In this episode, we are joined by Caroline Pearson, Senior Fellow at NORC at the University of Chicago, to discuss their recent survey that studied American’s perceptions of and knowledge about Medicare-for-all.
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Highlights of this episode include:
- Background behind NORC’s study with AmeriSpeaks that surveyed over 1,000 Americans aged 18+.
- What the current Medicare-for-all landscape in Congress looks like right now.
- The surprising results on how many Americans surveyed have not heard about a Medicare-for-all proposal.
- Why those surveyed are divided on how participation in a Medicare-for-All plan would work.
- And more…
Mike Passanante: Hi, this is Mike Passanante. And welcome back to the Hospital Finance Podcast.
During the 2018 elections, many democratic candidates and seated members of Congress came out in support of a Medicare-for-All plan. However, that idea means different things to different people.
To discuss a recent survey that looked at perceptions of Medicare-for-All, I’m joined by Caroline Pearson who is a senior fellow at NORC at the University of Chicago. In this role, she generates insights for a diverse set of stakeholders by applying NORC’s rigorous analytics and research capabilities, innovative solutions, and deep subject matter expertise to critical topics in healthcare.
Caroline, welcome to the program.
Caroline Pearson: Thanks so much for having me.
Mike: Caroline, for those who are not familiar, could you tell us a little bit about NORC and what you do there?
Caroline: Yeah, absolutely. NORC is an objective non-partisan research institution. And we help governments, non-profits and businesses make better decisions through data and analysis.
Mike: Sure enough! And as I’ve mentioned at the head of the podcast, you did a study recently on Medicare-for-All. But before we dive into that study, could you just talk to us a little bit about the Medicare-for-All landscape as it stands in Congress right now.
Caroline: Absolutely. Well, as your listeners probably know, Medicare-for-All was a very important topic for democrats who were running in the 2018 elections. And I certainly expect that it’s going to be a central issue throughout the presidential campaign for 2020.
At this point, we have at least eight legislative proposals in Congress. And we know that there’s more in the way. And those proposals vary widely in terms of who’s eligible to participate in the Medicare-for-All program, whether their enrollment would be mandatory or optional, and then what the coverage and benefits would be.
So, the range is wide. On the one hand, you’ve got bills like that introduced by Senator Bernie Sanders where he would actually eliminate all private coverage. He would require all Americans to enroll in Medicare. And then you’d see enhancements to the benefits including no cost-sharing for any of the medical services people receive.
At the other end of the spectrum, we’ve got some plans that are more incremental. And they would really extend Medicare just to subsets of people—for instance, older people over 50 or 55—and they’ve given them the option to enroll in Medicare basically as it exists today.
So, you really run the gamut with the proposals thus far.
Mike: Yeah. And if memory serves, when they talked about the exit polls from those mid-term elections, healthcare was still the number one issue among most voters, wasn’t it?
Caroline: Yes, healthcare has been and remained a very important issue among voters, particularly among democratic voters. And I think that’s one of the reasons that you continue to see democrats bringing new ideas to the table despite the fact that the ACA was really the dominant issue in prior elections.
Mike: Yeah, no doubt. So, let’s dive into this study. Can you briefly explain just what you were looking at and trying to get at with this particular study?
Caroline: Sure. So, given all of the public discussions about Medicare-for-All and the wide variety of proposals that have been put forth from lawmakers, we really wanted to understand what the general public thought that this plan was. And when they heard the words “Medicare for all,” what would it mean to them?
So, we conducted a survey using our AmeriSpeak panel which is a nationally represented panel of households in the US. And we basically asked people what they thought about a plan called Medicare-for-All, what have they heard about it, what did they think it was going to mean, and what would the impact be for them.
Mike: Yeah. And I guess perhaps you and I being mired in healthcare in the way that we are, we hear about this all the time. But the survey showed that maybe not everyone has heard about Medicare-for-All, isn’t that right?
