Americans on Health Care Policy
3. Single-Payer Insurance
Though a majority believes the government has the responsibility to ensure the outcome of universal health care, the public leans against the idea the government should undertake a large-scale effort requiring significant tax increases. The public also leans against the idea of a full-scale single-payer government health insurance program.
However, other polls reveal that, when given more diverse options, while an overwhelming majority favors government effort to expand health insurance coverage, there is not a clear majority in favor of a truly large-scale government effort. For example, in December 1999, a Kaiser/Harvard survey found that, when asked to choose among three statements, 82% of respondents wanted government to make at least some effort to provide health insurance to more Americans. Thirty-nine percent wanted the government to "make a major effort to provide health insurance for nearly all uninsured Americans," even if it that meant a tax increase, while another 43% wanted the government to "make a limited effort Ö for some of the uninsured" [emphasis in original]. Just 11 percent wanted to "keep things the way they are now."22
A July 2000 Washington Post/Kaiser/Harvard study presented a set of questions with similar wording. First the survey asked, "Generally speaking, should the federal government work to increase the number of Americans covered by health insurance, or is this not something the federal government should be doing?" Seventy-two percent favored government action, and just 24% did not. Those who wanted the government to work to increase insurance coverage were then asked, using the same language as above, how much of an effort they preferred. Fifty-two percent (38% of all respondents) wanted the government to make a major effort even if that meant a tax increase, while 43% (31% of the total sample) wanted the government to make a limited effort that would not require a tax increase.23
Single-Payer Government Health Insurance
Consistent with the lack of majority consensus for a major government effort, there is no clear evidence of support for a single-payer plan, such as in the Canadian system. Since 1998, Kaiser/Harvard has gauged support for various ways to "guarantee health insurance for more Americans." Four times their surveys have found 47 to 58% opposing "a national health plan, financed by taxpayers, in which all Americans would get their insurance from a single government plan," while just 38 to 44% favored it. Most recent was a July 2000 poll administered along with the Washington Post in which 38% favored such a national plan but 58% opposed the idea.24
However, one recent poll, from July 1998, found that a slim majority (51%) supported "a government-run health care plan that covers everyone the same way, like the system used in Canada." In that Zogby poll, just 38% were opposed. Importantly, while the question noted that "it would be paid for through taxes," it also asserted that such a plan would "cover all necessary medical costs."25
Data from the National Election Studies archive at the University of Michigan show a public divided on the issue. Since 1970, NES has asked a variant of the following question, which asks respondents to answer on a 7-point scale, with 1 meaning a government insurance plan and 7 meaning a private insurance plan:
Some people feel there should be a government insurance plan which would cover all medical and hospital expenses for everyone. Others feel that all medical expenses should be paid by individuals and through private insurance plans like Blue Cross or some other company-paid plans. Where would you put yourself on this scale, or havenít you thought much about this?
In 1996, the most recent year for which data are readily available, the public was split, with 35% answering 1, 2 or 3 and 35% answering 5, 6 or 7. Nineteen percent gave the middling answer of 4, and 12% said they had not thought enough about it.26
Trend line questions from the late 1980s and early 1990s do show, however, majority support then for a reform explicitly based on the Canadian model single-payer system. In November 1991, a Harris poll found that more than two-thirds (68%) supported a "system of national health insurance in which the government pays most of the cost of health care for everyone out of taxes, and the government sets all fees charged by doctors and hospitals." Only 29% opposed such a system. However, the last time the question was asked Ė by the Wirthlin Group in June 1995 Ė just 48% supported the Canadian system, and 45% opposed it. Several CBS/New York Times polls from 1990-1993 found support for "national health insurance, which would be financed by tax money, paying for most forms of health care." Support peaked at 66% in July 1992, then dropped to 59% in March 1993, and the question has not been asked since.27
Focus group comments support the idea that the public is now very ambivalent about moving toward a Canadian-style system. Most say they do not know enough details of the Canadian system to have an opinion, but in almost all the responses there is a great deal of tension between the desire for universal coverage and misgivings about more government control.
As far as the Canadian model is concerned, I donít know whether thatís a good idea or not. Everything that Iíve heard about is just stories. This person has to wait too long for health care. That person is delighted with their health care. I wanted to know more about that model before I could give an informative opinion about it. (Woman, Cleveland)
I think the country is kind of confused. I think everybody agrees that [people without health insurance are] a serious problem but at the same time they donít want sort of a socialized medicine situation Ö We sort of balance the great technological opportunities we have in this culture with the idea of how much this is going to cost Ö I think itís a very important issue but at the same time there doesnít seem to be a clear consensus on what the answer should be. (Man, Richmond)
I believe everybody should have access to health care [but] I donít know if thatís really the governmentís responsibility to be paying for all of it. (Woman, Cleveland)
I think that the government should try to help to bring down the cost of health care so insurance is more affordable. I donít necessarily think that the government should be funding. I donít want the government making decisions about where I can and canít go to receive treatment and what tests I can and cannot have. (Woman, Cleveland)
We want the government to do good but we donít want the government to do too much. (Man, Richmond)
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