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Willingness to accept Medicare for All policy hinges on its implementation, survey shows

While optional Medicare for All is popular among voters, many are wary of breaking from the traditional private insurance system.

Jeff Lagasse, Associate Editor

Medicare for All is a policy proposal that's been getting a lot of attention, thanks to a handful of Democratic presidential candidates who support it in one form or another. But is it gaining traction with the voting public?

Based on new surveys in a HealthPrep Data Service report, the answer suggests it's largely dependent on whether Medicare for All is optional or mandatory.

A Medicare for All option -- such as the one proposed by candidate Mayor Pete Buttigieg -- enjoys a 2:1 preference against mandatory programs proposed by Senators Elizabeth Warren and Bernie Sanders. Voting age Americans would prefer no change at all to the current private health system over mandatory Medicare for All.

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Optional Medicare for All was the most popular policy among respondents to the poll, at 45.4%. Keeping the current private system intact came in second at 33.3%, while a mandatory Medicare for All system garnered the least support at 21.2%.

This suggests that, while there's public support for a shift to some form of universal healthcare, voting age Americans are wary of a complete break from the current system. In short, a majority of voters reject mandatory Medicare for All, while a majority supports a Medicare for All option.

In a further breakdown of the numbers, no demographic segment of the population -- by age, sex or region -- preferred the mandatory Medicare for All policy over the Medicare for All option. Medicare-based healthcare reform moves from majority support to majority opposition based on whether its implementation is optional or mandatory, respectively.

Given a choice between single-payer Medicare or the existing private health system, voting age Americans choose the existing system. And compared to a public option or no change at all, Medicare for All is extremely unpopular.

The surveys focused on Democratic policy proposals since the current administration, as well as congressional Republicans, are all but unified in their opposition to any kind of single-payer system, instead favoring approaches to expand health coverage by leveraging market forces.


Medicare for All has been a hot topic among Democratic presidential hopefuls, but the public isn't the only one in opposition.

Insurers oppose it for obvious reasons: It would eliminate private insurance, at least if it was mandatory. Providers also oppose it, saying it would ultimately result in lower reimbursement.

Sanders and Warren have been the most outspoken about their support for a mandatory Medicare for All system, whereas Buttigieg favors a Medicare for All opt-in that would retain private insurance models for those who want it. Former Vice President Joe Biden supports a public option such as Medicare for those who choose the coverage, offering premium-free access only for those who would otherwise qualify for Medicaid, but live in states that have not expanded Medicaid under the Affordable Care Act.

Traditional Medicare is fee-for-service, which is at odds with the value-based care paradigm being promoted by the Centers for Medicare and Medicaid Services, in which reimbursement is tied more to care quality than to volume.

Twitter: @JELagasse

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