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Why this “die-hard Republican” voter is open to Medicare-for-all

Dylan Scott covers health care for Vox. He has reported on health policy for more than 10 years, writing for Governing magazine, Talking Points Memo and STAT before joining Vox in 2017.

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This week, I listened to what 16 Trump voters thought about a single-payer, Medicare-for-all health care program.

Most of these folks don't trust the government to run a health care system and don't believe philosophically it should. They are worried about their taxes going up. They are worried about losing the health insurance they've got now and they like.

But there was one surprise in these groups, which took place near Harrisburg, Pennsylvania, and were run by opinion researcher Michael Perry. Her name was Kate.

Kate, who said she works in sales, didn't like her current insurance. She gave it a 3 out of 10; she said her deductibles had "skyrocketed.

"I have had to struggle to pay for my insurance," she said.

The most revealing moment came when Mike asked everybody if they thought health care was a right. A few said yes. A few said no. Kate was last.

This is what she said:

I’m conflicted. I’m truly conflicted.

You say the government shouldn’t be in medical care, but it is — Medicare, Social Security. You’re talking about the lower to middle class. You are stuck in the middle, paying taxes they don’t reap benefits from.

I don’t want to say it’s not fair. But I don’t see any way out of that, unless you go to a single-payer system.

I am truly a die-hard Republican. But over the last few years, I wonder about a single-payer system, something like the Canadian system. I want people who don’t have health care to have health care.

Toward the end of the meeting, Mike came to Kate again. She elaborated a little bit on where she was coming from.

There's inability to move forward with anything, and in health care we’re talking about human beings’ lives here.

It’s like food. Everybody should have food, and I really think people should not have to worry about going to the doctor. That should be one thing taken away from their daily worries.

Maybe the government could find something.

But she shared some of the same concerns as her peers, particularly about the government's ability to run a health care program well.

I think it should be debated because I think it could have a place.

But I really worry about the bureaucrats getting their hands on it. They like paper and they like to generate more of it.

I should emphasize again: Kate was the exception. The other Trump voters we spoke with believed, as a matter of principle, that the government is not responsible for everybody's health care. Or they simply didn't trust the government to run a program effectively. They had heard horror stories about other countries' health care systems, long waiting lists and the like.

This also wasn't quantitative research. We talked to 16 people — enough to get some impressions, hardly a rigorous national survey.

But Kate was a useful reminder that even an issue this divisive and ostensibly partisan doesn't break down strictly on party lines. We know from the Kaiser Family Foundation that about one-quarter of Republicans say they would favor a single-payer system. There are other Kates.

Her frustrations with the status quo and this conflict between her ideological beliefs and what she actually thinks might help to alleviate those frustrations, and could tell us something about where the health care debate is heading.

Chart of the Day


Free insurance. As Sarah documented recently, President Trump's decision to end some key Obamacare payments to health insurers has had a strange side effect: It's going to lead to some people getting better deals on health coverage.

Now Avalere is out with some new numbers that follow the same trend: In almost every county using, people near poverty should be able to get a bronze plan, which covers about 60 percent of medical costs, for free.

It's a reminder to shop around. Sarah broke down yesterday the other things you need to know about open enrollment.

Kliff’s Notes

Your daily top health care reads, with research help from Caitlin Davis

News of the day

  • “Tax reform bill doesn't include repeal of Obamacare mandate, sources say”: “The House GOP’s tax reform bill set does not include a repeal of Obamacare’s individual mandate, despite a demand from President Trump. The mandate requires everyone to have health insurance, and is not included in the bill set to be unveiled Thursday, according to sources familiar with the matter.” —Robert King, Washington Examiner
  • ‘Blue Dog Dems back bipartisan health bill”: “"This endorsement is a call to action in the House to develop a bill that mirrors the Alexander-Murray health care legislation and bring it to the floor for full consideration,” said Rep. Daniel Lipinski (D-Ill.), Blue Dog co-chair for policy.” —Jessie Hellmann, The Hill
  • “Hospital groups to sue CMS over $1.6 billion cut to 340B program”: “Less than an hour after the CMS released the final rule, America's Essential Hospitals, the American Hospital Association and the Association of American Medical Colleges said they believe the agency has overstepped its statutory authority by cutting 340B drug payments by $1.6 billion, or 22.5% less than the average sales price.” —Virgil Dickson, Modern Healthcare

Analysis and longer reads

  • “What Did Bernie Sanders Learn in His Weekend in Canada?”: “He ended the trip with a speech at the University of Toronto titled, “What the U.S. Can Learn From Canadian Health Care.” But our question is this: What did Bernie Sanders learn from his weekend in Canada?” —Margot Sanger-Katz, New York Times
  • “One big thing people don’t know about single payer”: “It is generally assumed that the biggest obstacle to a national health plan like Medicare for All will be the large tax increase needed to pay for it. But new polling shows another challenge: Almost half of the American people don't know that they would have to change their current health insurance arrangements if there was a single-payer plan.” –Drew Altman, Axios
  • The opioid crisis: Crucial next steps”: “In the spring of 2016, just as the Centers for Disease Control released “Guideline for Prescribing Opioids for Chronic Pain,” POLITICO convened a group of policymakers and stakeholders to explore the opportunities and obstacles around changing the culture of prescribing, particularly in primary care. In October 2017, we convened a similar group — some of the same participants, some new ones — to identify where progress has been made, and what policy gaps need to be filled to reduce addiction, abuse and dependence — and save lives.” —Politico Staff

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