Those who believe that the government should provide everybody with free healthcare have long struggled with a way to brand it. The term socialized health insurance has a negative connotation and “single-payer healthcare” is too wonky. So in recent years, activists have pushed leading Democrats to adopt the term “Medicare for all.”
The “Medicare for all” branding allows activists to latch onto a program that remains broadly popular. It will be an easier lift, liberals presume, if they can convince everybody that they just want to build on something that Americans already know and like. Because the term “Medicare for all” means different things to different people, it can allow politicians to claim support for it without alienating one group or another. But an increasing amount of polling data show that the vague promise of “Medicare for all” is creating a lot of confusion — even among Democratic voters.
A Navigator Research poll found that 60% of voters (including 73% of Democrats!) believe that “Medicare for all” is a program that allows everybody to buy into Medicare, rather than private insurance, if they want to.
In reality, the leading “Medicare for all” proposal from Sen. Bernie Sanders, I-Vt., which is endorsed by four of his 2020 rivals, would require everybody to enroll in a government healthcare plan and abandon their private insurance within four years, and the only private policies allowed would be narrowly tailored supplemental plans that do not duplicate any of the benefits offered by the new government plan.
A Kaiser Family Foundation poll tracks similar confusion, which cut both for and against the proposal. Majorities believe that people would continue to pay co-pays and deductibles, that they’d be able to keep their employer plans, that they’d be able to keep private insurance, and that they’d continue to pay premiums. In all cases, the Sanders plan promises to do the opposite: get rid of premiums, deductibles, and co-pays and replace private insurance at the individual and employer levels.
There’s also good reason to believe that the association with Medicare is contributing to the confusion, as Kaiser quotes an independent voter as saying, “My mom is on Medicare and she has to pay co-pays.”
The truth is that even among liberals, there’s a lot of debate about what “Medicare for all” really means, and the Democratic presidential candidates are adding to the confusion because they want to be associated with the concept of “Medicare for all” while giving themselves flexibility down the road. “When we talk about ‘Medicare for All,’ there are a lot of different pathways,” said Sen. Elizabeth Warren, who has co-sponsored the Sanders plan, but hasn’t offered her own.
The most straightforward interpretation of the phrase “Medicare for all” is that the government is going to offer healthcare to everybody. Yet, even Sanders’ doesn’t technically do that. His proposal would actually create a new government-run plan (which he claims is more generous than existing Medicare), and then he’d transfer everybody over to the new plan, including Medicare beneficiaries. Joe Biden has indicated a preference for giving people the option to enroll in some sort of Medicare-like plan, though he has yet to spell out the details.
The problem with not agreeing on a clearly defined policy and then selling it, is that not only does it open Democrats up to attacks during the general election, but even if they win, it makes it much more difficult to rally around any sort of proposal once in power.
A good example of this is Republicans, who unified around the phrase “repeal and replace” over the course of four election cycles, only to find out once they got power that the party had fierce disagreements over what that actually meant. The “Medicare for all” gambit could similarly backfire.