When Bernie Sanders stumps for “Medicare for all,” his plan to enroll everyone in government healthcare plans instead of private plans, he claims people won’t miss their private health insurance because they don’t like the plans to begin with.
But polling among people with private coverage, particularly among those who get their coverage through work, shows the opposite. Not only do numerous surveys show that most people with employer plans are happy with them — they also show that the public balks at the idea of gutting private insurance or the government becoming more involved in healthcare.
Those facts indicate that Sanders and the Democratic Party would be taking an enormous risk in campaigning on a platform that would end private plans. Such a platform plank would endanger the votes of a bloc that is now critical to the party’s coalition, namely middle-class and professional, suburban voters who get coverage through their employers. Those demographics have trended toward Democrats during the Trump era, but the prospect of “Medicare for all” could mean a reversal.
A “Medicare for all” platform, as favored by Sanders and Elizabeth Warren, could also undercut Democratic efforts to punish President Trump for his record on healthcare. The party has an opportunity to run against a lawsuit supported by Trump that would throw out all of Obamacare and that threatens coverage for 20 million people — as well as protections for the sick. By running on “Medicare for all” rather than merely defending Obamacare, though, Democrats would give Trump the chance to accuse them of trying to take away employer health insurance from 160 million people and causing massive disruptions.
At Super Tuesday polling locations in prosperous northern Virginia, many voters were skeptical of “Medicare for all.”
“We have great health insurance. I wouldn’t want to give it up,” said Rose, 58, who lives in Fairfax County, Virginia, and voted for Joe Biden, who favors letting people buy into a government plan. “I don’t want to give up the relationship with doctors” built up over decades, said Rose. Rose and others asked for their last names to be withheld for fear of retribution online and to keep their voting preferences private.
“I don’t think I’d want to give it up,” said Brian, 50, who works in software IT and lives in Falls Church, Virginia. Despite that stance, he voted for Warren, who favors “Medicare for all.” He explained that he doesn’t think that a “Medicare for all” plan would get through Congress but does think Democrats would still be able to boost coverage. Brian had planned on voting for Pete Buttigieg, whose tagline on healthcare was “Medicare for all who want it” before he dropped out.
“I like my plan, but I want more people to have insurance,” Brian said.
There’s recent history to suggest that taking away private insurance is politically toxic. After Obamacare shut down plans that didn’t fit the law’s requirements in late 2013, voter anger over healthcare helped propel Republicans to majorities in the House and Senate under President Barack Obama. Republicans still frequently remind people that Obama once said, falsely, that his healthcare law would allow people to keep their plans if they liked them.
Even many Democrats understand the political difficulty of going after people’s private healthcare plans. As Sanders and Warren have pushed “Medicare for all,” more centrist rivals Biden and Michael Bloomberg have stressed that their healthcare ideas, for the most part, would give people the option of buying into a government plan rather than forcing them into one.
“I think there should just be options for people,” said Nam, 49, a CFO for entrepreneurial businesses. Nam purchases her plan directly but has been on her husband’s work plan in the past and thought it worked well.
“I just don’t know if the quality of the coverage will be there the way they are now,” she said. “Right now, people can choose. If they want more coverage, they can pay for it. If they want less coverage, they can go with the cheaper plan. For those that can’t afford it, there should be public programs for them.”
Yet defending private insurance plans isn’t totally safe either, given the flaws with the status quo. There are a lot of reasons that Sanders claims that people “do not love their health insurance companies” and that Warren declares confidently that she has “never actually met anybody who likes their health insurance.”
For one, the cost of employer coverage is rising faster than wages, now costing more than $20,500 to insure a family of four. On top of that, more and more workers have coverage that won’t protect them from sizable medical bills.
“It’s been happening gradually, and people hadn’t been paying attention to a large extent and just weren’t aware of how much they and their employers were paying. And they also didn’t realize that’s their money we’re talking about,” said Wendell Potter, the president of Business for Medicare for All, which aims to persuade companies to back a fully government-financed healthcare system. He added, however, that there appeared to be growing awareness about paying higher costs and that people were “seeing the value of their coverage decline.”
