Medicare and 'Free College' – Why Are Democrats So Split?

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Sen. Bernie Sanders introduces the 'Medicare for All Act of 2019' on April 9, 2019, in Washington, D.C. (Mark Wilson/Getty Images)

In an election year where Democrats are almost singularly focused on beating President Trump, a couple of policy issues have still emerged as incredibly divisive among left-leaning voters: proposals for government to pay for health care, college and student loans.

It's a divide that's been playing out around kitchen tables and on the campaign trail as the programs' biggest champion, Sen. Bernie Sanders, surges ahead of most of his primary opponents — and his closest rival, former South Bend Mayor Pete Buttigieg, goes on the attack.

"In this election season, we have been told by some that you must either be for a revolution or you are for the status quo. But where does that leave the rest of us? Most Americans don’t see where they fit in that polarized vision," Buttigieg told supporters Tuesday night in New Hampshire.

The 38-year-old candidate has positioned himself as a center-left candidate who supports giving Medicare "for all who want it," and free college to kids in families making under $100,000 a year — but not everyone.

Buttigieg isn't alone in feeling skeptical about these types of proposals.

Whether it's expanding Medicare to all Americans (whether they want it or not), making public college tuition free or providing student loan forgiveness, polls show that Democratic voters are split on these issues (though Republicans are more squarely opposed to them).


A Divide Among Liberals

A poll commissioned in January for KQED News by Change Research found that broadly, California Democrats like free college, loan forgiveness and Medicare for All as ideas — their favorability ratings among Democrats are above 70%. And, a stunning 92% of Democrats in that poll said they support Medicare For All.

But things get a little squishier when you ask independents — who make up more than one-quarter of the California electorate.

The Change Research poll found independents more conflicted over Medicare for All, supporting it by 57% to 40%. And other polls, like the Public Policy Institute of California survey that asked more detailed questions, show some more nuance among Democrats and significant differences among different demographic groups.

In a November survey, 42% of Democrats polled told PPIC that they support single-payer insurance like Medicare for All — but 36% said they prefer a mix of private and government insurance, which is what more centrist candidates like former Vice President Joe Biden and Buttigieg are pushing.

In the broader electorate, self-identified liberals are the most likely (47%) to support single-payer insurance, compared to 18% of moderates and 8% of conservatives. Single payer was also much more popular with 18-44 year olds (40% support); while half of people over 45 said they don't believe it's the responsibility of the federal government to provide health care at all — even though people over 65 get Medicare.

Latinos, renters and people who make less than $40,000 a year were all more likely to support single payer than other groups as well.

So what gives?

Political Ideology Isn't Pure

The first thing to understand, said Stanford University's Jon Krosnick, who studies political attitudes, is that almost no one is consistently liberal or conservative.

"Almost everybody is a mix of liberal and conservative," he said.

Instead, Krosnick said, most voters pick a party based on a single issue, or even a handful of policy areas they are passionate about. So just because two people are Democrats, or consider themselves liberal, they may have come to that position for very different reasons.

UC Irvine professor Peter Ditto agrees. He studies partisan political bias — how political ideology biases our political judgments and behavior. Ditto said that while most Americans identify with a political philosophy or party, they really "have a hodgepodge of beliefs and attitudes."

"(People) identify with groups or tribes — so when they're saying 'I'm a liberal' or 'I'm a conservative,' 'I'm a Democrat or a Republican,' they're saying something about the kind of people that they go along with," Ditto said. "And sometimes when they buy into that, they have to kind of shape their attitudes to fit those things."

So while a large percentage of voters identify as liberal, or Democrat, that doesn't mean they all agree with the idea of "free" programs.

And liberals and conservatives have different ideas of what is fair, Ditto said.

"Liberals tend to emphasize equality — people should all be treated the same. And very often conservatives, when they think about fairness, think more about their equity or proportionality," he said.

So for a liberal, Ditto said, classic unfairness "might be discriminating against somebody based on the color of their skin," while "conservatives may think more about, 'freeloaders,' like welfare, people who get money from the government not given anything back."

And that gets us to another theory: That all of this division is actually driven by racial bias.

The Rise of Dog Whistle Politics

That's the argument made by two admittedly liberal researchers: political messaging expert Anat Shenker-Osorio and UC Berkeley Law Professor Ian Haney López.

Both Shenker-Osorio and Haney López contend that opposition to government programs like Medicare for All or free college are rooted in 50 years of a racial narrative first promulgated by Republicans but also embraced at times by Democrats.

