Citizen juries demonstrate massive support for single-payer

By Kip Sullivan, JD for PNHP

“They contradicted both beltway and public opinion polls. The whole damn world seems to think the Clinton plan is the way to go. Yet they like the single-payer system, which isn’t even getting considered in Washington.”

That was how the president of the Jefferson Center characterized the outcome of a five-day “citizen jury” experiment in which 24 “jurors” listened to and questioned 30 experts on health care reform. (Patrick Howe, “‘Citizens jury’ supports Wellstone’s health care proposal over Clinton plan,” Minneapolis Star Tribune, October 15, 1993, 10A.) Of those 30 experts, only one, Senator Paul Wellstone (D-MN), spoke in favor of single-payer. (Gail Shearer of Consumers Union, which had endorsed single-payer by 1993, was one of the 30 experts to speak to the jury, but it is not clear from the Jefferson Center record that she spoke in favor of single-payer.)

The jury heard expert testimony for and against all three of the major types of health care reform legislation that have been promoted in the US over the last four decades. Senator Wellstone presented the case for his single-payer bill, numerous speakers made the case for Bill Clinton’s managed competition bill (a bill based on competition between insurance companies that use managed-care cost-control techniques), and numerous speakers made the case for what later came to be called “consumer-driven” health insurance policies (competition between insurance companies that sell policies with deductibles on the order of $2,000 for individuals and $5,000 for families).

The jury voted by massive majorities to reject the market-based proposals – managed competition and high-deductible policies – and, by a landslide majority (17 out of 24, or 71 percent), to endorse Wellstone’s single-payer bill. At the time the Jefferson Center report noted only that a majority of jurors voted for single-payer. The actual vote count was reported years later by Barry Casper in his book, Lost in Washington: Finding the Way Back to Democracy in America.

The unbearable lightness of polls

Observers were surprised at the jury’s rejection of the Clinton plan because polls taken at the time the Jefferson Center jury was meeting (the second week of October 1993) were reporting that a majority of the public supported Clinton’s Health Security Act, his “managed competition within a budget” bill that was supposed to create a system of universal health insurance. For example, a Gallup/CNN/USA Today poll (see Exhibit 1 page 10) released on September 24, 1993 showed 59 percent endorsed Clinton’s bill. But just three weeks later, on October 14, 1993, the jury rejected Clinton’s bill by a vote of 19 to 5. Five jurors out of 24 comes to 21 percent, far below the 60-percent level one would have expected based on polls.

The enormous gap between the citizens jury’s vote on Clinton’s bill and contemporary poll results illustrates a well known problem with polls: Although they can produce consistent and accurate results when the question is about something the respondents are familiar with, such as whether they have health insurance, they can produce wildly divergent and inaccurate results when the question is about a complex issue that respondents have had little time to study or even to think about.

Contrast, for example, a 2007 AP-Yahoo poll, which found 65 percent of Americans support a Medicare-for-all system, with a 2009 CBS poll which found only 50 percent think “government” would do a “better job” of providing health insurance than the insurance industry. The AP-Yahoo poll posed this question (the order of the two solutions was reversed from one respondent to the next):

Which comes closest to your view?

The United States should continue the current health insurance system in which most people get their health insurance from private employers, but some people have no insurance;

The United States should adopt a universal health insurance program in which everyone is covered under a program like Medicare that is run by the government and financed by taxpayers.

Sixty-five percent of respondents chose the second solution – the Medicare-for-all solution – while only 34 percent chose the current system.

Now consider the June 12-16, 2009 CBS poll which asked: “Do you think the government would do a better or worse job than private insurance companies in providing medical coverage?” Fifty percent said “the government” would do a better job versus 34 percent who said “the government” would do a worse job.

Now, just to raise your skepticism about polls another notch, consider this wrinkle. When CBS asked the same question two months later – during August 27-31, 2009 – they found 13 to 14 percent of respondents had changed their minds in favor of the insurance industry. That is, by late August (by which time dozens of tumultuous “town hall” meetings about the Democrats’ health care “reform” legislation had taken place), the percent who thought “the government” would do a better job had fallen to 36 (from 50 percent) while the percent who thought “the government” would do a worse job had risen to 47 (from 34 percent).

How do we make sense of these seemingly contradictory results? Do we trust the late-August CBS poll and say only one-third of Americans support single-payer? Or do we go with the AP-Yahoo poll and say two-thirds support single-payer? Or do we split the difference and say the June CBS poll got it about right – that half of Americans support single-payer?

Fortunately, we are not reduced to rolling dice or drawing straws. We can examine research that uses methods more reliable than those used by the typical poll, notably two citizen jury experiments. And we can examine polls that have produced contradictory results to see if we can find a reason why. I will use the remainder of this paper to report on the two citizen juries. I’ll examine polling data more closely in Part III of this series.

The Jefferson Center’s methodology

The Jefferson Center, a non-profit organization created in 1974 by Ned Crosby, invented the “citizen jury” label and developed the rules for them that are now used around the world, especially in the United Kingdom. These methods include: random selection of jurors; selection of experts and moderation of the discussion in a manner that minimizes bias; recording of the proceedings; a report from the jury indicating votes taken on major issues presented to it and recommendations from the jury; questionnaires for jurors after the jury has completed its work to inquire about their perception of the fairness of the process; and oversight and review by a steering committee to minimize bias.

