Americans still aren't on board with universal health insurance

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Colin LalleyContent Director, Home & Auto InsuranceColin Lalley is the content director for home and auto insurance at Policygenius, where he's been writing about insurance since 2015. His insights have been featured in Inc. Magazine, Betterment, Chime, Credit Seasame, Zola, and the Council for Disability Awareness.

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Only 37% of Americans believe health care is a right, according to a new Policygenius survey. Moreover, 31% aren’t willing to pay anything extra in taxes for health insurance that covers all medical expenses, including dental and vision care, for them and their dependents.

In fact, 57% are unwilling to pay more than $1,000 a year — or $83 a month — for fully funded health care. That price tag is much lower than what Americans currently shell out just to have health insurance through work.

Data from the Kaiser Family Foundation shows that, in 2017, people who have employer-sponsored health insurance contributed around $1,204 and $5,817 in annual premiums for individual and family plans, respectively. That breaks down to around $100 and $485 a month, and doesn’t even account for what Americans pay out-of-pocket for doctor visits, prescription drugs, and other medical care.

Americans are confused about health care

Part of Americans’ unwillingness to pay for universal health care is they may not understand just how much they’re currently paying for their coverage. Earlier this year, a separate Policygenius survey found many people don’t know the basic tenets of health insurance, such as open enrollment dates or plan requirements. The lack of understanding may extend to the cost of health insurance, and overall long-term savings an alternate health care system might provide.

However, Policygenius’ survey results underscore another aspect of the debate over the U.S. health care system.

“People don’t want to pay for other people’s health insurance, even if that might lead to an overall more affordable system for everyone,” Jennifer Fitzgerald, Policygenius CEO and cofounder, said.

How much for single-payer health care?

Former President Barack Obama’s health care law, colloquially called ‘Obamacare’, but officially named the Affordable Care Act (ACA), has had a rough go since its inception. Attempts to overturn or severely neuter it have ramped up since the 2016 presidential election. They’ve mostly failed, but made the future of the law unclear. That’s prompted the question: What could come next? Do we regress to a private pre-Obamacare system, or has the fight for the law and the surprising resonance of Sen. Bernie Sanders, I-Vt., pushed us closer to a universal single-payer system?

Over the summer, the Kaiser Family Foundation noted “modestly strong” support for a single-payer system while cautioning that it was “malleable”. Depending on the wording of questions and the arguments against a single-payer system, people were still easily swayed from it.

However, Policygenius’ recent survey measuring sentiment toward health insurance suggests “easily swayed” is an understatement.

A test case

Take Sanders’ “Medicare for All”, for example. The plan — which closely resembles the fully-funded medical, dental and vision insurance our survey proposed — would cost an estimated $1.4 trillion a year. Based on some quick calculations, with 139.6 million taxpayers in the U.S., funding works out to about $10,100 per person each year.

There’s obviously some nuance missing here. Not everyone pays the same in taxes and high-income earners would, theoretically, bear more of the burden. Still, given only 5.3% of survey respondents said they are willing to pay over $10,000 more in taxes for health care, it’s clear people aren’t willing to pony up the money to make it work.

Health care is personal

There’s no doubt a financial component at play — $10,000 isn’t a small amount of money, especially given the median household income in the U.S. was $59,039 in 2016.

But those at the lower-middle end of the income spectrum were more willing to contribute tax money to pay for fully-funded health care than those at the top. Twenty-seven percent of those making over $150,000 annually would contribute $0, compared to 17% making $35,000 to $50,000. Meanwhile, 25% of people making $75,000 to $99,000 a year would contribute $2,000 to $5,000 a year, compared to 20% making over $150,000.

Those results would be surprising if the case for a single-payer health insurance system was based more on financial gain and less on ideology. The core argument is people shouldn’t die simply because they’ve been priced out of care, and as a society, it’s worth the money to make sure it doesn’t.

“To support universal health care, Americans have to buy into the idea that health care is a right,” Fitzgerald said.

Most Americans, however, simply don’t feel that way. When asked what is a right of all Americans, regardless of income — including public utilities like clean water, roads, police and fire services, public education, and trash pickup — fully paid health care was near the bottom. Only 37% of Americans considered it a right. The only utility that ranked lower was trash pickup, at 30%. Public education ranked highest, with 62% of people considering it a right.

The demographics supporting universal health care

Just as we’ve seen in political debates, sentiment around health care was clearly divided along party lines.

Far fewer Republicans considered fully paid health care a right of all Americans compared to any other political affiliation: Just 20% of Republicans believed this, compared to 69% of Democrats, 43% of Independents, and 36% of those who don’t affiliate with any party.

Democrats were also willing to pay more for fully-funded health care. Just 13% of Democrats said they wouldn’t pay any additional taxes to fund universal health care, compared to 30% of Republicans, 24% of Independents, and 35% of those who don’t associate with a party.

“The ACA has improved the coverage situation in America, but it isn’t a perfect health care system,” Fitzgerald said. “As we continue to debate how to improve it, how to repeal it, or what the next generation of health insurance looks like, it’s important to take into account what people want and what they expect. And a single-payer system may not be in the cards.”

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