare for All, some supporters will get skittish. Or that some skeptics will get more enthusiastic. Or both.

A lot depends on how the debate unfolds and, ultimately, whether proponents or opponents are more successful at getting their messages across to the public.

But this much is clear: Opinion about Medicare for All isn’t at all fixed.

The Public Misconceptions Cut Both Ways

Medicare for All is the catchphrase for a policy proposal that would enroll all Americans into a new, government-run health insurance program.

Ever since Bernie Sanders, the independent Vermont senator, made Medicare for All a cornerstone of his 2016 presidential campaign agenda, support for the idea has become something of a litmus test for progressives. He’s running on Medicare for All again this year, and this time he has a lot more company, with nearly a dozen other Democratic presidential candidates claiming that they support the idea too.

It’s safe to assume these Democratic candidates wouldn’t be so openly enthusiastic about Medicare for All if surveys hadn’t shown the concept to be so popular with voters in general and with Democratic voters in particular. But, according to a new telephone poll that the Henry J. Kaiser Family Foundation published Tuesday morning, many of those voters seem to think that Medicare for All would do things it wouldn’t ― or, more precisely, that it wouldn’t do things it would.

Sen. Bernie Sanders is Medicare for All's best known proponent, and he has been upfront about what it would mean for private insurance.
Sen. Bernie Sanders is Medicare for All's best known proponent, and he has been upfront about what it would mean for private insurance.
Sarah Silbiger via Getty Images

That’s especially true when it comes to the future role of private insurance. Two-thirds of Democratic voters think that people with employer coverage could hold on to their policies under Medicare for All, according to the Kaiser study, which used a nationally representative sample of more than 1,200 adults.

In reality, both the Sanders proposal and its House counterpart, from Rep. Pramila Jayapal (D-Wash.), would prohibit the sale of private insurance that is “duplicative” of what the new government plan would offer.

That would effectively wipe out existing employer policies. Private insurers could still offer supplemental plans, but only to pay for extras, like cosmetic surgery and premium hospital rooms, that the government plan didn’t cover.

Veterans of past health care policy fights, including many sympathetic to Medicare for All in principle, have warned about this kind of disruption and its potential to alienate voters ― especially with Republicans and with advocacy groups that represent the health care industry already making a big issue out of it.

Awareness of those dangers undoubtedly helps explain why some Democratic candidates, including Sens. Kamala Harris of California and Elizabeth Warren of Massachusetts, have made it clear they would support incremental steps toward Medicare for All ― while others, including former Congressman Beto O’Rourke of Texas and Mayor Pete Buttigieg of South Bend, Indiana, have said they prefer starting with an alternative to Medicare for All that would preserve a role for employer coverage.

Other Democrats have declined to endorse Medicare for All, even in principle. That group includes Joe Biden, the former vice president. He has said he supports the creation of a government-run insurance program open to all, but he would stop short of getting rid of existing arrangements.

But the voters’ lack of awareness about Medicare for All extends to some of its benefits.

A key selling point of the Sanders and Jayapal proposals is that they would eliminate out-of-pocket expenses. Copayments, coinsurance, deductibles ― they’d all go away, so health care would be literally free at the point of service.

That could make Medicare for All a lot more appealing to the growing number of people with “good” insurance who struggle with out-of-pocket costs. In some extreme cases, people are literally begging for help on GoFundMe pages in order to pay their bills and get medical care they or their loved ones need.

The ability to wipe out out-of-pocket costs is an advantage of Medicare for All that rival plans, as written, would not have. In all of them, some people would still have out-of-pocket costs, sometimes significant ones, although the most ambitious among them, a proposal called “Medicare for America,” would at least prohibit deductibles and have exemptions for people at lower incomes.

People Are Just Starting To Make The Issue Personal

The lack of understanding about Medicare for All is consistent with some other recent polls, including a new online survey from Navigator Research in which a majority of respondents and a large majority of Democrats failed to realize that Medicare for All would effectively wipe out existing private coverage.

The confusion also showed up in a series of six focus groups that the Kaiser Foundation conducted in Florida, Texas and Pennsylvania, according to Liz Hamel, the foundation’s director of public opinion and survey research.

“I don’t think people are familiar even with the basic details,” she told HuffPost.

She said, for example, that many respondents assumed Medicare for All meant simply allowing people to enroll in the existing Medicare program, which has substantial out-of-pocket costs. That is one reason many people assumed that, under Medicare for All, people would still be on the hook for co-pays and deductibles.

Opinion about Medicare for All frequently reflects partisan leanings, Hamel said, which likely has something to do with the fact that health care is so complicated. Unable to figure out the details of a plan, voters will listen to and then repeat what their favorite politicians say.

But in the focus groups, Hamel said, it was clear that people were beginning to think through what Medicare for All would mean for them personally, for better or worse. Among those who have insurance they like, Hamel explained, the participants were asking questions about “what would happen to my quality of care, my access to care … you could see inklings of that starting.”

At the same time, Hamel said, Medicare for All seemed appealing to people who had lousy insurance already ― and even some with employer coverage who had become frustrated with the hassle of getting bills paid. “While some sort of looked at the proposal and said, wow, this is complicated, some said, gee, if this could really simplify things for me, that would be great,” Hamel said.

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