Caroline: That’s right. I was definitely surprised to see the results. Forty-six percent of adults indicated that they had heard nothing at all about a Medicare-for-All plan. And only 13% of respondents said that they heard a lot about the plan. So awareness is definitely lower in the general public than it is among healthcare experts and policy [locks] I guess.
Mike: And so, among those who had some perception of Medicare-for-All, it seemed like there was also a diversity in who they thought should be or might be included in a Medicare-for-All scenario. Can you talk to us about that?
Caroline: Yeah, people were really all over the board in terms of what they thought Medicare-for-All would mean. First, we said, “Who do you think would be eligible?” And about half of people said that they thought all Americans would be eligible. And that sort of makes sense given the name, Medicare-for-All. But the other half were divided.
About a quarter of them assumed that only older people, people over 50, would be eligible. The other quarter of people assumed that would only be a plan for place who didn’t have access to other insurance.
People were similarly divided about whether participation would be mandatory or optional. So, 41% of people thought enrollment would be required, 55% thought it would be optional. But those numbers vary somewhat based on how much people actually said that they had heard.
So, folks who knew a lot about the Medicare-for-All plan were more likely to believe that it would be a mandatory program.
Mike: Okay. So no one has coalesced around the idea of universal coverage in other words. It could be something that’s voluntary in some people’s minds.
Caroline: That’s right. And I think it’s this divide between the name does imply that it would be universal coverage. But when folks think about what’s really going to happen, they sort of assume, “Well, I don’t think it would change anything for me. That’s probably a plan for somebody else.” And I think we’re starting to hear that dichotomy come out in the public debate.
Mike: You also asked about concerns for various types of healthcare issues. And then, you went on and asked how Medicare-for-All might impact those issues. There’s a lot of data there. Can you break that down for us? Just explain what you looked at there.
Caroline: Yeah, absolutely. So first, we wanted to understand when people think about what’s wrong with healthcare, what are they most worried about? And far and away, the thing that people said they were most concerned about were consumer out-of-pocket costs, how much do I have to pay to receive medical services and can I afford it.
Second issue was also something that was very personal to people, it was which services are covered. So breadth of coverage and the cost to me were the number one issues.
Things that ranked lower on the list were bigger societal issues, the amount that the US spends on healthcare, the quality of care. Those were not things that rated as highly in terms of people’s concerns.
So, based on that, we then said, “Okay, tell us what you think a Medicare-for-All plan would mean for some of these issues. Would things get better or would they get worse under Medicare-for-All?” And generally, people were reasonably positive that Medicare-for-All would expand coverage and that it would lower patient out-of-pocket costs. People disproportionately thought more people would be insured, out-of-pocket costs would be lower. And the breadth of coverage for services would be expanded.
On the flip side, folks who did assume that the amount that the United States is spending in healthcare in total would increase as a result of a Medicare-for-All plan.
Mike: It’s interesting. It sounds like similar goals to the ACA in terms of lowering out-of-pocket costs or widening coverage, how does that square up to this type of proposal in your mind, Caroline?
Caroline: Yeah, I think it’s such an interesting question. And politicians, as they talk about this, are going to have to decide what problem they’re trying to solve. You can solve the coverage problem and get more people insured with broader coverage. But that’s a different solution than one that seeks to reduce the total healthcare costs in the country. And in fact, all of those details are still in play based on which particular proposal you look at. And I think we really need to decide what’s the priority. If we want to reduce costs, the levers that you pull for that are going to be different than what we did in the ACA which was largely a bill that was about coverage.
Mike: Great perspective, Caroline, and a very timely survey. If our audience would like to learn more about this survey, where can they go?
Caroline: Absolutely! We’ve got all of our results posted on our website at NORC.org. You can click there to read the press release as well as dig into more of the data that we weren’t able to talk about today.
Mike: Caroline Pearson, thanks so much for joining us today on the Hospital Finance Podcast.
Caroline: Thanks so much! Great to be here.