Universal vs. Government Health Insurance

For more than a decade, health insurance has been one of the most salient public policy issues in the country -- from President Bill Clinton's proposals in 1993 for comprehensive reform to the current debate over changes to Medicare and several Democratic candidates' proposals for extended coverage. Two recent poll questions by ABC News and Gallup, however, provide seemingly contradictory assessments of the public's preferences.

ABC's results suggest that most Americans want a new universal government health insurance system, while Gallup's results suggest that most Americans want to maintain the current system. But the polling organizations asked different questions, which provide different -- but compatible -- insights into what Americans want.

 

When reminded that the current system leaves some people with no insurance -- and when also told that a new government-run health insurance system would cover everyone and be like the Medicare system -- Americans said they preferred the government system, by a 62% to 32% margin.

But when offered a simple choice between the current system, based mostly on private health insurance, or a government-run system, Americans rejected the government system by a margin of 57% to 38%. These figures represent a 49-point swing in opinion -- from a 30-point margin in favor, to a 19-point margin opposed.

Why such a massive swing?

The key appears to be conflicting feelings Americans have about a new universal health insurance system run by the government. They strongly favor the universal part, but balk at government participation.

Public Favors Universal Coverage

Public sentiment in favor of universal coverage is revealed by ABC's October poll, which showed 80% of Americans saying it is more important to provide healthcare coverage for all Americans than to hold down taxes.

Which of these do you think is more important: (providing healthcare coverage for all Americans, even if it means raising taxes) or (holding down taxes, even if it means some Americans do not have healthcare coverage)?

 

Gallup's poll in November provides reinforcing information that the public favors government involvement in obtaining coverage for all Americans, though the question is quite different from the one that ABC asked.

Do you think it is the responsibility of the federal government to make sure all Americans have healthcare coverage, or is that not the responsibility of the federal government?

 

In January 1994, toward the beginning of the national debate on health insurance, Gallup found public sentiment similar to what ABC recently found. According to a Jan. 28-30, 1994, poll, 79% of Americans said they would support "a healthcare reform package that guarantees every American private health insurance that can never be taken away," while just 16% were opposed. By August 1994, after much negative publicity about the Clinton health insurance plan, 69% of Americans still said they wanted a new healthcare program that guaranteed universal coverage.

Would you support or oppose a healthcare reform package that guarantees every American private health insurance that can never be taken away?

 

Public Is Cautious About "Government" Programs

The same Gallup survey in 1994 that showed 69% support for universal health insurance also found that a majority of Americans were more concerned about government involvement than about not obtaining universal coverage.

Thinking about healthcare reform, which of the following concerns you more: That Congress will pass a plan that gives the federal government too much control over the nation's healthcare system, or that Congress will pass a plan that does not guarantee health insurance for every American?

 

These results make clear that while Americans will express support for health insurance programs that cover everyone, they back off from such support when the specter of government "control" is raised.

The ABC question noted at the beginning of this column helped to tone down Americans' concerns about a government-run program because the question mentioned that everyone would be covered (which most people like) and that the program would be "like Medicare" (a government program that previous polling shows the vast majority of Americans like). Thus, the ABC results found a public with 2-to-1 support for a "universal health insurance program . . . like Medicare . . . run by the government."

Because the Gallup question mentioned only that the new program would be run by the government, the public's instinctive reaction was mostly negative.

So, can the polls tell us how people will react to real-world proposals for universal health insurance run by the government? Some clues are found in the public's reaction to the Clinton health insurance program in 1993-1994. Initially, most Americans favored the program, especially the provisions for universal coverage "that could not be taken away." But when Republicans launched ads criticizing the proposal for too much government control, support waned. And by August 1994, shortly before Congress voted on the various healthcare proposals, a majority of Americans opposed the plans that were being considered -- though they still expressed support for universal coverage.

These results point to the difficulty in polling on this subject. Given the public's strong feelings about universal coverage and government control, poll results will depend largely on the emphasis that each of the two items receives in the poll question. The difficulty is even greater for political leaders in favor of a new universal health insurance program. They know that the public favors such a program in principle, but will quickly balk at significant government involvement -- the only way such coverage can be guaranteed.