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How Americans Split on Health Care: It’s a 3-Way Tie


Where the groups differed was in how a universal health care system should be achieved. Eighty-five percent of the Medicare for all enthusiasts thought it was the responsibility of government to ensure all Americans had health coverage. Only 73 percent of those supporting more incremental Democratic reforms agreed. Among those supporting the Republican plan, the number was 20 percent. Sixty-five percent of people in that group said the government should become less involved in health care in the future.

On many questions about policy and values, there was broad overlap between the supporters of Medicare for all and supporters of a more incremental approach to coverage expansion. And many survey respondents struggled to express a strong preference between the two choices.

Those factors lead Mr. Blendon to believe there are immediate opportunities for Democrats to devise a plan with broad appeal. The underlying shared values endorsed by supporters of both Democratic approaches — about rights to health care, protections for the sick, and a larger role for the government in ensuring equity — could be paired with a more modest set of policy changes.

In the long term, however, the appeal of Medicare for all may hinge on how well the current health care system serves the public. Recent research has found that employer health plans, the most common and popular form of health insurance for working-age Americans, have become substantially less affordable. More Americans are now what experts call “underinsured,” meaning that their coverage still leaves them exposed to a damaging financial hit if they get sick. If those trends continue, a greater share of Americans may find themselves dissatisfied with the system and fearful about how it will treat them if they need it.

“Most Americans want everyone to have coverage, but some people are willing to sacrifice more to get there than others,” Mr. Blumenthal said. “The people who are willing to sacrifice more are the people who have less to lose.”

If the status quo gets bad enough, the number of people seeking big changes could grow.


The survey included landline and cellphone telephone interviews with 2,005 nationally representative adults. Interviews were conducted in English and Spanish. The margin of error is plus or minus 2.5 percentage points for most questions.

To divide the panel into the three groups, respondents were asked to select a favorite of three policies described as:

Changing our health care system so that all Americans would get health insurance from Medicare, which is now mainly for people age 65 or over and is paid for by taxpayers. This plan is often called Medicare for all.

Keeping the existing Affordable Care Act, also known as Obamacare, and passing additional legislation to improve how it works.

Replacing the Affordable Care Act, also known as Obamacare, with a new law that would give taxpayer funding to states to design their own health insurance systems with fewer rules.


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