The Popularity of Government-Run Health Insurance
The flipside of Americans’ loss-aversion about their current health coverage, discussed below, is that those people who have the opportunity to benefit from government-run health insurance tend to be much more loss-averse than those experiencing private sector insurance. The United States actually contains an interesting experiment in this issue because Americans over the age of 65 suddenly transition into the Canadian-style program known as Medicare (conveniently, Canada’s national health insurance program is also called “Medicare”). About a month ago Mark Blumenthal pointed out that customer satisfaction is much higher inside Medicare:
More importantly, the higher scores for Medicare are based on perceptions of better access to care. More than two thirds (70 percent) of traditional Medicare enrollees say they “always” get access to needed care (appointments with specialists or other necessary tests and treatment), compared with 63 percent in Medicare managed care plans and only 51 percent of those with private insurance.
As Ezra Klein noted yesterday you see the same thing internationally:
As you can see here, there are a variety of appealing models. People like Canada’s Medicare for All approach, just as people here like Medicare. What the Dutch do is quite different, is somewhat more appealing to the wonk’s sensibility, and is also quite popular. The UK approach which is, again, totally different and really does feature the dread “rationing” is also really popular. Nothing can quite beat the American system for producing widespread dissatisfaction.
31 Responses to “The Popularity of Government-Run Health Insurance”
Register
RSSLogin
Yglesias Tweets
Topic Cloud
ArchivesBlog RollAbout Matt YglesiasContact Me
Donate
July 29th, 2009 at 10:54 am
Of course this is a large part of why the GOP is fighting any sort of public option tooth-and-nail: the damn thing will undoubtedly be very popular!
July 29th, 2009 at 10:56 am
I don’t know much about Medicare Advantage, but I thought it was to be dismantled by most of the HC reform proposals being worked on. But it seems to have the highest cust sat ratings (though it’s supposed to me more expensive than straight medicare).
Anyone able to explain this? Esp since (per the chart) it’s managed care v. pay for service, which is one of the perverse incentives driving hc costs through the roof, or so I thought.
Just wondering.
July 29th, 2009 at 10:59 am
nice charts.
too bad we’ll never get any kind of meaningful reform.
July 29th, 2009 at 11:01 am
And some of them said this openly in 1993 and are saying it openly now. This is really what it’s all about.
Which makes it all the more stupid and enraging that the Blue Dogs are enabling them. Who’s going to get punished first if voters blame the Dems for screwing this up and turn against them in 2010? Blue Dogs in the districts that are the reddest shades of purple. I can only explain this apparently suicidal behavior by their being whores bought and paid for by their big donors.
July 29th, 2009 at 11:03 am
Seems that Medicare Advantage is the most popular coverage of them all. Perhaps we ought to be moving everyone into Medicare Advantage.
July 29th, 2009 at 11:06 am
Keep the government out of my Medicare!
July 29th, 2009 at 11:07 am
All health systems “feature the dread rationing” if ours does – there’s no country where patients can get all the treatments you can get in America, if you can pay for them yourselves, free on the state. This obviously includes America. But here in Britain we can still get all the treatments you can get in America, if we can pay for them ourselves, we just can’t get quite all of them free from the state. What doesn’t make sense about the “rationing” debate in America is that even in Britain we don’t have what people seem to be talking about – Government saying you can’t buy whatever you want and can pay for yourself. Even in Britain nobody ever suggests doing that!
July 29th, 2009 at 11:07 am
well, sure, but that’s because there’s so many more people in the US than in those countries!
July 29th, 2009 at 11:09 am
Of course, Democrats are NOT touting the wonderful advantages of Medicare because Medicare is $32 TRILLION in the hole and will go bankrupt in a few years if heavy taxes are not levied to support it.
Of course, the huge baby boomer generation is going to be FURIOUS when their expected benefits are cut deeply — they, after all , have been paying heavy payroll taxes for 40 FUCKING YEARS for these benefits.
But just like Bernie Madoff, Democrats have been running a Ponzi scheme — the premiums have been spent and the assets ain’t there.
One thing to remember: Bernie is HAPPY to go to prison — he wrangled a decent facility and he is PROTECTED by high walls, fences and armed guards from all those people he made promises to.
July 29th, 2009 at 11:09 am
Since when is Congress supposed to enact the Will of the People?
Congress exists for just one reason, to protect the riches of the wealthy.
Even if 95% of Americans were marching in the streets for single-payer health care, Congress would still NEVER enact it.
Why is anyone surprised?
July 29th, 2009 at 11:24 am
By the way, after the Democrats set up a massive healthcare system , will they ensure that –a few years from now — a Republican President and Blue Dog Democrats won’t steal $Trillions out of it and give the money to the Superrich as a tax cut?
The same way they stole $3 Trillion out of Medicare in 2001 to fund the $2 Trillion tax cut for the rich and the Iraq War.
Without a single fucking member of the Democratic Caucus so much as letting out a PEEP. Not even a strangled groan.
July 29th, 2009 at 11:36 am
How do you explain Medicare Advantage beating Medicare? Is it because people get both subsidized healthcare and greater choice of plans? In other words, something similar to what the administration is proposing?
July 29th, 2009 at 11:56 am
Oh, Al, you ever-reliable hack.
Medicare Advantage is basically a boondoggle designed by the GOP to give private insurers a piece of the pie from seniors. The insurers are prepared to give it up, mainly because they can’t believe they got away with it as part of the 2003 “reforms”, after a vote in which the Blue Cross Dogs’ sense of fiscal conservatism was notable by its absence.
Anyone able to explain this?
The providers get massive subsidies over the same services as provided by Medicare, so there’s plenty of motivation to keep people signed up to those plans satisfied.
