The Washington PostDemocracy Dies in Darkness

How do Americans feel about single-payer health care? It’s complicated.

Karen Vermilya waits to enter the “Our First Stand: Save Health Care” rally at Macomb Community College in Warren, Mich., in January. (Rachel Woolf/Getty Images)
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In the wake of the collapse of the Republican health-care proposal on Friday, there was an instantaneous effort by the progressive left to pick up the fumble and return it for a touchdown. As The Washington Post’s Dave Weigel reported, some Democrats quickly saw the failure as an opportunity to advance a long-held objective: a national, single-payer, health-care system matching those in countries such as Canada and Britain.

That effort was bolstered by tweets like this one, from progressive filmmaker Michael Moore.

“Remember this poll,” he tweeted, “the majority AGREE!”

But it’s not that simple.

Moore links to an article from The Post published in May, as the Democratic nominating contest was wrapping up. That article looked at polling from Gallup that presented respondents with a series of nonexclusive options for how the American health-care system might move forward: federally centralized health care, a repeal of the Affordable Care Act (i.e., Obamacare) or keeping Obamacare as the system.

Of those three, federally funded health care — that is, single-payer — was the most popular, with 58 percent support.

As is usually the case, members of the two parties were widely split on the choices. Single-payer emerged as the most popular in part because Republicans disliked it less than keeping Obamacare in place. (Fifty-five percent of Republicans opposed single-payer.)

At a town hall meeting in Vermont on Saturday, Sen. Bernie Sanders (I-Vt.) announced plans to introduce legislation pushing for single-payer. Rep. Peter Welch (D-Vt.), who plans to introduce similar legislation in the House, was realistic about such an effort’s chances, saying that “in this Congress, we won’t pass it, but I think we have to do keep the goal out there.” Given the results above and Republican control of Congress, Welch is clearly right.

But of recent polling on single-payer, Gallup’s results were the most generous.

A few months earlier, CBS News had asked about the idea (thanks mostly to Sanders having raised it during his campaign). Democrats, particularly Democrats who’d voted in or planned to vote in the party’s primaries, supported the idea of single-payer. Republicans broadly did not, and independents were, at best, split.

In CBS’s polling, under 50 percent of respondents approved of the idea. It’s worth noting, though, that the numbers had improved very slightly from when CBS asked in 2014. Then, the split was 43 to 50 against. Last year, the split was 44 to 47.

A more recent poll, conducted by the Associated Press and the NORC Center, offered much less favorable views of the issue. Asked if they support a single-payer system, 38 percent of respondents said they did — again with a big partisan split. But in this case, only 51 percent of Democrats favored the proposal.

Those results dropped dramatically when respondents were asked if they supported single-payer “if it would result in large increases in government spending.” At that point, only a quarter of respondents supported the idea — including a little over a third of Democrats.

One problem with polling on single-payer, and one reason that the results above vary so widely, is that the idea itself isn’t complicated but the ramifications may be. That point about costs, for example, resulted in a big shift in responses — and it’s an argument that would certainly be made by the legislation’s opponents. (Analysis of Sanders’s single-payer plan last year found that the senator from Vermont had likely underestimated the expense his proposal would incur.) That Gallup poll didn’t introduce the idea that costs might increase substantially.

Of course, none of these polls discussed the possible benefits for the system, either. Such details matter. While Republicans broadly support repealing Obamacare, support from the party for the specific proposal Republicans were hoping to pass last week was under 50 percent. Reports about the likely effects of the legislation clearly influenced members of the party (and nearly everyone else) against it.

There aren’t a lot of things that are universally agreed upon in American politics (infrastructure spending being one exception). A single-payer proposal certainly isn’t. The hope for Sanders and others on the left probably isn’t be that poll Moore cited but the one from CBS showing a small, slow change, which is the point Welch was making. To continue the analogy with which we started: Recovering the fumble itself might be progress, even if you can’t score right away.