Understanding the Vulnerabilities of Single Payer

Democrats are united in the dual goals of covering everyone and lowering their health care costs. The question, though, is how to achieve those goals.

Fortunately, there are plenty of good ideas. Many policymakers and organizations have proposed ways to tackle rising costs and ensure more people have affordable health insurance. One of those ideas, however aspirational, carries substantive and political risk: single payer. To help policymakers sort out how to handle health care, we list a series of analyses, polls, articles, editorials, and op-eds that show the vulnerabilities of single-payer.

Analyses

• Medicare for All a Vote Loser in 2018 U.S. House Elections
  Alan I. Abramowitz, Sabato's Crystal Ball (November 14, 2019)
• Will M4A Doom Democrats in the General?
  Third Way memo (November 12, 2019)
• Choices for Financing Medicare for All
  Committee for a Responsible Federal Budget (October 28, 2019)
• Can you keep your doctor under single payer?
  Third Way one-pager (September 16, 2019)
• What could happen to reproductive health care under single payer?
  Third Way one-pager  (September 13, 2019)
• Has single payer ever worked in the US?
  Third Way one-pager (September 13, 2019)
• 7 Inconvenient Truths About Single Payer
  Third Way one-pager (July 25, 2019)
• Single-Payer Health Care: A Tale of 3 States
  Third Way report (July 17, 2019)
• Seven political and substantive risks of single payer.
  Third Way memo (May 4, 2019)
• The federal cost for single payer would be approximately $32 trillion over 10 years.
  Urban Institute (May 9, 2016) Mercatus Center (July 30, 2018)
• Seven-of-ten households with private health care coverage would pay more under a fully-funded single payer plan than they currently pay for their own health plan.
  Kenneth E. Thorpe, PhD (January 27, 2016)
• Single payer requires complex policy decisions.
  Congressional Budget Office (May 1, 2019)
• “The Virtues and Vices of Single-Payer Health Care.”
  Jonathan Oberlander, Ph.D., The New England Journal of Medicine (April 14, 2016)
• “Medicare for All's winners and losers: How payment rates would change for doctors.”
  Caitlin Owens, Axios (July 3, 2019)

Polls

• “Medicare for All has grown increasingly unpopular among all American voters.”
  Quinnipiac University National Poll (November 26, 2019)
• Swing voters in Michigan, Minnesota, Pennsylvania, and Wisconsin see Medicare for All as a "bad idea."
  Kaiser Family Foundation (November 7,  2019)
• Support for Medicare for All dropped 5 percentage points since April while opposition increased by 9 points.
  Kaiser Family Foundation (October 15, 2019)
• Medicare for All may have reached peak popularity. Support for Medicare for All did not budge when voters heard positive arguments for the policy but fell precipitously when voters heard negative arguments.
  Third Way (September 24, 2019)
• 56% of registered New Hampshire Dems and unaffiliated voters would like to have a public option in addition to private insurance; 23% want to replace private insurance with a single public plan like Medicare for All.
  Monmouth  (September 24, 2019)
• “56% of registered voters oppose a Medicare for All plan that would replace private insurance.”
  WSJ/NBC (September 22, 2019)
• Only four-in-ten likely Democratic Iowa caucusgoers support Medicare for All, 28% fear it could cost the party the general election, 24% say it’s bad policy.
  Des Moines Register/CNN/Mediacom Iowa Poll (September 22, 2019)
• “55% of Democrats and Democratic-leaning independents prefer a presidential candidate who wants to build on the ACA, compared to 40% who prefer a candidate who would replace it with Medicare For All.”
  Kaiser Family Foundation (September 12, 2019)
• Capping out-of-pocket costs ranked the third most popular option for controlling health care costs for small businesses (behind generic drugs and disclosing the list prices of drugs). Medicare for All polled 27 points lower.
  Public Private Strategies (September 10, 2019)
• Democrats and Democratic-leaning independents support building on the Affordable Care Act (55%) over replacing the ACA with a Medicare-for-all plan (39%).
  Kaiser Family Foundation (July 30, 2019)
• Nearly 75% of Democrats incorrectly believe Medicare for All “lets anyone buy Medicare instead of their private insurance if they want to.”
  Navigator (June 17, 2019)
• Only 13% of Americans want Medicare for All if it means the end of private insurance.
  Matthew Sheffield, The Hill (February 7, 2019)
• Public support for single payer drops significantly once details are known.
  Ashley Kirzinger, Cailey Muñana, and Mollyann Brodie, Kaiser Family Foundation (January 23, 2019)
• 31% of Americans support single payer when given four options.
  Jocelyn Kiley, Pew Research Center (October 3, 2018)
• “Fact check: Americans aren’t clamoring for single-payer health insurance.”
  Calvin Woodward and Emily Swanson, AP/Stat (September 17, 2018)

