It was a moment so surreal, it seemed almost like a dream. During Fox News' Monday night town hall with Sen. Bernie Sanders, I-Vt., host Bret Baier asked audience members how many had private health insurance. A large majority raised their hands. He then followed up by asking how many would like to see Medicare-for-all enacted. Almost all the same hands went up - remember, this was on Fox News! - with wild cheers to boot.
Baier's action violated a major rule of lawyers: Never ask a witness on the stand a question to which you don't know the answer. However, I must point out, only in the Fox News bubble would anyone be surprised by the popularity of Medicare-for-all - polls routinely find more than half of Americans say they support it, including one from last year that found a majority of Republicans say they back Sanders' signature initiative.
As I watched the hand-waving, cheering crowd on Fox, I immediately thought about a statistic that landed on my desk earlier Monday, which showed how employer-based health insurance is offering less financial protection for low-income Americans than many realize. According to a study on the employer health insurance market from the Kaiser Family Foundation and the Peterson Center on Healthcare, households with incomes at 200% of poverty - slightly more than $50,000 for a family of four - are spending on average 14% of their income on premiums, deductibles and medical bills - a number that jumps to 18.5% if someone in the family suffers a health crisis.
Health care and health insurance costs are putting increasing strains on all budgets, not simply those of people living paycheck to paycheck. As the Kaiser Family Foundation reported, the typical health insurance premium for a family increased at double the rate of inflation in 2018, after soaring by 55% over the previous decade. The average deductible is also in the four figures, having increased by slightly more than 50% over a five-year period. People find medical services increasingly unaffordable, even when they are insured, with almost a quarter of people prescribed prescription drugs - including 23% of senior citizens - saying they are having an increasingly hard time affording their medicines.
Nonetheless, many health care policy wonks and more than a few politicians remain convinced that Americans are enamored of the current system. They point to surveys finding that people are satisfied with their current plans, not realizing that those findings are all relative. Stability in the health insurance market is wildly exaggerated: A few years back, a survey found that only 7 in 10 people with employer insurance in Michigan remained on the same employer plan a year later. Second, dissatisfaction with employer health insurance is hardly unknown: For starters, it was one of the causes of the teacher strikes and job actions last year in red-state West Virginia and solidly blue Jersey City, New Jersey. Almost everyone is concerned about increasing costs. Even when people are happy with what's on offer, they can feel trapped, something economists call job lock: People who suffered cancer in childhood, for instance, often fear changing jobs because they are afraid of coverage gaps or higher medical costs going forward.
All this goes a long way toward explaining why parts of the health insurance industry went on the offensive Tuesday after Sanders' appearance on Fox, attempting to scare the American public into submission to the current, clearly unacceptable status quo. David Wichmann, the CEO of UnitedHealth, the nation's largest health insurance company, said on a company earnings call that Medicare-for-all plans would "surely jeopardize the relationship people have with their doctors, destabilize the nation's health system and limit the ability of clinicians to practice medicine at their best." Actually, that sounds like our current reality, where insurance companies routinely impede the relationship between doctors and patients, insisting on approving medications, treatments and even requests for physical therapy sessions, sometimes denying them willy-nilly.
While I suspect more than a few people believe Medicare-for-all means something more like the Center for American Progress plan called Medicare Extra for All, which would permit people to keep employer-based health insurance if they prefer, I don’t think very many believe, as House Speaker Nancy Pelosi, D-Calif., indicated in a recent interview with The Washington Post, that they mean simple universal health coverage. Nor does it simply mean upping subsidies for the Affordable Care Act plans. I think it means people want at least the option of joining the plan that works so well for people over the age of 65. Much of American politics - like, say, tax cuts - comes down to some variant of “What about me?” Why would health care be any different?
Helaine Olen
Helaine Olen is a contributor to Post Opinions and the author of “Pound Foolish: Exposing the Dark Side of the Personal Finance Industry.” Her work has appeared in Slate, the Nation, the New York Times, the Atlantic and many other publications. She serves on the advisory board of the Economic Hardship Reporting Project.