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Clarifying The Vocabulary That's Surrounding The Medicare For All Debate


When I went to New Hampshire recently to report on the Democratic debate over health care, I ran into an interesting statistic. According to one poll, 87% of Democrats support "Medicare for All." Sixty-four percent of Democrats support single-payer health care. Here's the catch - those two phrases describe basically the same thing. The language in this debate is murky, confusing and hugely consequential. So we've asked NPR health policy reporter Selena Simmons-Duffin to explain it for us.

Hi, Selena.


SHAPIRO: Is there any actual reason that somebody would want Medicare for All but not want single-payer? Or is this just purely confusion about what the words mean?

SIMMONS-DUFFIN: This is confusion about what the words mean.

SHAPIRO: (Laughter) OK.

SIMMONS-DUFFIN: The poll that you mentioned was done by the Kaiser Family Foundation. And I called up Liz Hamel, who runs polling there. Here's what she told me about how confused people are.

LIZ HAMEL: We asked people, have you ever heard the term single-payer? Do you think it means the same thing as Medicare for All? And pretty universally, people say, no, that doesn't sound like the same thing as Medicare for All.

SHAPIRO: But you're here to clarify, Selena. It basically is the same thing.

SIMMONS-DUFFIN: Yeah. Let me see if I can give a little nuance to it.

SHAPIRO: Please.

SIMMONS-DUFFIN: So if single-payer is a fruit, Medicare for All is a banana.


SIMMONS-DUFFIN: Single-payer is like a category of coverage. Medicare for All is a specific bill that was written by Senator Bernie Sanders.

SHAPIRO: I recall him saying he wrote the bill, yeah.

SIMMONS-DUFFIN: Yeah, he likes to say that. And it does things in a specific way, but it is a single-payer system.

SHAPIRO: OK. Another phrase we hear a lot on this debate is public option. Explain what it means and how that's different from single-payer.

SIMMONS-DUFFIN: So the idea of a public option was floated back in 2009 when the Affordable Care Act was getting debated. And the idea is, along with the private options that you might have through your employer or through the exchanges, there would be a way to buy into a government-run program, like Medicare.

SHAPIRO: It's an option. It's a choice people have.

SIMMONS-DUFFIN: It's an option. There's like a million different kinds of public options. Different candidates have different ideas on how it would work. Would you lower the age for Medicare? Would you create a different thing that's not Medicare or Medicaid that people could buy into?

SHAPIRO: Another confusing thing about these plans is that what people are calling Medicare for All actually makes Medicare look very different from what it is today, right?

SIMMONS-DUFFIN: Right. So Medicare for All is kind of a misnomer because Medicare doesn't cover a whole lot of things, like hearing and vision and dental, that this program would cover.

SHAPIRO: So it's like an evolved, different version of Medicare for All.


SHAPIRO: The way Republicans often characterize these proposals is government-run health care. And is that actually what candidates like Elizabeth Warren and Bernie Sanders are talking about?

SIMMONS-DUFFIN: No. They wouldn't be running the whole health care system. This is not the government owning hospitals and employing doctors. This is just the payment side of things. And I think that one way to clarify what single-payer means is if you think about it as if you're a doctor. So a patient comes in, and you give them health care. Who's paying you for that care? In this case, it wouldn't be Aetna and Cigna and Blue Cross and Medicaid. It wouldn't be all of these different kinds of insurance plans. It would just be one. You would have one...

SHAPIRO: The single payer...

SIMMONS-DUFFIN: ...Single payer.

SHAPIRO: ...The government.


SHAPIRO: So if somebody is watching a presidential debate and all of the different candidates on stage have all these different platforms and they're throwing around phrases that are hard for voters to understand, what does that mean for public opinion and actually people casting their votes?

SIMMONS-DUFFIN: Yeah. It's a really good question. And Liz Hamel, who I mentioned from the Kaiser Family Foundation, said that one thing she's noticed about this debate in particular is that it's malleable. So the way that you talk about Medicare for All changes how positively people feel about it. So, for example, if you say to people, Medicare for All would eliminate premiums, which is one...

SHAPIRO: They're like, yeah, I like that.

SIMMONS-DUFFIN: They're like, great. But if you say to people it will eliminate private insurance, as you point to, that's controversial, and support kind of falls back. So the rhetoric around these ideas really changes how voters might be thinking about where they want to see health care in America go.

SHAPIRO: That's NPR health policy reporter Selena Simmons-Duffin.

Thanks a lot.


(SOUNDBITE OF MUSIC) Transcript provided by NPR, Copyright NPR.

Selena Simmons-Duffin reports on health policy for NPR.