with Paulina Firozi


There’s one thing Americans understand about Medicare-for-all: It would mean higher taxes.

But they’re otherwise pretty confused about what a single-payer health-care system could mean for them and their families.

Large sections of the public believe a Medicare-for-all-type system would result in smaller changes than what its leading proponents in Congress — Sen. Bernie Sanders (I-Vt.) and Rep. Pramila Jayapal (D-Wash.) — have proposed, according to a Kaiser Family Foundation poll released today

Majorities of Americans said they think that under a national health plan, people would still be paying premiums, deductibles and co-pays for health coverage and could keep their employer-sponsored plans — even though the system envisioned by Sanders and Jayapal and embraced by many of the 2020 Democratic presidential candidates would do away with all of that in favor of a single government-backed plan.

It’s not terribly surprising that Americans would have differing ideas of what Medicare-for-all would mean. Such a sweeping overhaul of the country’s patchwork health insurance system hasn’t been attempted before — and even though the 2020 contenders frequently mention it, they tend to shy away from details on exactly how the whole thing would work.

About half of the two dozen or so Democrats trying to unseat President Trump say they support some version of Medicare-for-all, according to this extremely helpful graphic from Paulina and our Washington Post colleagues Kevin Uhrmacher, Kevin Schaul and Jeff Stein. Eight of the candidates say they’d prefer some type of incremental approach, such as providing people with a public option among existing private plans.

But it’s telling that the candidate most favored in polls so far, former vice president Joe Biden, hasn’t jumped into the Medicare-for-all pool. His campaign hasn’t responded to requests from our colleagues to describes exactly where he stands on the matter, although he has expressed support for allowing everyone to buy into Medicaid. Last night at a candidate forum, "Biden outlined a new health-care proposal, which would build on the Affordable Care Act by increasing access for lower-income people," according to my colleague Chelsea Janes.

The Post's Amber Phillips:

Candidates who do promote Medicare-for-all-type ideas face a sizable public knowledge gap. As we’ve written before, Sanders and Jayapal have gotten relatively specific with how they'd like such a system to work, proposing to extend an extremely generous set of benefits to every individual with virtually no cost-sharing.

But Americans seem most familiar with the fact that Medicare-for-all would require massively higher taxes — and less familiar with some of its easier-to-sell components, such as its potential to close the country’s uninsured gap or its guarantee of affordable prescription drugs.

Larry Levitt, senior vice president at the Kaiser Family Foundation:

Some of the Kaiser poll’s findings:

— Seventy-eight percent of respondents, including 85 percent of Republicans and 78 percent of Democrats, said taxes for most people would increase.

— Despite the title “Medicare-for-all,” just 62 percent said all U.S. residents would have health coverage under Medicare-for-all, including 76 percent of Democrats and 45 percent of Republicans.

— Fifty-two percent said doctors and hospitals would be paid less under Medicare-for-all, including 42 percent of Democrats and 64 percent of Republicans.

— Just 39 percent said people who buy their own insurance wouldn’t be able to keep their health plans, including 24 percent of Democrats and 53 percent of Republicans.

— Twenty-seven percent said people wouldn't continue paying deductibles and co-pays when they use health services. That was virtually even for Democrats and Republicans.

Some Democrats appear cognizant of the political potholes posed by the phrase “Medicare-for-all.” House Ways and Means Chairman Richard Neal (D-Mass.) acknowledged to the Intercept last week that he encouraged his members to instead focus on ways to achieve “universal health coverage” at a hearing last week.

Like any big government program, Medicare-for-all probably would mean that wealthier Americans end up paying more for health care while poorer people would pay a lot less. Opponents love to emphasize the tax increases:

Conservative advocacy group FreedomWorks:

But Sanders and supporters of Medicare-for-all argue that the country’s overall health-care spending would still decline, because waste would be eliminated and people wouldn’t have to pay for private coverage any longer.

