Sorry, Republicans, but Most People Support Single-Payer Health Care

By Catherine Rampell, The Washington Post

22 April 17

espite the rise of the tea party and unified Republican control of government, one decidedly anti-free-market idea appears ascendant: single-payer health care.

And it’s no wonder, given that a record-high share of the population receives government-provided health insurance. As a country, we’ve long since acquiesced to the idea that Uncle Sam should give insurance to the elderly, veterans, people with disabilities, poor adults, poor kids, pregnant women and the lower middle class.

Many Americans are asking: Why not the rest of us, too?

A recent survey from the Economist/YouGov found that a majority of Americans support “expanding Medicare to provide health insurance to every American.” Similarly, a poll from Morning Consult/Politico showed that a plurality of voters support “a single payer health care system, where all Americans would get their health insurance from one government plan.”

Divining the longer-term trend in attitudes toward this idea is difficult, as the way survey questions on the topic are asked has changed over time. Views of a health-care system in which all Americans get their insurance from the government single payer vary a lot depending on how you frame the question. Calling it “Medicare for all,” for example, generally elicits much stronger approval, while emphasizing the word “government” tends to depress support.

But at the very least, some survey questions that have remained consistent in recent years show support has been rising back up over the past few years for the broader idea that the federal government bears responsibility for making sure all Americans have health-care coverage.

In a way, stronger public support for single payer is the logical conclusion of recent health-insurance trends.

Since 1987, the share of Americans who receive some sort of public insurance has roughly doubled, to about 4 in 10  as of 2015. That’s not even counting the people who receive subsidies to buy private insurance on the Affordable Care Act exchanges.

The increase in the share of Americans on government insurance is partly due to demographics (baby boomers aging into Medicare) and partly due to deliberate policy changes growing the pool of Americans eligible for government insurance (such as the creation of the Children’s Health Insurance Program and Obamacare’s Medicaid expansion).

Expansions of government coverage have been cheered on by many liberals, but they have also bred suspicion and jealousy.

In both the recent YouGov and Morning Consult polls, for example, the age group most opposed to single payer was the only one that basically already has it: those 65?and up. In other words, single payer for me but not for thee.

That’s not because older Americans hate their experience with Medicare and wouldn’t wish something similar upon their worst enemy. To the contrary, those on Medicare are more satisfied with how the health-care system works for them than people on private insurance are, according to Gallup survey data.

Rather, seniors are probably worried that expanding government coverage to more Americans could put their own generous benefits at risk. That is, they want single-payer enthusiasts to keep your government hands off their Medicare.

Many of those not among the growing pool of public-insurance beneficiaries, on the other hand, have become resentful of the fact that everyone else seems to be getting a big fat government handout. Or so they perceive.

Many of the stories in the booming “blue-state reporter ventures into Trump country” genre have featured Trump supporters with deep hostility toward Obamacare, among other government programs. Some of these Trump supporters are, perhaps puzzlingly, themselves Obamacare beneficiaries, receiving government subsidies for private insurance on the individual exchanges. But often what these Trump voters say they want is not a return to pre-Obamacare days; rather, they want in on the great insurance deal that they think their lazy, less-deserving neighbors are getting.

In fact, that recent YouGov poll found that 40 percent of Trump voters support expanding Medicare to all Americans. Among Republicans overall, the share rises to 46 percent. 

Among Republican politicians, needless to say, attitudes are somewhat different.

Expanding public health coverage to more people costs a lot of money, which doesn’t exactly jibe with their tax-cutting agenda. House Speaker Paul D. Ryan (R-Wis.) and his congressional compatriots seem to further believe — despite all evidence to the contrary — that the private sector is on the verge of some innovation that will magically reduce health-care costs and give all Americans the coverage and care they yearn for. 

But it’s probably not fair to paint Republicans as the only roadblock here. Even Democrats don’t have the stomach for the battle required to replace our jury-rigged, mostly employer-sponsored insurance system with single payer. Which is understandable — while I also favor universal health-insurance coverage, I’m skeptical it will be achieved through single payer, given both the state of our political process and Americans’ cultural allergy to tax hikes.

Science in America

By Neil deGrasse Tyson, Neil deGrasse Tyson's Facebook Page

22 April 17

century ago Albert Einstein laid the theoretical foundation for the laser. Many will argue that all science should be practical, with tangible stated benefits to society. But history shows this posture to be frankly, naïve. When Einstein derived his equations, I’d bet neither he nor anyone else was thinking “Barcodes!” or “Lasik Surgery!” or “Rock Concerts!”

