Poll Shows Majority Support Single-Payer
Scary “rationing” be damned (we ration here in the US, by ability to pay), take a look at the numbers this poll from last month:
Associated Press-Yahoo Poll
Interview dates: December 14 – 20, 2007
14. Which comes closest to your view?
34% – The United States should continue the current health insurance system in which most people get their health insurance from private employers, but some people have no insurance
65% – The United States should adopt a universal health insurance program in which everyone is covered under a program like Medicare that is run by the government and financed by taxpayers
2% – Refused / Not Answered
15. Do you consider yourself a supporter of a single-payer health care system, that is a national health plan financed by taxpayers in which all Americans would get their insurance from a single government plan, or not?
54% – Yes
44% – No
2% – Refused / Not Answered
So much for that whole “Americans would never support government-run medicine” bit.
Hi Graham,
I’ve been reading your blog for sometime and I thought I would insert a comment for you for an article I figure you have looked at
(http://www.nytimes.com/2008/01/06/fashion/06professions.html?em&ex=1199854800&en=753f3fc83f4f52bf&ei=5087
and may blog about in the near future. The article clearly has a viewpoint to get across, but I think the data used to support it neglects the overall trend in the past five years (e.g. http://www.aamc.org/data/facts/charts1982to2006.pdf)
Additionally, at 32,000 2007-2008 first-time applicants, (http://www.aamc.org/newsroom/pressrel/2007/071016.htm), this represents the largest first-time applicant group in AAMC history.
The data for 2007-2008 applicants jumps to 42,315. (http://www.aamc.org/data/facts/2007/2007school.htm)
In any case, thought you might find that of interest.
Interesting numbers but I am curious what the support would be like if the question were phrased more along the lines of would you support a single payer system even if it meant a substantial increase in your taxes which would be necessary to fund such a system
Actually, Dr. Tdd, single-payer is the one type of reform that would not increase costs. See anything on my site about “The Lewin Group,” which has done multiple independent state analyses.
And if you ask that question, drtdd, that would be considered push-polling, which is questionable poll procedure at best. And illegal defamation at worst.
Of course single-payer is the ideal answer, and I’m fully in favor of it. But there are some obstacles that need to be worked out and/or communicated to American voters before it could be taken seriously.
Namely, how do you maintain quality of care and increase preventive medicine if there is less of an incentive for doctors to do so? Or, phrased differently, how do you incentivize primary care physicians to promote preventive measures?
Also, how could we go about dissolving HMOs? That’s a multi-multi-billion dollar business that would just go *poof* one day? Ideally, yes, F*ck them. But that’s not realistic.
Also, Healthline blogger, JC Jones, is doing a series analyzing the presidential candidates’ proposed plans to reform healthcare.
She’s starting with the current candidate who is most likely to be elected, Barack Obama: http://www.healthline.com/blogs/healthline_connects/2008/01/healthline-analysis-presidential.html
I’m with you on the single-payer bit, but this poll doesn’t do much to support the point. It only shows that folks would prefer single-payer to the current system, which really doesn’t say much considering the state of current system. If there were intermediate choices–that is, if the poll reflected practical decision-making–I’d bet they’d win out by a sizable margin.
No way in heck – if “single-payer” were replaced with “Canadian-style” or “British-style”, and the explanation “where care is rationed by fiscal priorities” were added, Americans would rebel.
It doesn’t have to be single-payer; keeping competition and a profit motive in at least parts of the system preserves innovation, and that’s important to me. Getting *EVERYBODY* in the pool and defining a minimum level of benefits that working adults and their families are, in fact, *entitled* to – that’s where we need to start healthcare reform. Pay for it by rolling back the Bush tax cuts that affect only the wealthiest .1% of Americans.
E
There was also a survey which indicated that Americans would in fact be willing to pay higher taxes to support a universal healthcare system.
It’s hard to know where to put this survey. There’s not a lot of information given to the respondents, so the answers probably indicate softer support than the numbers imply. For example, the question of taxes would reliably drive the support down a bit. But it’s encouraging.
This is why it would be nice to have a guy like Edwards as the nominee. He’s demonstrated a lot of real leadership on this issue and would probably be the most aggressive in defending a universal health proposal from the pack of lies Harry and Louise will throw at them. With a leader making the case for it, I think the people might follow. Pity he never caught fire.