Haney López notes that five decades ago, public colleges were largely free in California — and that Democratic President Lyndon Johnson overwhelmingly won a reelection victory in 1964 promising to eradicate poverty.

"People then widely supported the idea that government had not just the ability, but the duty to intervene in the economy in ways that redistributed the wealth downwards, that created routes of upward mobility," Haney López said.

He said that today's proposals "are small fry in comparison to what Johnson was proposing."

"So the real question is why did so many Americans in a landslide support Johnson in '64? And yet things that are far less ambitious seem radical in 2020? And what's the answer? I think more than anything else, the answer is race," he said.

Presidential hopeful Barry Goldwater (right) with his running mate William Miller in 1964.
Presidential hopeful Barry Goldwater (right) with his running mate William Miller in 1964. (AFP/AFP via Getty Images)

Haney López argued that Johnson's opponent, Republican Barry Goldwater, led a new faction of the GOP that "came to understand that they could use rising racial resentment as a way to break the Democratic coalition of African Americans, the white working class and liberals."

Goldwater didn't do this by aligning with white supremacists or attacking the civil rights movement or people of color, Haney López said: He did it using coded language, like "states rights."

"It became a way to mobilize racial resentment, but even more. It provided him a way to demonize government itself," he said.

"What he ended up saying was, 'Look, government programs that supposedly help everyone — they're actually giveaways to undeserving minorities.' Now, Goldwater would lose big. But over the next 12 years, in part through the campaign of Richard Nixon, this sort of politics would become very, very powerful."

Haney López said the master of this was President Ronald Reagan, who beat Democrat Pat Brown in the 1966 California governor's race, then went on to campaign for president a decade later with his "welfare queen" narrative, which relied on the idea that hard-working white people were having their money taken by government and given to lazy minorities.

Of course, Democrats, led by Bill Clinton, would also embrace a similar strategy in the 1990s with the war on crime and illegal immigration, Haney López said.

In California, Shenker-Osorio also sees proof of this in the language used to promote the 1978 anti-tax measure Proposition 13, which she said relied on an "us versus them" narrative that demonized Mexican immigrants and started the tax revolt across the nation.

Shenker-Osorio, who does empirical research on political messaging, said some of this is probably embedded in our DNA as both Americans and, to a greater extent, Californians.

"The puritan work ethic, the idea that people should have to endure and suffer, that it's character building ... and that people who don't pay are getting away with something," she said.

But there's more at play, she argued, noting that the countries with the most generous social welfare policies tend to also be the most homogeneous racially.

"People would accept and vote for increase in whatever public program we are talking about if it did not apply to people outside their race," she said.

But she and Haney López say that these messages have become so embedded in our collective consciousness that it isn't just white people who hold these views.

"Let's be a little more sophisticated about how we understand race," Haney López said. "This rhetoric affects people of all different races ... The story we're being offered by the right is, 'The reason some people are rich is because they work hard ... And the reason so many are poor is because there's something wrong with them. They didn't work hard or they're lazy or they're cheaters or they have an entitlement mentality.' "

That doesn't mean, said Haney López, that Americans can't have a legitimate debate about what programs we should offer, or even who should qualify for them. But, he said, those having the conversation should take into account what deeply embedded biases might be informing their viewpoint.

Election 2020

He pointed to anger over the idea of making college free for future generations — the divide was perhaps best exemplified at a recent Elizabeth Warren event in Iowa, where a man confronted the Massachusetts senator, asking why she wants to pay for college for people who didn't save their money while people like him, who did save, "are getting screwed."

Haney López said that conversation is "undergirded by a view of demographic change. It's a view that rests on a statement like, why should I pay for other people's children? Well, why are they other people's children? Why aren't they our children? Why isn't there a collective sense that as Americans, we're all in this together?"

Of course, even people who like the idea of a single-payer health care system may be grappling with another hurdle, said Shenker-Osorio — their personal experience.

"People are incredibly risk averse, and their lived experience is health care only getting worse," she said. "We know the current system is bad, but we have absolutely no lived experience that change can make it better."

Peter Ditto, the UC Irvine professor, said showing people that something new works is the easiest way to change their minds — he pointed to how relatively quickly gay marriage has become more broadly acceptable over the past decade.

But, it's not easy to convince people of a collective good, he said.

"The natural state of people is to break up into groups and dislike each other — that's human history. You know, the American government is pushing against the grain of a million years of human evolution and try to say, yeah, you should get along with people who disagree with you," he said.

It's easier to try to drive people apart — a strategy that President Trump has embraced to devastating effect, Ditto said.

And countering that, no matter which flavor of candidate voters choose, might be the biggest challenge facing Democrats this election year.