Articles, Editorials & Op-Eds

• How Medicare for All Keeps Crippling Democratic Frontrunners
  Michael Tomasky, The Daily Beast (December 6, 2019)
• The Democrats’ Medicare mess
  Ezra Klein, Vox (December 4, 2019)
• What’s at stake in the Democratic Presidential Primary
  Joe Keefe, Sea Coast Online (November 29, 2019)
• Warren’s Big Bet on Medicare for All Is Not Paying Off
  Sam Stein, The Daily Beast (November 27, 2019)
• Democrats Increasingly Vocal in Calling ‘Medicare for All’ a Political Liability
  Lisa Lerer and Katie Glueck, New York Times (November 26, 2019)
• 5 Things the 2020 Democrats Aren’t Telling You About Medicare for All
  Alice Miranda Ollstein, Politico (November 25, 2019)
• Medicare for All’s jobs problem
  Rachana Pradhan, Politico (November 25, 2019)
• Reeling progressives meet behind closed doors after 'Medicare for All' barrage
  Alex Thompson, Holly Otterbein, and Alice Miranda Ollstein, Politico (November 20, 2019)
• “Democrats Have Spent All Year Freaked Out About ‘Electability.’ That Panic Is Increasingly Focused On Medicare For All.”
  Molly Hensley-Clancy, BuzzFeed (November 7, 2019)
• “Democrats give Warren's ‘Medicare for All’ plan the cold shoulder”
  Peter Sullivan, The Hill (November 6, 2019)
• ‘This is going to cause down-ballot damage’
  Marc Caputo and Alex Thompson, Politico (November 1, 2019)
• “Want Medicare for All? Be Ready to Wait”
  Ramesh Ponnuru, Bloomberg (October 30, 2019)
• “The Most Pressing Issue for Our Next President Isn’t Medicare”
  David Leonhardt, New York Times (October 27, 2019)
• “Someone needs to say it: Medicare-for-all is a pipe dream”
  Rahm Emanuel, The Washington Post (October 25, 2019)
• “The Peril Of Medicare For All”
  Bobby Clark, Health Affairs (October 22, 2019)
• “The Eye-Popping Cost of Medicare for All”
  Ronald Brownstein, The Atlantic (October 16, 2019)
• “Medicare for All — and ultimately abolishing private health insurance plans — could turn off many voters [in Ohio].”
  Jeff Zeleny, CNN (October 15, 2019)
• “This Is the Strongest Argument Against Medicare for All”
  Peter Suderman, New York Times (October 9, 2019)
• “Will Medicare-for-all hurt the middle class? Elizabeth Warren and Bernie Sanders struggle with questions about its impact.”
  Matt Viser and Sean Sullivan, Washington Post (October 5, 2019)
• “Opinion: If Democrats want universal coverage, they need to abandon the 'Medicare for all' fantasy”
  LA Times (October 4, 2019)
• “Pelosi to Cramer: There’s no need to reinvent health care — just improve Obamacare”
  Berkeley Lovelace Jr., CNBC (September 18, 2019)
• “Democrats, Stop Helping Trump”
  David Leonhardt, New York Times (September 8, 2019)
• “Democrats' Medicare for All must consider union-won plans: AFL-CIO”
  Amanda Becker, Reuters (August 29, 2019)
• “Senate battleground Dems shun 'Medicare for All'”
  Alice Miranda Ollstein and James Arkin, Politico (August 25, 2019)
• “Democrats back off once-fervent embrace of Medicare-for-all”
  Chelsea Janes and Michael Scherer, The Washington Post(August 20, 2019)
• “How are you going to get it passed?”
  Harry Reid (August 20, 2019)
• “A question missing from the health-care debate: Will doctors make less money?”
  Catherine Rampell (August 1, 2019)
• “‘Medicare for All’ isn’t the only way to cover everybody”
  David Blumenthal and Sara Collins (July 23, 2019)
• "Medicare for All is a political loser."
  Joe Lockhart, CNN (July 11, 2019)
• “The Most Critical Argument Democrats Will Have in 2020”