[...] Graham seems really excited about this load of BS from AP/Yahoo, so I hate to rain on his parade. But duty compels me to do so.  The poll purports to show that only 34% the public want a private sector health care system and 65% support a “universal” government-run alternative. In reality, it shows nothing of the kind. [...]
I’m starting to come around on Edwards, too, Shadow – I thought his individual mandate was soft, but it’s closer to Hillary’s than I grasped on the first pass.
The thing is, I *like* one aspect of Hillarycare – aside from the mandate, aside from the Play or Pay for large employers, I’d give my *eyeteeth* as a small employer to buy into FEP Blue, GEHA or any of the other FEHB carriers. Edwards use of the “Regional Healthcare Markets” seems less efficient than expanding FEHB.
Matt Miller has discussed funding this at length in _The 2% Solution_ – it’s a pragmatic proposal – turns out that you could create universal coverage through the private sector through an increase in federal spending that represents about .5% of GDP and moving around some of the other costs – including putting controls on Medicaid utilization comparable to private plans…..
E
Anyone who has ever survived the less then tender mercies of a single payer healthcare system will tell you that our government is not capable of running a healthcare system. The scandal at Walter Reed last year is a perfect example of how our government has and will run their single payer system. Ask any US service person, and they will tell you that they will always use private sector health care providers, because the military healthcare (run by the same people who will run the nation if given the chance) is indifferent to their suffering and general needs. Anything other than routine care must be approved by a panel that meets monthly, (the same is true of Medicaid as well), and then your fate is determined by strangers who do not know your or your families individual needs. Our Healthcare system does need major changes, most notably accountability and transparency in billed charges as well as agents disclosing their commisions and over rides, (I am an agent, and while the majority are honset and work with in the law, I have seen as mony agents rape their clients as I have providers “Doctor” their bills) But the biggest reason that insurance is expensive is because healthcare is expensive, and healcare in the US is expensive because the US population is unhealthy. 90% of all healthcare costs are attributable to 10% of the population, and most of them are over wieght and/or smoke. If we take responsiblity for our life style, we are healthier and our healthcare costs go down.
The poll is obviously ridiculous, because it forces you to make one of two anwers: employer-sponsored or government-run health care. Imagine asking the same question about anything else: auto insurance, fire & theft insurance, life insurance! You would immediately understand that the question is absurd and that the correct choice is to give the individual the money and let him buy it himself.
To believe that a “single payer” system would not increase costs is a myth. Prior to the advent of Medicare, the AMA had published a projected cost for the program if it were passed by Congress. If I remember correctly, it was about twice if not three times the cost projections published by Congress. The Medicare bill was passed and the AMA proved to be correct. I started practice in 1967 and I was certainly pleased with the reimbursement I received from Medicare. All one has to do to see what happens with the cost of a single payer system is to examine the steady decline in Medicare reimbursement and the increase in the monthly premiums paid by Social Security recipients since then. As the “baby boomers” start using Medicare the costs of the program are going to skyrocket.
Heavy lobbying by organized medicine has temporarily blocked the proposed 10% cut in physician reimbursement that was slated to go into effect on January 1, 2008.
Graham, in all your passion for a single payer system I don’t think you look carefully at what has happened to Medicare to see what the future of such a system might be. If Medicare were expanded to every American I doubt if any young physician would go into primary care.
Eric spoke of putting controls on Medicare utilization comparable to private plans. If that were attempted the AARP would go ballistic.
Dr. Thompson (wish I could convince people to call *me* that ;0) )
Let AARP go off. I don’t think primary care physicians see enough fits of apoplexy in the geriatric set these days. Could be fun to watch. (Although, I think there’s increasing awareness, even among pre-Boomers, that saddling the grandkids with a million dollars of debt, each, might not be the best plan – but, I digress)
You’ll note, though, that I said Medicaid. We’ve made a legal commitment to Medicare that I can’t see a way out of for a long time (although I support means-testing Medicare in the most vigorous way possible). I think if we replaced Medicaid with vouchers to purchase insurance products from the private sector we’d be in a better position to limit frivolous use of the resource.
It’s also obvious to me that we need some “clarification” in EMTALA.