So, now that Al’s shown that his fiscal conservative credentials are worthless, let’s see if he’s willing to accept healthcare reform that provides billions of dollars in subsidies, but passes them on to the general public instead of for-profit insurers.
July 29th, 2009 at 12:10 pm
Medicare Advantage offers an attractively-wrapped package promising no/low premiums, low copays, and a drug benefit, much like regular Medicare in a pretty wrapper. They specialize in enrolling relatively healthy patients and managing expensive (e.g. hospital) benefits aggressively to maximize their profits. We can’t afford to expand this program, as it costs substantially more per person than regular Medicare (even though they pay out less for care).
DTM hits the nail on the head — an easy-to-use, equitable health benefit would be horrible for the Republicans. Fortunately for them, it appears the Democrats are focusing on fiscal responsibility rather than improving the social safety net. If “reform” is perceived as another way government can help the average family, the Democrats will win big, but they don’t appear to be interested in that.
July 29th, 2009 at 12:19 pm
“Really does feature the dread ‘rationing.’”
There’s tension here. At the end of the phrase rationing gets postmodern scare quotes, but at the beginning you acknowledge it as part of reality.
July 29th, 2009 at 12:22 pm
You are surprised that people overwhelmingly like something that someone else pays for?
July 29th, 2009 at 12:24 pm
The United States actually contains an interesting experiment in this issue because Americans over the age of 65 suddenly transition into the Canadian-style program known as Medicare…
US Medicare is even more perniciously subversive than Matt describes it. Ir’s really a lot more like the French system than the Canadian, characterized as it is by national government management (as opposed to states/provinces), and top ups via private, supplemental policies.
July 29th, 2009 at 12:31 pm
First, Matt is a fucking moron. The most popular is Medicare Advantage which is a privately run health plan; essentially, it’s a voucherized system, with private benefits management provided at public expense. And Medicare’s satisfaction scores are, of course, a product of a system that is also to be dismantled. You always get the care you want? Not any more; that’s the purpose of the medipac-on-steroids “reform”.
July 29th, 2009 at 12:36 pm
People like their subsidized Medicare that pays for all sorts of specialists? Well, go figure! I’m sure there are profound lessons we can learn from that!
July 29th, 2009 at 12:38 pm
First, Thomas is either a fucking moron, a fucking hypocrite, or a fucking hack. He can get a diagnosis of which one applies via a Medicare Advantage insurer with a massive taxpayer subsidy.
July 29th, 2009 at 12:40 pm
MY “What the Dutch do is quite different, is somewhat more appealing to the wonk’s sensibility”
No kidding. Keep it complex so only 10 politicians and 200 pompous wonks know what the hell is going on. Job security. Too smart Yglesias.
July 29th, 2009 at 1:41 pm
By the way, I assume everyone is aware of this already, but in case not: the House Democratic leadership worked out a deal with four of the Blue Dogs on Energy and Commerce, and a bill (with a public option) will move out of committee this week. I personally think the terms of the deal are fine on their own, although of course every little concession now is one less concession that could be reserved for later in the process. Still, if I had to bet, I’d say something like the Senate HELP bill is where this is all heading in the long run.
July 29th, 2009 at 2:17 pm
I suppose I’d be pretty satisfied with something that I got for free as well. There’s even a phrase for it. Something about a horse’s teeth . . .
Obviously if you pay for something, as I do for my health insurance and health care, you may ask for it to be better. If I get it for free, or paid for by others, then I am less apt to bellyache.
July 29th, 2009 at 2:50 pm
people usually perfer subsidised loans i know i do
July 29th, 2009 at 3:50 pm
I wish we could have a pole of people who want the government to give them 1,000 bucks. Clearly the government must act!
Looking at the study, this was interesting:
Can we get an independent source at least? I remember Michael Moore actually believing Cuba had the lowest premature death rate in the world to explain why Cuba was fucking awesome!
And how many people actually bought private insurance themselves? Would be nice to to make an attempt to tease out those statistics before flatly saying private insurance is a failure, when it’s an employer based system people have no financial incentive to opt out of.
Further investigation turns up this chart of how people rate their “health care” not to be confused with “health plan.”
https://www.cahps.ahrq.gov/content/NCBD/Chartbook/HEALTHPLAN08/cahps08chart18.htm
People rate private insurance slightly better than Medicaid, and slightly worse than Medicare. Hardly conclusive.
July 30th, 2009 at 12:40 pm
Wonder what’s gone wrong in Germany.
July 30th, 2009 at 12:53 pm
As with several poll numbers published, there can be some interesting interpretations of this information. For example, could it be that since Americans actually pay for their medical care that they expect more from the system, and thus may seem less satisfied? There’s also a possibility that the questions were asked in different ways as to sway the answers. Who did they poll? How large was the polling pool? In any case, polls do not sway my views anywhere near actual evidence (statistics on actual coverage, etc).
July 31st, 2009 at 9:09 am
[...] posts by Kevin Drum (Mother Jones), Mark Blumenthal (National Journal), Matt Yglesias, and Ezra Klein (Washington Post) all draw conclusions from comparisons that potentially suffer [...]
July 31st, 2009 at 2:01 pm
[...] medicine is akin to socialism and would be disastrous. But the government already runs several successful, well-loved health care programs — most notably, Medicare. Yesterday, Rep. Anthony Weiner (D-NY) decided that it was [...]
July 31st, 2009 at 3:38 pm
[...] is akin to socialism and would be disastrous. But the government already runs several successful, well-loved health care programs — most notably, [...]
August 1st, 2009 at 9:08 am
[...] medicine is akin to socialism and would be disastrous. But the government already runs several successful, well-loved health care programs