In the midst of a crowded Democratic primary field, one of the most complex and contentious issues at play are the candidates’ positions on the future of American health care, and a new study by insuranceQuotes shows that public sentiment is divided and slightly perplexed.
According to this year’s annual State of Healthcare and Politics report, which was conducted via telephone in September, 62 percent of Americans “most strongly support” a U.S. healthcare system that includes both public and private insurance, while 25 percent favor a Medicare for All system that ends private insurance altogether and just 9 percent favor a system that includes only private insurance.
These figures come on the heels of the October 15 Democratic primary debate, wherein Sens. Elizabeth Warren, Massachusetts Democrat, and Bernie Sanders, Vermont Independent, continued to pitch and defend their plans for universal Medicare — and the eventual elimination of private health insurance — while other candidates made more nuanced appeals to the notion of combining public and private health insurance options for Americans in the future.
What’s more, the insuranceQuotes study complements sentiments expressed in other polls surrounding this topic, where support for Medicare for All seems to be waning. For instance, a recent survey conducted by the Kaiser Family Foundation found that 51 percent of Americans back Warren and Sanders’ Medicare for All proposals, which is down 5 percentage points since their last survey in April.
The insuranceQuotes survey, which tracked responses from 1,009 respondents, generated these additional takeaways on Americans’ outlook on healthcare-related issues.
- 58 percent believe that undocumented immigrants should have insurance access, while 39 percent believe they should not.
- 50 percent of Americans say that since President Trump took office, the U.S. healthcare system has stayed about the same in quality, while 28 percent say worse and 18 percent say better.
- 43 percent assert that Medicare is at risk of going bankrupt in the future, while 43 percent assert that it is not.
- 34 percent are unaware that Obamacare is still in effect.
The future of U.S. health care will undoubtably feature prominently in the 2020 presidential election, so what do these figures tell us about the pulse of American sentiment regarding key health insurance matters?
Public, private or health care combo?
In the days following the October Democratic primary debate, a great deal of time and energy was spent parsing the potential viability — and messaging strength — of both Sanders’ and Warren’s respective plans to eliminate private health insurance in lieu of a Medicare for All nationwide insurance plan. And while the insuranceQuotes survey shows 25 percent of respondents support this approach, the vast majority — 62 percent — favor a mixture of public and private insurance.
According to Dr. Tarek Hassanein, professor of medicine at University of California San Diego’s School of Medicine, the survey data supports the broader perspective Americans have about wanting a more incremental approach to health insurance reform.
“We cannot go from private insurance to totally government-based insurance, knowing our attitudes toward government-run activities,” Hassanein says. “The idea that we will have both available makes a lot of sense, and it keeps public insurance competing with private.”
What’s more, Hassanein believes there are age demographic differences at play in assessing this particular point, and that voters understand the competitive value in allowing both private and public health insurance to coexist.
“If you have young people voting, they will vote on public, not private. The older people who really need care will go with the private insurance — or a mixture,” Hassanein says. “They are really seeking the services. The combination lets them choose according to their needs and financial abilities. I think competition is the future — you need the public and the private at the same time so you can control the expense. The private will never increase their rates if the public is giving a good service with public rates.”
But according to Harvard health economist and epidemiologist Eric Feigl-Ding, it’s difficult to extrapolate too much from polling data about this issue because Americans are generally underinformed when it comes to the complex nuances of something like Medicare.
“If you talk to someone under the age of 60, I guarantee you they know almost nothing about Medicare. It’s incredibly complicated and comprehensive,” says Feigl-Ding. “And I don’t blame them. You have 12 [Democratic primary candidates] up on stage and they don’t have time to go into detail. And they don’t want to lose people so they keep things as generic and vague as possible. But that doesn’t actually educate the public in a meaningful way.”
As a result, Feigl-Ding says that polling Americans about their feelings toward Medicare for All is like asking, “Do you want to live on Mars?”
“The average person doesn’t know anything about Mars and its air pressure, its average temperatures, or the magnetic shielding that makes it impossible to grow crops on the surface,” says Feigl-Ding. “And Medicare is like Mars to anyone under the age of 60. People just don’t know about the complexities.”
