The Iowa Caucuses Showed That Medicare for All Is Still a Winner

Despite a fierce and well-funded campaign by special interests, a strong majority of Iowa Democrats support a single-payer, Medicare for All system.

Supporters of Democratic presidential candidate Sen. Bernie Sanders cheer during his caucus night watch party on February 03, 2020 in Des Moines, Iowa. Alex Wong / Getty

The debacle in Iowa has produced delayed results and a flurry of questions about the Democratic Party’s capacity to hold a fair and transparent primary process.

But in the midst of it all, exit polls point to a surprise winner that wasn’t even on the ballot: Medicare for All (M4A). According to polling conducted by Edison Research, some 57 percent of Iowa caucusgoers favor a single-payer system that eliminates private insurance, compared to 38 percent opposed.

Much of the recent commentary surrounding the health-care policy debate has noted a drop in support for M4A among Democrats — albeit in the wake of a concerted industry effort to undermine it that’s been taken up, directly and indirectly, by many candidates running for the party’s presidential nomination.

Seen in this light, the results out of Iowa suggest special interests have indeed made some headway in their campaign to keep the provision of health insurance expensive, cumbersome, and profitable for shareholders. In September 2017, for example, polling put M4A support at around 70 percent among Democrats. And, as Slate’s Jordan Weissmann observed last October: “The phrase ‘Medicare for All’ tended to poll well early on, but its popularity tended to drop once respondents were told it would require them to give up their private insurance.” It’s notable, then, that the question posed in Edison Research’s Iowa exit poll included direct language about the replacement of private insurance with a single-payer model — and still more notable that M4A continues to score so well with Democratic primary voters given the obstacles and organized opposition it faces.

Elsewhere this week, Morning Consult also noted a drop in overall support for M4A across self-identified Democrats, Republicans, and Independents. Yet its analysis took care to emphasize the robustness and resilience of single-payer health care in the face of the concerted campaign to undermine its popular image:

After a year that pulled the decades-long movement for a single-payer health care system to the forefront of the Democratic presidential primary, where its heightened visibility in the political mainstream left it vulnerable to attacks from opponents of all political persuasions, “Medicare for All” survived with a majority of voters’ support, albeit a bit damaged . . . In a testament to the resilience of Medicare for All, across 13 surveys spanning 13 months, the share of the electorate that backs it never slipped below 50 percent.

Opponents of Medicare For All, particularly those running for the Democratic nomination, will often argue that the legislative hurdles facing a sweeping transformation of America’s health-care system are simply too great for it to be a viable policy goal. Given the ubiquity of this talking point on the Democratic debate stage and in the media, it should be emphasized again and again that the fiercest resistance to single-payer health care continues to come from organized interests and political elites rather than from actual voters — who, despite several years of insurance-industry agitprop, are still more likely to support than oppose it.

Against all odds, the Iowa caucuses showed us that Medicare for All remains a political winner — and a vital policy that centrist Democrats and their corporate allies will not simply wish away.