Is single-payer healthcare just around the corner? Highly unlikely, says Geoff Manville in his 2019 legislative outlook. But you can expect to hear a lot about the topic, with “Medicare-for-All” now a litmus test for Democratic 2020 presidential candidates.
The current proposals range from Medicare-for-all programs to a Medicare buy-in option for older Americans. Some Medicare-for-all proposals would eliminate private and employer-sponsored coverage and provide public healthcare coverage to all Americans, but they come with a hefty tax increase (estimates project Sen. Sanders’s bill to cost $32 trillion over 10 years). The majority of the current proposals stop short of providing coverage to all Americans. Instead they retain some form of employer-sponsored healthcare coverage and would require public plan enrollees to pay premiums. The government would regulate healthcare prices under all of the proposals.
What Americans think about Medicare-for-all depends on how much they know. In a January Kaiser Family Foundation Health Tracking Poll, 56% of the pubic favors a Medicare-for-all plan. But those views shifted significantly after learning more about the proposal. Favorability swings up to 71% when people hear this plan would guarantee health insurance as a right for all Americans. Favorability drops to 37% when people find out the proposal would eliminate private health insurance, including employer-sponsored coverage, and drops to 26% when told it would lead to delays in getting medical tests and treatment.
A poll conducted last year by the insurance trade group America’s Health Insurance Plans showed that 71% of Americans are satisfied with their current employer-provided coverage.
Whether single-payer will be a winning strategy for the Democrats remains to be seen. The KFF poll shows Democratic support has dropped since March 2018, showing how hard it will be for Democrats to sell the universal coverage plan demanded by the left wing of the party while appealing to a broader electorate with deep concerns about proposals that abolish private healthcare coverage. Instead, 51% percent of Democrats say they would prefer Congress focus on improving and protecting the ACA.