Why Americans Don't Want Single-Payer

By Bernie Horn, Campaign for America's Future. Posted June 8, 2009.

No matter how good a single-payer system might be in theory, these voters are easily turned against any plan that they think might force them off their current health insurance. That’s what the 1994 “Harry and Louise” ads were all about—claiming that the Clinton plan would force Americans to “pick from a few health care plans designed by government bureaucrats.” The Harry and Louise ads thoroughly scared voters—and that’s why they were so effective.

How do we know this? Over the past two years, progressive groups have conducted an unprecedented amount of public opinion research about universal health care. Usually it’s the conservatives who have all the polling data. This time, our side has the upper hand. In fact, I believe progressive advocates have more polling, focus group, and “dial group” research on this than on any issue in history. That research shows that, even if a single-payer proposal starts out with a majority of Americans in support, it won’t hold majority support after the insurance industry clobbers it with ads.

When voters hear this debate, they already have preconceptions and stereotypes in their heads. A proposal that’s anything like single-payer makes them see negative images—long lines, surly bureaucrats, and denial of services. It will take years to “educate” voters that single-payer wouldn’t do that. And we don’t have years—if we fail to pass health care reform this year, the opportunity may not present itself again for a generation.

The bottom line is that in order to get persuadable voters on our side, our health care plan must give everyone the choice to keep their private health insurance if they want to. If voters think we’re giving them the Canadian or British health system, we lose—that’s why Obama talks about creating a “uniquely American solution.” And we also lose if voters think we’re offering “Medicare for All”—the phrase has been thoroughly tested and it just doesn’t work.

That brings us to the idea of a public health insurance option. If you support single-payer, the very best thing you can do is fight like hell for the public option. Just as Americans overwhelmingly want the choice to keep their existing private insurance, they also overwhelmingly want the option to enroll in a government-sponsored insurance plan.

Single-payer describes a financing system. It’s the most efficient system. But the important goal isn’t financing, it’s coverage for every American. A couple of years ago, Paul Krugman concluded that:

In an ideal world, I’d be a single-payer guy. But I see the chance of getting universal care, imperfect but fixable, just a couple of years from now. And I want to grab that chance.

I agree with the Nobel Prize-winner.

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Bernie Horns writes for the Campaign for America's Future

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