47% support a government-run system, the highest in Gallup's seven-year trend
Support for private insurance-based system is down to 48%
Attitudes about a "Medicare for all" plan split; majority has
no opinion
WASHINGTON, D.C. -- Americans' preferences for a government-run healthcare
system versus a system based on private insurance are now divided. This
marks a significant shift in attitudes from earlier this decade, when
Americans consistently preferred the private insurance option.
Since 2010, Gallup updates have shown as much as a 27-percentage-point
gap in favor of the private insurance system versus one run by the government.
That gap shrank to 10 points last year and essentially disappeared in
this year's survey, conducted Nov. 2-8, with 48% preferring the private
health insurance system and 47% preferring the government-run system.
This mixed reaction toward a government-run healthcare system is similar
to those seen in the past, when Democratic presidents proposed ways to
increase government involvement in healthcare:
Harry Truman proposed a national healthcare insurance system just after
World War II, but fierce opposition from the American Medical Association
and others kept it from becoming law. Americans initially supported the
idea but ultimately opposed it.
Lyndon Johnson proposed a government-based system for paying for healthcare
for senior citizens (Medicare) and those with low incomes (Medicaid),
which was passed into law. Surveys conducted in 1964 and 1965 found strong
support for the new program, making this the exception to the more divided
opinions on other healthcare proposals.
Bill Clinton proposed an elaborate national healthcare system in 1993,
which failed in Congress. The public -- as was the case for Truman's
proposal -- was initially in favor but ended up opposing the effort.
Most recently, Barack Obama oversaw the passage of the Affordable Care
Act in 2010.
Americans' attitudes toward the ACA have been mixed, tilting toward opposition for a number of years before
more recently shifting to net approval.
Given this Democratic legacy in promoting increased government involvement
in healthcare, it is not surprising that current attitudes are intensely
partisan. Two-thirds of Democrats and independents who lean Democratic
favor a government-run system. Three-quarters of Republicans and independents
who lean Republican favor a system based on private insurance.
Predictable and Large Partisan Gap in Views on Government-Run Versus Private
Insurance-Based Health System
Gov't.-run system
System based on private insurance
%
%
Republicans/Leaners
22
76
Democrats/Leaners
67
29
GALLUP, Nov. 2-8, 2017
Although the 22% of Republicans who support a government-run system is
low on an absolute basis, it is the highest in Gallup's seven-year
trend. Republicans' shift in attitudes accounts for most of the overall
increase in support for the government system in this year's update.
Americans Split on a Medicare for All System
Vermont Sen. Bernie Sanders in recent years has become a highly visible
Democratic politician calling for expanded government involvement in the
nation's healthcare system. He -- along with one-third of Democratic
senators -- recently introduced a Senate bill calling for a single-payer,
"Medicare for all," government-funded health insurance system.
Gallup's Health and Healthcare survey this year included a question
asking directly about support for this specific type of plan, including
an explicit "don't know enough to say" option. Although
most Americans choose the "don't know" option, those with
an opinion about the specific Sanders-type bill as described in Gallup's
wording are about evenly divided.
Majority Doesn't Know Enough to Have Opinion on "Medicare for
All," Single-Payer Health System
As you may know, some senators have proposed a "Medicare-for-all,"
single-payer health insurance program that would be administered by the
federal government and financed through taxes. Please tell me if you favor
or oppose this proposal, or if you don't know enough to say?
%
Favor
17
Oppose
21
Don't know enough to say
61
GALLUP, Nov. 2-8, 2017
Other survey organizations also have found generally mixed opinions about
a single-payer, government system -- although the results vary, depending
on how it is described. The high percentage who say they "don't
know enough to say" when that is a response option (as in Gallup's
wording) suggests that Sanders' efforts to promote a single-payer
plan throughout his run for president and over the past two years have
not made it a widely understood or familiar proposal.
Implications
The debate over the appropriate role for the U.S. government in delivering
healthcare has been on the nation's policy agenda for three-quarters
of a century. During this time, Americans' attitudes toward increasing
government involvement in healthcare -- in general and in reaction to
specific healthcare plans -- have been decidedly mixed.
Currently, the public is as likely to say they favor the concept of a healthcare
system run by the government as to favor a private insurance system, a
shift from all prior years this decade. These divided views suggest that
Americans have yet to be persuaded that either a government-run system
or a system based mostly on private insurance is the most desirable alternative
for addressing issues relating to healthcare access and cost.
The healthcare issue has been, and continues to be, highly partisan, with
debates over healthcare options among the most rancorous of the day. Republicans
continue to push for dismantling the ACA, while many Democratic senators
want to go beyond what the ACA does and institute a government-run, single-payer
system. The mixed guidance from the public shows that the challenge for
both sides remains persuading a significant majority of Americans that
their way is the right way.
Survey Methods
Results for this Gallup poll are based on telephone interviews conducted
Nov. 2-8, 2017, with a random sample of 1,028 adults, aged 18 and older,
living in all 50 U.S. states and the District of Columbia. For results
based on the total sample of national adults, the margin of sampling error
is ±4 percentage points at the 95% confidence level. All reported
margins of sampling error include computed design effects for weighting.
Each sample of national adults includes a minimum quota of 70% cellphone
respondents and 30% landline respondents, with additional minimum quotas
by time zone within region. Landline and cellular telephone numbers are
selected using random-digit-dial methods.
