Medicare-for-All vs. Single Payer: The Impact of Labels

This was published as a Wall Street Journal Think Tank column on February 25, 2016.

Results from February Kaiser Family Foundation Health Tracking Poll surveying how Democrats respond to health-care proposals described as Medicare-for-all, guaranteed universal health coverage, single-payer health insurance, or socialized medicine.

Sen. Bernie Sanders describes his health-care proposal as a Medicare-for-all, single-payer plan. The plan, however, would not expand the current Medicare program but replace it, along with Medicaid, private insurance, and other programs with what might be described as a Medicare-like, government-run single-payer plan. New polling shows why Mr. Sanders’s label works well politically in the primary campaign: Among Democrats, the term “Medicare-for-all” generates a much more enthusiastic reaction than does “single-payer.” With this discussion still mostly at the stage of broad concepts and messaging, language matters.

As the chart above shows, the latest Kaiser Family Foundation health tracking poll found that 53% of Democrats were “very positive” about Medicare-for-all, compared with 21% who felt that way about a “single-payer national health-care system.” A separate 37% are “somewhat positive ” about the term “single-payer.” Medicare-for-all elicits the strongest positive reaction. About the same percentage were “very positive” about the term “socialized medicine” as single-payer. Medicare is a famously popular and well-known program, and associating any universal coverage plan with it makes that idea more popular.

The current debate about single-payer is a discussion of ideas, concepts, and terms that are generally popular with Democrats. There has been coverage in the media and discussion among some experts of the details in Sanders campaign’s outline of his single-payer plan, but a national debate about single-payer legislation–similar to the debate the country had about the Affordable Care Act–would be an entirely different animal. Major topics include how to finance such a system, who wins and who loses, and how to transition from the current system. That broader debate, of course, would engage independents and Republicans, many of whom are far less enamored of single-payer. A partisan debate would also follow should the more incremental approaches to expanding coverage further, such as those favored by former secretary of state Hillary Clinton, be on the table.

A lot remains fluid in the presidential contest. But the primary campaign so far has made clear the value of labels and messaging, whether applied to candidates (“Jeb Bush is low-energy”) or health plans (“Medicare-for-all”).


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