Jan 30, 2019
David Leonhardt of the New York Times has highlighted a survey from the Kaiser Family Foundation that, if true, would suggest that Medicare for All is not nearly as popular as initial polling would suggest. Based on this survey's results, Leonhardt concludes that Democrats who support the idea are committing an "unforced error."
Unfortunately, that survey is deeply misleading. While pollsters made it clear that they were merely presenting "some arguments some people have made for or against a national Medicare-for-all plan," they only presented partial arguments in favor of Medicare for All while presenting deeply deceptive arguments against it. Their questions almost certainly skewed the results.
The poll finds that 56 percent of voters surveyed initially support "Medicare for All" and 42 percent oppose it, for a net favorability rating of +14 percent. When arguments in favor of Medicare for All are presented--it will guarantee coverage to all Americans and reduce out-of-pocket costs--net favorability rises to +45 percent. (KFF does not provide the raw numbers here.)
Support reportedly falls dramatically when people hear arguments against the program. The problem, however, is in the presentation.
The pros, as presented, are understated. Medicare for All would not "reduce" out-of-pocket costs. It would eliminate them for all medical interventions, including hospitalization, surgery, pharmaceuticals, medical devices, and doctor visits.
The pros, as presented, are understated. Medicare for All would not "reduce" out-of-pocket costs. It would eliminate them for all medical interventions, including hospitalization, surgery, pharmaceuticals, medical devices, and doctor visits. The use of "reduce" suggests that any out-of-pocket savings would be marginal at best, which is not true.
The KFF survey told respondents that Medicare for All would "require most Americans to pay more in taxes." It did tell them that health insurance premiums would be eliminated, but failed to explain that the vast majority of families would pay considerably less in taxes than they currently pay in premiums and out-of-pocket costs. Many working Americans with employer-based insurance are unaware of how much is deducted from their paychecks in premiums, which also dilutes the impact of this question.
The survey told respondents that Medicare for All would "eliminate private health insurance companies," but it did not tell them why: these corporations add to the overall cost of health care without providing anything of value.
It gets worse. The pollsters then presented the statement that Medicare for All will "threaten the current Medicare program." While this is a common Republican line of attack, it is an openly deceptive one. Medicare for All proposals would expand and improve coverage for seniors and the disabled under the current program, by expanding the scope of services rendered and eliminating out-of-pocket costs in most cases.
Surveyors also offered the argument that Medicare for All could "lead to delays in people getting some medical tests and treatments." There is no evidence to support this assertion, and no reason to believe it's true. The opposite should be the case, in fact. While increased demand could lead to limited delays, the elimination of insurance company bureaucracy, paperwork, network restrictions, and pre-certification procedures means that overall wait times should be reduced.
Despite the survey's methodological flaws, Leonhardt uses it to conclude that Medicare for All is politically unfeasible. He suggests that Democrats embrace another plan instead: the Center for American Progress proposal (in Leonhardt's words from an earlier column) "through which any American, regardless of age, could buy health insurance" from the government.
There are serious actuarial problems with this approach, however. As has been seen with Medicare Advantage, the private-insurance option for today's Medicare, insurance companies are experts at "cherry-picking" healthy enrollees. (As some whistleblower cases demonstrate, they can also be expert at committing fraud.) This would create service problems for enrollees and financial problems for the government.
The immediate questions are these: Why was the KFF survey so flawed, and why has Leonhardt (and presumably others) been so quick to embrace it? Leonhardt describes KFF as "one of the country's most respected health care pollsters," and so it has been. But KFF, like other mainstream health institutions, is deeply embedded in the current health care system's political culture. A centrist Democrat and two former Republican senators sit on its Board of Trustees, one of whom is former Senate majority leader and physician William Frist. Frist is the son of Thomas Frist, founder of Hospital Corporation of America. The Washington Post reported that his HCA holdings represented a "significant source of his wealth" (a reported $13 million in 1994).
Given its internal culture, it may not have been possible for KFF to present the arguments for and against Medicare for All in an unbiased manner.
It's true that the GOP (and centrist Democrats) will likely present these misleading arguments in much the same way they do. But why should Democrats tailor their platform to voters' reactions, when those reactions are based on a biased or one-sided set of arguments? An important proposal like Medicare for All should be subjected to public debate, so that the public gets a deeper understanding of its ramifications. That is, after all, why we have elections.
And why would Leonhardt or political scientist Brendan Nyhan (whom he quotes) embrace such a flawed survey instrument so quickly? It may be a simple case of confirmation bias, since the survey appears to support their ideas about Medicare for All. That doesn't make its findings accurate or meaningful. The nation deserves a meaningful debate about Medicare for All.
This article was produced by Economy for All, a project of the Independent Media Institute.
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