Introduction to a Six-part Series By Kip Sullivan, JD for PNHP Blog –
“Americans are scared to death of single payer.”
These words were not uttered by some foaming-at-the mouth wingnut. They were written by Bernie Horn, a Senior Fellow at the Campaign for America’s Future, a member of Health Care for America Now, on June 8, 2009. Horn explained that he was moved to write this tripe because single-payer supporters were asking why Democrats had taken single-payer off the table to make room for the “public option”:
The question most frequently asked by progressive activists at last week’s America’s Future Now conference was this: We hear Obama and congressional Democrats talking about a public health insurance option, but why aren’t they talking about a single-payer system like HR 676 sponsored by Rep. John Conyers? Why is single-payer “off the table”?
Horn went on to assert that single-payer had been taken off the table because Americans want it off the table. He claimed polling data supported him, but he cited no particular poll. The truth is that the Campaign for America’s Future (CAF) and other groups in Health Care for America Now (HCAN) had decided years earlier they would push Democratic candidates and officeholders to substitute the “option” for single-payer, and they would tell both Democrats and progressive activists that Americans “like the insurance they have” and that Americans oppose single-payer.
The argument that single-payer is “politically infeasible” is not new. That argument is as old as the modern single-payer movement (which emerged in the late 1980s). It is an argument made exclusively by Democrats who don’t want to support single-payer legislation – a group Merton Bernstein and Ted Marmor have called “yes buts.”
The traditional version of the “yes but” excuse has been that the insurance industry is too powerful to beat or, more simply, that “there just aren’t 60 votes in the Senate for single-payer.” But the leaders of the “option” movement felt they needed a more persuasive version of the traditional “yes but” excuse. The version they invented was much more insidious. They decided to say that American “values,” not American insurance companies, are the major impediment to single-payer.
How did the “option” movement’s leaders know that Americans oppose single-payer? According to Jacob Hacker, the intellectual leader of the “option” movement, they knew it because existing polling data said so. According to people like Bernie Horn and Roger Hickey at CAF, they knew it because focus group “research” and a poll conducted by pollster Celinda Lake on behalf of the “option” movement said so.
About this series
This six-part series explores the research on American attitudes about a single-payer (or Medicare-for-all) system to evaluate the truth of the new version of the “yes but” argument. We will see that the research demonstrates that approximately two-thirds of Americans support a Medicare-for-all system despite constant attacks on Medicare and the systems of other countries by conservatives. The evidence supporting this statement is rock solid. The evidence against it – the focus group and polling “research” commissioned by the “option” movement’s founders – is defective, misinterpreted, or both.
In Part II of this series, I will describe two experiments with “citizen juries” which found that 60 to 80 percent of Americans support a Medicare-for-all or single-payer system. The citizen jury research is the most rigorous research available on the question of what Americans think about single-payer and other proposals to solve the health care crisis. It is the most rigorous because it exposes randomly selected Americans to a lengthy debate between proponents of single-payer and other proposals.
Of the two “juries” I report on, the one sponsored by the Jefferson Center in Washington DC in 1993 remains the most rigorous test of public support for single-payer legislation ever conducted. After taking testimony from 30 experts over the course of five days, a “jury” of 24 Americans, selected to be representative of the entire population, soundly rejected all proposals that relied on competition between insurance companies (including President Bill Clinton’s “managed competition” bill) and endorsed Sen. Paul Wellstone’s single-payer bill. These votes were by landslide majorities. Washington Post columnist William Raspberry accurately noted, “Perhaps most interesting about last week’s verdict is its defiance of inside-the-Beltway wisdom that says a single-payer … plan can’t be passed” (“Citizens jury won over by merits of Wellstone’s single-payer plan,” Washington Post October 21, 1993, 23A).
In Part III, I’ll review polling data and explore the question, Why do some polls confirm the citizen jury research while other polls do not? We will discover an interesting pattern: The more poll respondents know about single-payer, the more they like it. We will see that polls that claim to find low support for single-payer provide little information about what a single-payer is (they fail to refer to Medicare or to another example of a single-payer system), they provide misleading information, or both. For example, when Americans are asked if they would support “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,” two-thirds say they would, but when they are asked, “Do you think the government would do a better or worse job than private insurance companies in providing medical coverage?” fewer than half say “government” would do a “better job.” Although neither question provided anywhere near as much information as the citizen jury experiments did, it is obvious the former question was more informative than the latter.
In Parts IV and V, I’ll discuss the evidence that “option” advocates cite for their claim that single-payer is opposed by most Americans. Part IV will examine polling data that Jacob Hacker uses to justify his refusal to support single-payer and his decision to promote the notion of “public-private-plan choice.” Part V will examine the survey and focus group “research” done by Celinda Lake for the Herndon Alliance and subsequently cited by leaders of HCAN, the two groups most responsible for bringing the “public option” into the current health care reform debate.
We will see that Hacker’s research relies on polls that pose such vague questions that the results resemble a Rorschach blot more than a guide to health care reform strategy. Would you make a decision about whether to abandon single-payer based on a poll that asked respondents to choose between these two statements: (1) “[I]t is the responsibility of the government in Washington to see to it that people have help in paying for doctors and hospital bills… ;” and (2) “these matters are not the responsibility of the federal government and … people should take care of these things themselves”? I wouldn’t, but Hacker did. If it turned out that about 50 percent of the respondents said it was the federal government’s responsibility, 20 percent said it was the individual’s responsibility, and the other 30 percent split their vote between government and individual responsibility, would you read those results to mean Americans “are stubbornly attached to employment-based health insurance”? I certainly wouldn’t, but Hacker did. Would you use this poll as evidence that “American values [are] barriers to universal health insurance”? I wouldn’t, but Hacker did.
The “research” that Celinda Lake did for the Herndon Alliance used strange methods. For example, she selected her focus groups based on their answers to questions about “values” that had nothing to do with health care reform. The values included “brand apathy,” “upscale consumerism,” “meaningful moments,” “mysterious forces,” and “sexual permissiveness.” “Meaningful moments,” for example, was described as, “The sense of impermanence that accompanies momentary connections with others does not diminish the value of the moment.” Do you think it’s important to ask Americans about their “sense of impermanence” before deciding whether you will support single-payer legislation? I don’t, but Celinda Lake and the Herndon Alliance did.
The “option” movement’s “research” turns out to be no match for the more rigorous research which demonstrates two-thirds of Americans support Medicare-for-all.
In Part VI I discuss the wisdom of allowing polls and focus group research to dictate policy and strategy, something the “option” movement’s founders talked themselves into doing. Hacker has been especially vocal about this. He repeatedly urges his followers to think “politics, politics, politics,” a squishy mantra that, in practice, translates into an exaltation of opportunism. The failure of Hacker and HCAN to object to the shrinkage of the “public option” by congressional Democrats, from a program covering half the population to one that might insure 1 or 2 percent of the population, documents that statement.
The fact that two-thirds of the American public supports single-payer does not mean the enactment of a single-payer system will be easy. It won’t be. But it does mean the new “yes but” justification for opposing single-payer, or indefinitely postponing active support for single-payer, is false and should be rejected.