Our recent fact-checking video on whether Sanders's Medicare-for-all plan would save Americans money, as he claims:


AHH: The new Kaiser survey also found health care is the top issue most Democrats and Democratic-leaning independents want to hear about in the presidential primary debates that start next week.

The poll found 87 percent of that group says it’s “very important” for the candidates to talk about health care during the debates and 80 percent also said it’s “very important” for candidates to talk about issues affecting women. Gun policy came in second, with 72 percent saying they want to hear about it. 

The Kaiser Family Foundation asked respondents who said health care is at least somewhat important for the presidential candidates to discuss in the Democratic primary debates to elaborate on what they want addressed. Nearly 30 percent of Democrats and Democratic-leaning independents mentioned lowering people’s health costs, 8 percent mentioned lowering prescription costs, 18 percent mentioned increasing access to health care, 16 percent mentioned the Affordable Care Act and protections for individuals with pre-existing conditions, 15 percent mentioned single-payer and Medicare-for-all and 8 percent said reproductive health care services is an issue they want the candidates to discuss during the debates.

OOF: The latest health crisis is spreading from phone line to phone line. The rash of annoying robocalls has impacted hospitals across the country and created a constant interruption in a setting where every second counts, our Post colleague Tony Romm reports. When phone lines need to be available for incoming patients, the last thing hospitals want is a scam call tying up the line.

At Tufts Medical Center in Boston, administrators say they received more than 4,500 of these calls between 9:30 a.m. and 11:30 a.m. on April 30, 2018. Hospital officials say they were unable to block the incoming calls through the hospital’s telecom carrier.

“Administrators at other hospitals, cancer centers and medical research organizations around the country share Tufts’s robocall concerns,” Tony writes. “They fret that such a seemingly obvious tech malady has worsened in recent months and that government regulators and phone companies have been too slow to help. And they fear that robocallers could eventually outmatch their best efforts to keep hospital phone lines free during emergencies, creating the conditions for a potential health crisis.”

Another issue related to the calls that’s been hampering hospitals: Spammers often use a technique called spoofing, which means recipients see numbers that look similar to their own. Hospitals may believe the caller is a nearby patient. “They can't not pick them up,” Steven Cardinal, a top security official at the Medical University of South Carolina, told Tony. “They don't have any indicator it's a spoof until they answer it.”

OUCH: Since 2017, the federal government has given states $2.4 billion in state grants to address the opioid crisis.

But states are also struggling to tackle methamphetamine use that has spiked nationwide, and federal opioid funding can’t be used to treat meth addiction, Carmen Heredia Rodriguez, Elizabeth Lucas and Orion Donovan-Smith report for Kaiser Health News.

“Now I’m looking for something different,” David Crowe, the executive director of Crawford County Drug and Alcohol Executive Commission in Pennsylvania, told them. “I don’t need more opiate money. I need money that will not be used exclusively for opioids.”

“According to the most recent data from the Centers for Disease Control and Prevention, 11 states have reported that opioids were involved in fewer than half of their total drug overdose deaths in 2017, including California, Pennsylvania and Texas,” Carmen, Elizabeth and Orion write.

The methamphetamine use that’s rising across the country is also harder to address, with a narrower set of treatments available for meth addiction than for opioids.


— House Speaker Nancy Pelosi (D-Calif.) is already railing against the president for his comments about a new Republican health-care plan to replace Obamacare.

“The American people already know exactly what the President’s health care plans mean in their lives: higher costs, worse coverage and the end of lifesaving protections for people with pre-existing conditions,” Pelosi said in a statement, ABC News’s Mariam Khan reports.

She added: “President Trump has waged an assault on health care since the start, and continues to order the Justice Department to ask the courts to destroy protections for people with pre-existing conditions and strike down every other protection and guarantee of affordable health care for America’s families.”

Trump told George Stephanopoulos in an interview with ABC News over the weekend that health care will be a top issue during his reelection bid, vowing to release a new health care plan in “about two months. Maybe less.” 