  Ron Brownstein, The Atlantic (July 4, 2019)
• “How the Democrats Could Blow the Election Over Health Care”
  Michael Tomasky, The Daily Beast (July 2, 2019)
• If Democratic “candidates pitch big, sweeping changes to the health care system without addressing voters’ concerns about cost and access, their advantage won’t necessarily hold up.”
  Amelia Thomson-DeVeaux, Vox (May 13, 2019)
• “Democrats, don’t ditch the ACA for Medicare-for-all.”
  Former Senator Heidi Heitkamp, The Washington Post (May 8, 2019)
• “No matter what Sanders says, there’s no Medicare-for-all without tradeoffs.”
  Editorial Board, The Washington Post (May 4, 2019)
• “Sorry, Bernie, but most Americans like their health insurance the way it is.”
  Megan McArdle, The Washington Post (May 3, 2019)
• Vermont failed to implement their single payer plan due to the risk of economic shock.
  Amy Goldstein, The Washington Post (April 29, 2019)
• “Elevating the prospect of eliminating private health insurance altogether has some Democrats nervous.”
  David Catanese, US News & World Report (April 12, 2019)
• Fourteen things you may not know were in single payer.
  Alice Miranda Ollstein and Joanne Kenen, Politico (April 10, 2019)
• “Don’t make health care a purity test: There are multiple ways to achieve universal coverage.”
  Paul Krugman, The New York Times (March 21, 2019)
• “We don’t start from scratch.” Instead, we should expand the ACA and fill in the gaps in coverage.
  President Barack Obama (March 19, 2019)
• “Stop the empty rhetoric and pursue attainable paths in the immediate interest of our patients’ lives and their pocketbooks.”
  Professor Vin Gupta, The Wall Street Journal (March 7, 2019)
• “There’s no plausible route from here to there” on single payer.
  David Brooks, The New York Times (March 4, 2019)
• “If Democrats back single-payer health care, it could assure Trump’s re-election.”
  William Galston The Wall Street Journal  (February 12, 2019)
• “We can figure out universal coverage without Medicare-for-all.”
  Catherine Rampell, The Washington Post (February 4, 2019)
• “Medicare For All looks good in new poll, but there’s a big asterisk—some of the most popular counter-arguments make voters skittish.”
  Jonathan Cohn, HuffPost (January 23, 2019)
• Single payer would require massive tax hikes.
  Brian Riedel, Vox (August 7, 2018)
• “Democrats seize on cherry-picked claim that ‘Medicare-for-all’ would save $2 trillion.”
  Glenn Kessler, The Washington Post (August 7, 2018)
• “[S]ingle-payer is no policy panacea…[and] would require tax increases at politically suicidal levels.”
  Former Congressman Henry Waxman, The Washington Post (April 8, 2018)
• “Democrats could eventually find themselves facing a Trumpcare-type debacle.”
  Paul Krugman, The New York Times (September 15, 2017)
• “Maybe we should hit pause before we get on this bandwagon.”
  Ron Pollack, Vox (September 14, 2017)
• “Single payer helps Republicans change the subject.”
  Drew Altman, Axios (September 14, 2017)
• "Bernie Sanders’s ‘Medicare for All’ plan can’t work.”
  Matthew Cooper, Newsweek (September 13, 2017)
• “A single-payer plan would be nice, in a world that looks nothing like the one we inhabit.”
  Jonathan Chait, New York Magazine (September 13, 2017)
• “Single payer is one way to get there. It’s how Britain and Canada do it. But there are other ways.”
  Michael Tomasky, The New York Times (August 14, 2017)
• “Medicare-for-All isn’t the solution for universal health care.”
  Joshua Holland, The Nation (August 2, 2017)