Rampell: The appeal of ‘Medicare for all’


Despite the rise of the tea party and unified Republican control of government, one decidedly anti-free-market idea appears ascendant: single-payer health care.

And it’s no wonder, given that a record-high share of the population receives government-provided health insurance. As a country, we’ve long since acquiesced to the idea that Uncle Sam should give insurance to the elderly, veterans, people with disabilities, poor adults, poor kids, pregnant women and the lower middle class.

Many Americans are asking: Why not the rest of us, too?

A recent survey from the Economist/YouGov found that a majority of Americans support “expanding Medicare to provide health insurance to every American.” Similarly, a poll from Morning Consult/Politico showed that a plurality of voters support “a single-payer health care system, where all Americans would get their health insurance from one government plan.”

Divining the longer-term trend in attitudes is difficult, as the way survey questions on the topic are asked has changed over time. Calling it “Medicare for all,” for example, generally elicits much stronger approval, while emphasizing the word “government” tends to depress support.

But some survey questions that have remained consistent in recent years show support has been rising for the broader idea that the federal government bears responsibility for making sure all Americans have coverage.

Since 1987, the share of Americans who receive some sort of public insurance has roughly doubled, to about 4 in 10 as of 2015. That’s not counting the people who receive subsidies to buy private insurance on the Affordable Care Act exchanges.

Expansions of government coverage have been cheered by many liberals, but they also have bred suspicion and jealousy.

In both the recent YouGov and Morning Consult polls, the age group most opposed to single-payer was the only one that basically already has it: those 65 and up. In other words, single-payer for me but not for thee.

Seniors are probably worried that expanding coverage to more Americans could put their own generous benefits at risk.

Many of those outside the growing pool of public-insurance beneficiaries, on the other hand, have become resentful of the fact that everyone else seems to be getting a big fat government handout. Or so they perceive.

Often what Trump voters say they want is not a return to pre-Obamacare days; rather, they want in on the great insurance deal that they think their lazy, less-deserving neighbors are getting.

In fact, that recent YouGov poll found that 40 percent of Trump voters support Medicare for all. Among Republicans overall, the share rises to 46 percent.

Among politicians, attitudes are somewhat different.

Expansion costs a lot, which doesn’t exactly jibe with the GOP’s tax-cutting agenda. House Speaker Paul Ryan, R-Wis., and his compatriots seem to further believe — despite all evidence to the contrary — that the private sector is on the verge of some innovation that will magically reduce costs and give all Americans the coverage and care they yearn for.

But even Democrats don’t have the stomach for the battle required to replace our system with single-payer. Which is understandable — while I also favor universal health-insurance coverage, I’m skeptical it will be achieved through single-payer, given both the state of our political process and Americans’ cultural allergy to tax hikes.

Even so, somewhere out there, Bernie Sanders is smiling.



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