— Senate Majority Mitch McConnell (R-Ky.) who has said tackling tobacco use is one of his priorities, has also had a decades-long relationship with the industry, NPR’s Tom Dreisbach reports.

A review of the senators history with the industry as well as of a trove of previously secret tobacco industry documents “found that McConnell repeatedly cast doubt on the health consequences of smoking, repeated industry talking points word-for-word, attacked federal regulators at the industry's request and opposed bipartisan tobacco regulations going back decades,” Tom writes.

He adds: "As a whole, ethics watchdogs say the documents raise questions about how McConnell is crafting legislation dealing with wealthy, powerful industries, even with millions of lives at stake.”

Even the Kentucky Republican's latest proposal on the issue — a bill introduced alongside Sen. Tim Kaine (D-Va.) to increase the legal age to purchase tobacco to 21 — may have been a move to follow the tobacco industry’s lead.

“In the month before McConnell announced his support for the measure, two government affairs executives at Altria donated to McConnell's Senate campaign,” Tom writes. “Some public health groups, such as the American Lung Association and the American Cancer Society Action Network, have praised the bill. But multiple antismoking groups have raised concerns about McConnell's bill and the industry's support for the legislation. The Campaign For Tobacco-Free Kids called for major changes to the bill. And the Preventing Tobacco Addiction Foundation has announced its ‘strenuous opposition.’”

— The Senate Health, Education, Labor and Pensions Committee is scheduled to meet this morning for a hearing on the Lower Health Care Costs Act of 2019, a bipartisan bill that was introduced by Chairman Lamar Alexander (R-Tenn.) and ranking Democrat Patty Murray (Wash.) last month.

According to prepared remarks sent to The Health 202, Alexander (R-Tenn.) will tout the bill’s transparency provisions and note its intention to reduce out-of-pocket costs for patients by ending surprise billing, eliminating gag clauses and banning pharmacy benefit managers from charging more for a drug than they paid for it.

"You can’t lower your health care costs until you know what your health care actually costs," Alexander will say, according to advance remarks shared with Health 202. "And third, it increases prescription drug competition — there are nine provisions to help bring more lower cost generic and biosimilar drugs to patients.”


— North Carolina Children’s Hospital will halt the most complicated heart surgeries following an investigation from the New York Times in which physicians and leaders at the institution expressed concerns about how patients fared after getting such a surgery there.

The hospital said yesterday it would stop performing these surgeries “until state and federal regulators and a group of outside experts complete investigations into the Chapel Hill institution,” the New York Times’s Ellen Gabler reports.

New data from UNC Health Care also found the mortality rate for patients who had heart surgery at the hospital continued to spike even as doctors made administrators aware of some concerns.

Ellen's initial report included secret recordings that revealed doctors' alarm over what was happening. “Would I have my children have surgery here?” one cardiologist asked in a clip.

— And here are a few more good reads: 



  • The Washington Post hosts FDA Acting Commissioner Ned Sharpless as well as Sens. Jack Reed (D-R.I.) and Shelley Moore Capito (R-W.Va.) at an event examining the latest developments in cancer prevention, detection and treatment.
  • The Senate Health, Education, Labor and Pensions Committee holds a hearing on the Lower Health Care Costs Act. 

Coming Up

  • The House Energy and Commerce Subcommittee on Oversight and Investigations holds a hearing on “Protecting Title X and Safeguarding Quality Family Planning Care” on Wednesday.
  • Politico hosts an event on “America’s Sky-High Drug Prices & the Role of Biosimilars” on Wednesday.
  • The House Oversight Subcommittee on Government Operations holds a hearing on “Ensuring Quality Health Care for our Veterans” on Thursday.
  • The House Energy and Commerce Subcommittee on Health holds a hearing on “Strengthening Health Care in the U.S. Territories for Today and Into the Future” on Thursday.

— A brief history of Trump’s germaphobia: 

In interviews over the past 25 years, President Trump has made his phobia of germs well-known. (The Washington Post)