A new KFF Health Tracking Poll helps explain why Medicare for All is gaining political traction.
Six in 10 voters said they were worried about affording healthcare. Health costs tied gasoline and other transportation costs as voters’ leading economic concern, exceeding worries about food, utilities and housing. Two-thirds of adults (66%) said they favor Medicare for All — the highest level of support KFF has recorded.
That should not be dismissed. The country’s mixture of government programs, employer-sponsored insurance, private coverage and third-party payment has failed too many patients, employers and taxpayers.
People all over the political map now see that the Affordable Care Act is not answering healthcare affordability problems. It expanded insurance coverage, but it did not solve the underlying cost of care. Premiums and medical bills continue to rise, while patients encounter restrictions on care their doctors recommend. Some of that reflects an uncomfortable reality that healthcare costs money, and valuable medical advances are arriving as the population ages.
Thankfully, KFF also tested what happens when people hear more than a bumper sticker.
When respondents were told Medicare for All could produce delays in medical tests and treatments, 76% opposed it. Sixty-four percent opposed it when told it could require higher taxes. Sixty-one percent opposed it when told it could threaten the current Medicare program. Support moved in the other direction when respondents heard the arguments made by supporters: 76% favored the proposal when told it would guarantee health insurance as a right, and 75% favored it when told it would eliminate premiums and cost-sharing.
In other words, people like guaranteed benefits. They do not like taxes, waiting or scarcity. Unfortunately, a healthcare system cannot be built from only the popular half of that equation.
U.S. Rep. Pramila Jayapal, D-Wash., boasted at the Oct. 7 Washington Health Policy Commons, where I also spoke, that all innovation comes out of Washington state’s 7th Congressional District. She was talking about the Medicare for All Act she’s introduced, which has attracted at least 117 House cosponsors. Once fully implemented, it would establish a national government health insurance program covering hospital services, primary care, behavioral care, prescription drugs, dental care, vision, hearing and long-term services and supports and more, without premiums, deductibles, coinsurance or copays for covered services.
It sounds wonderful because the costs and constraints have been edited out of the sales brochure. As Jayapal said in 2019, "The question is not about how we pay for it. The question is where is the will to ensure that every American has the healthcare they deserve."
Eliminating premiums and copays does not eliminate costs. It shifts them into federal budgets and requires taxes. The idea faces the same challenge the ongoing push for taxpayer-financed healthcare does in our state.
Under the representative's version of Medicare for All, after a two-year transition period, private insurers and employers could not offer coverage duplicating the government program’s benefits, although they could offer coverage for additional benefits the program did not cover. Hospitals and other institutional providers would be paid through annual global budgets negotiated with regional federal officials.
Medicare for All would change who pays providers and how institutions receive their money. Changing the payer does not, however, by itself, lower the underlying cost of delivering care. It does not create more people who contribute to healthcare spending. Nor does it create the doctors, nurses, medical assistants, behavioral-health professionals and other workers needed to provide everything the program promises.
Washington already has serious healthcare workforce shortages, particularly in rural areas. Expanding coverage, eliminating cost-sharing or creating a new public financing system could increase demand for services. If the workforce does not increase with it, patients may have an insurance card but struggle to obtain an appointment.
Washington state’s lawmakers should be looking broadly at ways to expand the supply of care. The state should consider universal license recognition, sensible scope-of-practice reform, expanded training and apprenticeship pathways, incentives for people entering high-need health professions, fewer unnecessary administrative burdens, greater use of telehealth and more room for direct primary care.
I spoke at the conference about one piece of that puzzle: making it easier for qualified professionals licensed elsewhere to work in Washington state. See my policy paper about the proposal here.
Promising everything for nothing doesn’t math
Medicare for All promises everyone a remarkably comprehensive package of services and places responsibility largely in federal hands. Centralizing payment and decision-making is not the way to bring more freedom and choice in healthcare. More competition, more healthcare workers and fewer unnecessary regulations and mandates would move us in the right direction. So would reducing our dependence on third-party payment for routine care and giving patients greater control over healthcare dollars.
There is danger in transferring even more healthcare decisions away from patients and providers. When public resources prove insufficient to meet public expectations, the government will decide what will be paid for, how much providers will receive and how quickly patients can obtain treatment — if they can obtain treatment.
Washingtonians, and all Americans, are right to demand something better than the system we have now. But dissatisfaction with the status quo is not evidence that Medicare for All will be better.
