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For 70 years, most Americans have supported single-payer government-run health insurance?
Americans are more politically polarized than they were a generation ago.
Yet consumer activist and four-time presidential candidate Ralph Nader argues in his new book that there is "an emerging left-right alliance" in the country that could "dismantle the corporate state."
Interviewed about the book on May 7, 2014, Nader told Wisconsin Public Radio host Joy Cardin that majorities of liberals and conservatives agree on a number of issues, such as raising the minimum wage.
Then he made an attention-getting claim about the enduring popularity of "single-payer" -- a health insurance system in which everyone is covered by the government and the government pays all the bills.
Nader’s quote is a bit jumbled, but his claim is clear.
"The reason why single-payer is not discussed -- even though a majority of the American people since Harry Truman days supported full Medicare for all, everybody in nobody out, free choice of doctor and hospital; very efficient, much more than the present wasteful system -- even though that is the status in terms of public opinion, it's not on the table," he said.
Wait. How often have most Americans agreed on any one thing for nearly 70 years?
And more specifically, has a majority of Americans supported single-payer -- or "Medicare for all," as Nader also referred to it -- dating back to the presidency of Harry Truman (1945-’53)?
Single-payer and politicians
Under single-payer, private insurers would be eliminated, although private medical providers would remain. Everyone would get health coverage from the government and government would pay all the bills. In that sense, it’s like Medicare, the federal health insurance program for people who are 65 or older and certain younger people.
Single-payer received mention in the debate during the run-up to Obamacare, which became law in 2010. But even some of its most prominent supporters have wavered on it.
In 2009, Obama earned a Half Flip on PolitiFact’s Flip-O-Meter. Compared to his earlier years in politics, Obama had moderated his statements in support of single-payer as he tried to appeal to a wider audience, our PolitiFact National colleagues found.
Similarly, after Republican former Gov. Tommy Thompson made single-payer an issue in the 2012 race for a U.S. Senate seat in Wisconsin, we gave a Half-Flip to Democrat Tammy Baldwin. Just before she defeated Thompson, Baldwin deflected questions about single-payer and said she was setting aside at least temporarily her efforts toward getting single-payer in place.
For his part, Nader -- who won 2.74 percent of the vote in the razor-thin 2000 presidential race -- cited through a spokesman portions of three articles to back his claim about the public’s support for the concept.
But none of the articles constitute evidence that most Americans have backed single-payer over the past seven decades.
A 1982 article in the New England Journal of Medicine, citing polls, argued that most Americans believed there was a "need for national health insurance and that it would require larger government intervention."
A 2003 article in the American Journal of Public Health said public opinion generally ran in favor of health care reform.
And a 2009 article by the Kaiser Family Foundation, a widely recognized authority on health care, said polls as far back as the 1930s show Americans have generally supported "the goals of guaranteed access to health care and health insurance for all, as well as a government role in health financing."
We wanted to know more about what polls have shown.
A Rasmussen Reports poll in April 2014 found that only 37 percent of Americans favored single-payer. And although the proposal has largely been out of the public debate since before Obamacare became law, earlier polling also didn’t find clear support.
In 2009, with the Obamacare bill being pushed in Congress, filmmaker Michael Moore said a majority of Americans favored a single-payer system. PolitiFact National rated his statement False.
Polls had consistently shown that a majority of Americans wanted some form of universal health care coverage — they want uninsured people to have insurance -- but there was wide disagreement about how to do that. For example, some people supported keeping the current the system, but with tax credits to help uninsured people buy private insurance, while others backed requiring employers to provide employee health insurance, or to pay into a government fund that would pay to cover those without insurance.
In other words, not majority support for a government-run health insurance system.
To get a longer view of the polling, we contacted two polling experts: Liz Hamel, the Kaiser foundation’s public opinion and survey research director; and Karlyn Bowman, a senior fellow at the conservative American Enterprise Institute.
Kaiser’s latest poll on single-payer, in September 2009, found that less than a majority of Americans -- 40 percent -- favored single-payer.
Conversely, seven other ways to expand health insurance coverage -- such as expanding Medicare or instituting an individual mandate requiring all Americans to have coverage -- all received higher levels of support.
Three years earlier, a 2006 Kaiser poll indicated possible majority support for single-payer -- but it was constructed as a limited either-or question:
"Which would you prefer -- the current health insurance system in the United States, in which most people get their health insurance from private employers, but some people have no insurance; or, a universal health insurance program, in which everyone is covered under a program like Medicare that's run by the government and financed by taxpayers?"
Fifty-six percent said they preferred a universal system.
Going back further, however, there was no such majority support.
In 2001, two directors of the Harvard Opinion Research Program reviewed more than 100 public opinion polls over a 50-year period. One key conclusion was that "most Americans remain satisfied with their current medical arrangements, do not trust the federal government to do what is right and do not favor a single-payer type of national health plan."
Given that it covered much of the period Nader referred to, that article is strong evidence refuting his claim. But we were curious about polling going back to the start of Truman's presidency. The results were mixed.
Two examples from that period:
On an either-or Gallup poll question in 1945, 53 percent said they favored "a plan set up by the government which would require every person to take part," while 34 percent preferred a voluntary plan "set up by the medical profession" and 13 percent had no opinion.
But when asked this question in 1949 -- "Should the U.S. Congress pass the government's compulsory health insurance program, which would require wage or salary deductions from all employed persons to provide medical and hospital care for them and their families?" -- the results were: Yes, 44 percent; No, 47 percent; No opinion, 9 percent.
Nader said a majority of Americans "since Harry Truman days" support single-payer health insurance, or "full Medicare for all."
While there are individual poll results dating back to 1945 that indicate majority support for single-payer, overall the results are mixed, at best. In fact, one review of more than 100 polls over 50 years found that most people opposed single-payer.
We rate the claim False.
To comment on this item, go to the Milwaukee Journal Sentinel website.
Wisconsin Public Radio, Joy Cardin interview of Ralph Nader, May 7, 2014
Email interview, Ralph Nader spokesman John Richard, May 8, 2014
Email interview, Kaiser Family Foundation public opinion and survey research director Liz Hamel, May 8, 2014
Email interview, American Enterprise Institute senior fellow Karlyn Bowman, May 9, 2014
PolitiFact National, "Michael Moore claims a majority favor a single-payer health care system," Oct. 1, 2009
PolitiFact Wisconsin, "Looking at Baldwin and a single-payer health care system for America," Nov. 1, 2012
PolitiFact Wisconsin, "Tommy Thompson says U.S. Senate rival Tammy Baldwin wants to go ‘far beyond Obamacare,’" Aug. 26, 2012
Kaiser Family Foundation, "National health insurance: A brief history of reform efforts in the U.S.," March 2009
Kaiser Family Foundation, "Health Care in America 2006 Survey," October 2006
American Journal of Public Health, "Health care reform and social movements in the United States," January 2003
Health Affairs, "Americans’ views on health policy: A 50-year historical perspective," March 2001
Rasmussen Reports, "37% favor single-payer health care system," April 28, 2014
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