E
Dr. T–all I’ve got is the multiple analyses by The Lewin Group (California, Vermont, Maryland, etc) and Mathematica, Inc, two totally independent economic analysis groups that did the economic forecasting, and showed that under single-payer, costs would not increase, but under every other type of program, costs were increased.
Now I’m not about to say the analyses were perfect–I don’t have enough background to say that–but I certainly would disagree that it would double or triple costs, especially compared to other reform ideas.
Search my site for the reports and read them for yourself.
[...] takes issue (”load of BS”) with my highlighting a recent poll showing support for single-payer over our current system, saying that the poll isn’t [...]
Whether people want it or not, that doesn’t mean it is the best system or the appropriate system, especially for a free country. People wanted Nazism and communism and fascism too before it was put into practice.
Yes, Kelly, a rational health care system, that exists in multiple countries in the world, is clearly similar to Nazism and fascism. Nice one.
Eric — First of all, single-payer proposals would keep competition in the system — competition between docs and hospitals, just not between insurance companies.
Second, please explain how insurance companies have anything to do with innovation. They regularly deny covering procedures that are standard in European countries. Here those procedures are “experimental.”
Third, as long as insurers are competing with one another to exclude caring for sick people and only covering healthy people, you’ve got a system where a big chunk of health care dollars might as well be flushed down the toilet. It’s simply not sustainable. Even if you do rescind the Bush tax cuts. We can’t spend a fifth or a quarter of our GDP on health care — any more than you can spend a fifth or a quarter of your family budget on it. But that’s where we’re headed with the current system.
Come now, Graham. Nurse K didn’t say that a rational healthcare system was naziism, or fascism.
She stated that the will of the people is not always in the people’s best interest.
I agree with her. I work with all sorts of “professional” people that can’t figure out how to use a fax machine, have no idea what the “cuban missile crisis” was, and frankly I’m surprised they find their way to work every day.
These same people can’t be bothered to read up on health policies when J-Lo and Britney Spears seem so much more important.
I lump a lot of the “gung ho” single payer advocates in with the same people in my state of Florida who voted for a high-speed rail system several years ago, and then had to vote it back down after realizing A) the cost of building it, B) they then couldn’t afford to purchase a ticket if it was built and C) nobody really wants to go to Tallahassee from Miami by train, high speed or otherwise.
Then again, I’m a bit of a darwinist, and don’t really believe in long-term social programs. Lose your job? I don’t mind helping until you get back on your feet. But if you don’t get back on your feet? Go hungry!
Kristen:
Plans compete now for business – additional coverages (CAM, for example), more convenient customer service options, ask-a-nurse; there are lots of ways that the current finance system supports innovation, not the least of which being that if company A doesn’t offer coverage for modality X, and they want the profit from the business of a given group, they may add it.
Healthcare competition doesn’t have to be about delivery – it can be about finance and customer service just as equitably. I’m not ashamed to say that a profit motive is a great thing in healthcare finance – bigger might be better, there may be economies of scale, insurers whose workforce is more productive should be able to make a buck…I’m all for capitalism. It just can’t come at the expense of delivering the care that people need, and I think that’s where I part ways with the single-payer crowd. If single-source agreements are so great, why did we break up AT&T? I would not hold up the Social Security Administration, the IRS, the power company, the cable company or virtually any other monopoly in the US as a paragon of customer service and compassion, and I fail to see why single-payer healthcare finance is going to be any better. Keeping the option of intermediaries that compete on customer service and efficiency helps keep the system customer focussed, because even though you’ve got to buy it, you could be buying it from someone else.
You’re right, though. This can’t be about insurers being able to compete on the quality of their actuarial acumen and ability to exclude people who might use the product. The two sides of the coin are community rating (rates set only by age, gender and broad geography) and an individual mandate (everybody’s in the pool).
Could you please point to therapies, supported by multi-center RCTs and a modest history of use overseas, that are routinely denied by insurers in the US? There are dramatic cases, for sure, and they tug at the heartstrings, but I’m not sure it’s as common as some advocates might claim. More common to me is consumers from countries with single-payer systems seeking treatment outside those systems, especially when it comes to high-complexity surgery, transplant medicine and oncology.
Eric
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