Nonetheless, Feigl-Ding says the insuranceQuotes study reveals two interesting things about public sentiment: First, that people want incremental change. And, secondly, that they really don’t trust the private health insurance sector.
“When you have 62 percent saying they favor a combination of private insurance and Medicare for All, that shows how people don’t want to move the needle too much. They want to move it a little but also stay with what’s familiar,” says Feigl-Ding. “The fact that only 9 percent said they’d favor a completely private system tells me that people have had really bad experiences with for-profit health insurance companies. They simply don’t trust them.”
Health insurance for undocumented immigrants
According to the insuranceQuotes study, 58 percent of Americans believe that undocumented immigrants should have health insurance access, while 39 percent believe they should not, and Feigl-Ding says this reflects a growing understanding that a healthy American immigrant population is always going to be better for the country at large.
“Putting aside the human rights issues here, this is all about productivity,” says Feigl-Ding. “People get sick regardless of their immigration status. And there are a lot of jobs being held by undocumented workers in this country. Do we really want them getting sick and going to the ER or not having the means to vaccinate themselves or their children? In this instance I think an ounce of prevention is worth a pound of cure, and people should support health insurance for these immigrants. It’s better for the country on the whole.”
For Hassanein, this issue hits close to home. Earlier this month he hosted a free health event in Chula Vista, a border town south of San Diego, allowing immigrants—documented or not—to receive free health scans and interact with insurance experts to understand the system. He says that “the system has to deal with their health issues, no matter what their status.
“The bottom line is that they need to have [health insurance],” says Hassanein. “They need vaccinations so they don’t get infected and infect other people. Pregnant people need to get the care they need. There are consequences if you deny them. Everyone needs basic insurance.”
Current state of Medicare and the Affordable Care Act
When it comes to the financial viability of Medicare, survey respondents were equally divided, with 43 percent asserting that Medicare is “at risk of going bankrupt in the future,” while 43 percent assert that it is not.
According to Feigl-Ding, this too comes down to faulty or incomplete information.
“Healthcare costs are skyrocketing out of control, yes, but Medicare can’t go bankrupt,” says Feigl-Ding. “Medicare is a non-discretionary budget item, which means the U.S. government has to fund it, and it can issue as much debt as it needs to. Could the U.S. theoretically default on its debt? Sure, but it never has and I don’t think there’s a risk of that happening any time soon.”
When it comes to the state of healthcare more generally — and the Affordable Care Act more specifically — this is where experts are a little more concerned.
According to the insuranceQuotes study, 50 percent of Americans say that since President Trump took office, the U.S. healthcare system has stayed about the same in quality, while 28 percent say it’s worse, and 18 percent say it’s better. What’s more, 34 percent are unaware that the Affordable Care Act (aka Obamacare) is still in effect.
“I think these two issues are related,” says Feigl-Ding. “The Trump administration has done everything it can to kick as many legs out from under the Affordable Care Act as possible. For instance, they don’t advertise for open enrollment anymore. And they eliminated the tax penalty for not having health insurance, so while there’s still a law saying you need health insurance there’s no penalty for not having it.
"As a result, you don’t have the risk pool of young, healthy people participating, which means premiums and deductibles are increasing while choices are decreasing. So I think this study reflects people’s frustration, but I’m not sure enough people actually know the source of why this is happening.”
Similarly, Hassanein blames people’s confusion about the Affordable Care Act (ACA) on the divisive political rhetoric that’s been injected into this conversation over the past three years.
“First, let’s not call it Obamacare. It’s called the Affordable Care Act. People think these two are different things, I’m sure of that,” says Hassanein. “The public thinks Obamacare was cancelled. It’s just political rhetoric. There is very little truth being told. The ACA is still in place! But the government is saying we will not fund it anymore so insurance companies are trying to save as much money as possible and thus are trying to pay for as little as possible. The rhetoric is helping the insurance companies. This affects the lives of all the people. And it’s a shame.”