Medicare-for-all and the Path to Public Judgment

Did Medicare-for-all damage Elizabeth Warren's presidential prospects? It's still early, but the case is growing stronger that her proposal to replace existing health care plans with an expansion of Medicare has diminished her support.

What gives? The answers aren't obvious. While a majority of Americans support a national health plan in which all Americans get insurance from a single government source, public support for Medicare-for-all shifts significantly when people hear arguments about potential tax increases or delays in medical tests and treatment. A good source for public opinion on the topic is the Kaiser Family Foundation, which tracks public opinion on health care.

The challenge in trying to understand public attitudes toward health care is not new. When public opinion pioneer Daniel Yankelovich presented his theory of public judgment in 1992, 77 percent of voters supported national health insurance. Then, as now, most people remained largely unaware of the more specific drivers of rising health care costs and plans to reign them in. Yankelovich pointed out that when public opinion is uninformed:

Many people express strong feelings, but vehemence does not mean settled views. Opinions at this stage are unstable, flip-flopping at the slightest provocation. People have not thought through the consequences of their views. Today, for example, most of the public remains mired in wishful thinking on protectionism and health care, resisting any attempt to confront with realistic information the costs and trade-offs each entails. Political candidates who act on the results of opinion polls on these issues will soon feel the ground give way under their feet.

This advice is just as relevant today as it was then. The takeaway for campaigns and companies is this: if you're offering a proposal for an issue as complex as health care, make sure you understand where your audience stands on the path to public judgment. Have they done the hard work of weighing tradeoffs and coming to a decision? Senator Warren is learning the complexity of public opinion right now, and the stakes couldn't be higher.