Consider the 1920s, when quantum physics was discovered. It was obscure and esoteric in its day, but now, there’s no creation, storage, or retrieval of digital information without an understanding of the quantum. By some measures, IT drives more than one third of the world’s GDP. Delay that research two decades, you might only now be getting your first email account. Cancel it altogether for being frivolous, and the AM radio continues as a major item of furniture in your living room.

Science has only one goal: to determine the world’s objective truths. Meanwhile, like anybody else, scientists are susceptible to bias that can distort one’s own observations and judgments. Self-aware, scientists specifically constructed methods and tools to minimize, if not remove entirely, the chance that a researcher thinks something is true that is not, or that something is not true that is. Furthermore, you’re famous overnight if you can show conclusively that someone else’s idea is wrong. Yes, the entire enterprise thrives on built-in, error-checking mechanisms.

This means scientific truths emerge by consensus — not of opinion, but of observations and measurements — rendering the research that falls outside of consensus the shakiest possible grounds on which to base policy. Politics is not a foundation on which you base your science. Science is a foundation on which you base your politics, lest you undermine a functioning, informed democracy.

In 1862 Abraham Lincoln, a Republican, understood this. A time when he clearly had other concerns, Lincoln creates the Land-grant university system, transforming education and agriculture in America. And in 1863 he creates the National Academy of Sciences (NAS), an independent, multidisciplinary group of researchers tasked with advising our government in all ways science matters to its needs.

With the help of Congress, the run of US presidents with enlightened scientific foresight through the 20th century crosses the left-right political aisle like an Alpine slalom skier:

In 1916 Woodrow Wilson, a Democrat, creates the National Park Service, an idea championed by Theodore Roosevelt, a Republican.

In 1930 Herbert Hoover, a Republican, creates the National Institutes of Health (NIH). Harry S Truman, a Democrat, creates the the National Science Foundation (NSF) in 1950.

In 1958 Dwight D. Eisenhower, a Republican, creates the National Aeronautics and Space Administration (NASA).

In 1962 John F. Kennedy, a Democrat, announces we’re going to explore the Moon. We do that, and discover Earth for the first time.

In 1970, with Mother Earth now on our radar, President Nixon, a Republican, creates the Environmental Protection Agency (EPA), and later that year, the National Oceanic and Atmospheric Administration (NOAA).

In the mid 1990s, Bill Clinton, a Democrat, boosts R&D funding that enables an exponential growth of the internet, as tens of millions of Americans come on line.

The creation of the NSF deserves some exposition. It was inspired by the 1945 report Science: The Endless Frontier. Written by Truman’s science advisor Vannevar Bush, the report compellingly argues for government-funded science as a driver of our wealth, our health, and our security. He further notes, “A nation which depends on others for its new basic scientific knowledge will be slow in its industrial progress and weak in its competitive position in world trade, regardless of its mechanical skill.” Bush also observed, “In 1939 millions of people were employed in industries which did not even exist at the close of the last war.” America in the 20th century would become the world’s largest economy, leading in every important category of innovation and production.

Meanwhile, did you ever wonder who conducts science in America? From 1900 onwards, on average about 10% of Americans have been first-generation immigrants. Yet first-generation immigrants have won 33% of all American Nobel prizes in the sciences since the award began in 1900, representing thirty-five countries from six continents. So immigrants to America are three times more productive at winning Nobel prizes than population statistics would predict.

Do you prefer one branch of science over another because you think its discoveries will be more useful in coming years? Consider that in hospitals, every machine with an on/off switch that diagnoses your health without first cutting you open, is based on one or more principles of physics, discovered by physicists and chemists who had no specific interest in medicine. This includes the MRI, PET scans, CT Scans, EKGs, EEGs, ultrasound, and of course, good old fashioned X-rays. So if you defund one line of research in favor of another, you thwart the entire moving frontier of discovery. In the end, nature cross-pollinates all sciences, so perhaps we should too.

To reclaim America’s greatness, anyone with business acumen could think of science investments within our various government agencies as the R&D of a corporation called the USA. Science is not a Liberal Conspiracy. It’s not even bi-partisan. Science is a fundamentally non-partisan enterprise that serves us all. Without it, watch America fade from relevance on the world stage, as we gasp for an era of scientifically enlightened governance to rise once again.