Additional complications come with people getting health insurance through work. If people get laid off, change jobs, or quit, their coverage doesn’t follow them to where they go next. Plus, nothing keeps employers from switching plans year to year, a disruption that can cause people to lose their doctors.
“If you were designing a system from scratch, tying insurance to employment wouldn’t make a lot of sense,” said Larry Levitt, executive vice president for health policy at the Kaiser Family Foundation. “But employer-based insurance is a way for businesses to attract a quality workforce. It’s what people are accustomed to.”
The practice dates back to World War II. At the time, the federal government froze wages to avoid inflation during a labor shortage, so businesses started offering health insurance as a benefit instead. By 1943, the IRS decided the coverage should be exempt from taxation.
More than 75 years later, those tax breaks have become expensive to the federal government. According to the Treasury, repealing the employer tax exclusion could reduce the federal budget deficit by as much as $3 trillion over a decade.
For a lot of these reasons, calls to ditch employer coverage have come not only from the Left but also from the Right. If conservatives could remake the healthcare system, they would want workers to shop for their own plans. When they considered doing so during the Obamacare repeal and replace efforts, however, they learned again how politically perilous it would be. Democrats won the House in 2018 in part by running against GOP healthcare plans.
The struggles of both parties with healthcare politics have underscored how running against a plan is easier than running for one.
Voters are wary about major changes to private plans — even though employers have dealt with rising prices by shifting more responsibility onto workers in the form of deductibles.
Still, only a small sliver of the population in any given year faces high costs. For instance, data shows that only 5% of the public is responsible for half of healthcare spending.
“For most of us who don’t go to the doctor much, which is the majority of people, insurance is working very well,” said Melissa Thomasson, an economist and health insurance expert at Miami University in Ohio.
Even surprise medical bills, meaning unexpected charges from seeing a provider out of network, hit a minority of patients — about 1 in 6. While there’s more awareness about the problem, many people with employer plans do get a large chunk of their medical care paid for by insurance.
“It’s still not happening to enough people enough of the time to swing the majority of sentiment [against private health insurance],” Thomasson said about surprise bills. She predicted, however, that surprise bills would become even more widespread absent legislative changes.
There is some polling to suggest that workers aren’t totally unaware of the problems with employer coverage. For instance, the Commonwealth Fund found that people are overall satisfied with their current plans but also found that 29% of people with employer coverage thought they wouldn’t be able to afford the care they needed if they were to become seriously ill. A recent Kaiser Family Foundation poll found that, for 24% of Republicans, costs ranked at the top of their concerns when it came to healthcare, even ahead of opposition to “Medicare for all.”
These fears, however, don’t necessarily translate to voters being willing to let the government step in to be the only healthcare payer.
Dawn, 50, who gets coverage through her husband’s work, said the coverage is a huge help. While she sees how well Medicare works for her mother, she said it still has its own problems with long-term funding. That’s mainly why she’s skeptical about “Medicare for all.”
“What will it look like? It sounds great on paper, but how is it going to work?” she said.
“The government isn’t always efficient,” said Michael, 48, a government employee voting in Fairfax, Virginia, who is in favor of universal healthcare while still allowing private insurance to operate.
“There has got to be a blend,” he said, referring to a possible expansion of government coverage that involves the private industry maintaining a role.
Sanders and Warren promise big changes. They vow to go much further than other countries that have universal coverage by having the government pay for nearly every type of medical care. Even though some voters might see problems with their employer plans, many haven’t bought into the idea that the government can do better than their employers or that the final product will look like what politicians promise.
“On paper, there’s no one that has insurance that’s as good as ‘Medicare for all,'” said Levitt from the Kaiser Family Foundation. “I think the question is whether people believe that’s what the coverage would actually look like once it got through the meat grinder of Congress.”
