Iowa Democrats Support Public Option Over Medicare for All

Sen. Bernie Sanders (I-Vt.) speaks during a health care rally on September 22, 2017, in San Francisco, California. (Justin Sullivan/Getty Images)

News Analysis

The majority of likely Democratic caucus-goers in Iowa prefer a health care system that would let people opt into a government Medicare plan, while only 1 in 5 support the Medicare for All system that would eliminate private health insurance, according to a Monmouth University poll conducted in early August.

Health care is the top issue for 55 percent of Iowa Democrats. The poll found that 56 percent of likely Iowan poll-goers prefer the so-called public option, while only 21 percent would like the socialist Medicare for All system.

Medicare for All has become a virtual litmus test of how far to the left Democratic presidential candidates are willing to go to secure enough support from the party’s far-left base to win the primary election. Socialist Sen. Bernie Sanders (D-Vt.), Sen. Elizabeth Warren (D-Mass.) and Sen. Kamala Harris (D-Calif.) were forced to defend their position on Medicare for All during the two Democratic presidential primary debates in late July.

More than half of Americans, or approximately 156 million people, receive health insurance on private plans provided by their employers. Nearly 7 in 10 of them are satisfied with those plans, according to a poll by the Kaiser Family Foundation.

In addition to eliminating private health insurance, Medicare for All would cost taxpayers $32 trillion over the course of a decade, according to one estimate. Sanders has said the cost could be up to $40 trillion.

The Monmouth poll also asked Democrats which candidate most closely aligned with their own views on health care. While Biden topped the list with 28 percent, support for the three Medicare for All candidates surprisingly totaled 49 percent. An additional 28 percent said they were unsure which candidate aligned with their views.

The confusion among voters is likely due to the ongoing failure by the Democratic candidates to clarify their positions on health care.

Confusion may also be the goal. Candidates who back Medicare for All or similar plans score points with the far-left base while knowing that their positions on the issue would harm the prospects in a general election because Medicare for All, a purely socialist policy, is unpopular with voters overall.

That’s especially the case once voters are clear on what Medicare for All stands for. Only 13 percent of likely voters say they would support Medicare for All if it meant the end of private health insurance.

Socialism is similarly unpopular. Among the candidates, only Sanders is a self-proclaimed socialist, while the rest have distanced themselves from the label.

As a result, candidates who back socialist policies can insulate themselves from damage in the general election by being vague about their positions. This fuzziness could account for the confusion among voters. While 63 percent of Americans don’t want to live in a socialist country, 66 percent believe the government should provide free universal health care, a purely socialist policy.

The Monmouth poll found that voters who back Medicare for All are clearly aligned with the two candidates fully backing the policy. Sixty-four percent said Sanders aligned with their views, and 44 percent said Warren did.

The voters who don’t want to end private health insurance are less clear about which candidates align with their views. Biden topped the list with 34 percent, yet Warren, who backs eliminating private health insurance, is in second place with 18 percent.

“Many voters remain confused on the single most important domestic policy issue of the 2020 race," Patrick Murray, director of the independent Monmouth University Polling Institute, said in a statement. “The Medicare for All crowd has their champions, but the vast majority of voters who want a public option are all over the place. Last month’s debates do not appear to have clarified where the candidates stand on health care.”

Keeping the current health care system unchanged was the least popular choice, with just 4 percent of likely caucus-goers backing the idea. An additional 13 percent said they’d keep the current system if tighter cost regulations were enacted.

Despite the importance of each candidate’s positions on the issues, the poll found that the majority of Iowa Democrats—72 percent—prefer to pick a nominee who is most likely to defeat President Donald Trump in the general election. Only 1 in 5 said they would back a candidate who aligned with their positions even if the candidate would have a hard time beating Trump.