The 24 jurors who gathered in a Washington, DC hotel on Sunday, October 10, 1993 were randomly selected from a pool of 2000. They included a 23-year-old college student from Colorado, a 27-year-old carpenter from Wisconsin, a 32-year-old janitor from Minnesota, a 44-year-old village clerk from New York, a 46-year-old banker from Indiana, a 51-year-old antique dealer from California, a 59-year-old retired nurse from Louisiana, and a 75-year-old retired insurance agent from Florida. Ten had voted for Clinton in the 1992 election, nine for George H.W. Bush, and five for Ross Perot. Three had no health insurance.

The experts who addressed the jury included three sitting US Senators, two former members of the House of Representatives, and 25 other experts including Gail Wilensky (who was the director of Medicare under the first President Bush and is a member of numerous corporate boards), Ira Magaziner (who directed Hillary Clinton’s health care reform task force), and Ron Pollack (director of Families USA). The discussion was moderated by Kathleen Hall Jamieson, dean of the Annenberg School for Communication at the University of Pennsylvania. Former CBS and NBC TV anchor Roger Mudd was on hand to film a documentary which aired in April 1994.

After five days of listening to and cross-examining the 30 experts (the jury asked the experts more than 500 questions), the jurors refused even to vote on the “managed competition lite” proposal presented by Senator Dave Durenberger (R-MN) and a high-deductible (Medical Savings Account) proposal presented by Senator Don Nickles (R-OK). In other words, the jury rejected the Durenberger and Nickle’s legislation by a vote of 24 to zero. They rejected Clinton’s Health Security Act by a vote of 19 to 5. When they were asked how many supported Sen. Wellstone’s single-payer bill (S. 491), 17 of 24 (71 percent) raised their hands.

Washington Post columnist William Raspberry wrote at the time:

Perhaps most interesting about last week’s verdict is its defiance of inside-the-Beltway wisdom that says a single-payer … plan can’t be passed. These jurors think it can – and ought to be. (William Raspberry, “Citizens jury won over by merits of Wellstone’s single-payer plan,” Washington Post, October 21, 1993, 23A)

I have already noted one reason why observers were surprised by the jury’s votes, namely, polls taken around the time the jury met indicated a majority of the public liked Clinton’s bill. But there was another reason to be surprised: The Jefferson Center created a playing field that was steeply tilted against Wellstone’s single-payer bill.

To begin with, the Center limited the jury to two questions: “Do we need health care reform in America?” and, “Is the Clinton plan the way to get the health care reform we need?” Second, the agenda called for presentations by a team of Republicans and their expert witnesses arguing for Republican proposals, and a team of Democrats and their expert witnesses arguing for Clinton’s Health Security Act. (The Republican team was managed and represented by former Minnesota Congressman Vin Weber; the Democrats were led by Hill and Knowlton lobbyist and former Connecticut Congressman Toby Moffett.) There was no team advocating for single-payer. There was only Wellstone.

But the jury was so attracted to Wellstone’s description of his bill during his initial presentation that they voted 22-0 to invite him back for two more question periods (see page 10 of the Jefferson Center report). No other witness was asked back even once. “In fact,” noted columnist Raspberry, “when the Minnesotan [Wellstone] dropped in at the jury’s farewell dinner Thursday night, he got a standing ovation.”

To sum up: The Jefferson Center’s citizen jury methodology was far more rigorous than any two- or three-sentence poll can be, and yet even the methods used for that jury permitted substantial bias against the single-payer approach. A total of 30 experts spoke to the Jefferson Center jury over five days. Only one of them, Senator Wellstone, made the case for single-payer. Even though the question of whether to support or oppose single-payer was not on the agenda, the jury took the initiative to get more information about it. The jury did not have to do that for any other proposal. Despite these obstacles, the single-payer proposal won by a 71-percent majority.

Minnesota citizen jury endorses single-payer by 79 percent

On October 1, 1996 I was part of another citizen jury project sponsored by the Minneapolis Star Tribune and Twin Cities Public TV which used a methodology similar to the Jefferson Center’s jury and which had a nearly identical outcome. In this case, the jury consisted of 14 randomly selected Minnesotans, only three experts spoke, and the entire event lasted just four hours. I made the case for single-payer (at that time I represented Minnesota Citizens Organized Acting Together), Michael Scandrett (then the director of the Minnesota Council of HMOs) stated the case for managed competition, and a woman who had just left a job with the Minnesota Department of Health to create her own advocacy group for Medical Savings Accounts (MSAs, now referred to as Health Savings Accounts) presented the argument for MSAs.

At the end of four hours, the moderator for the evening (an officer of the Minnesota League of Women Voters) put several questions to the jury for a vote. Her first question asked each juror which proposal they supported. Eight voted for single-payer, three voted for managed competition, one woman split her vote between single-payer and managed competition (she said she wanted the two proposals to be married somehow), no one voted for MSAs, and two of the 14 abstained. If we allocate a half of the vote by the woman who wanted some combination of managed competition and single-payer to each proposal, single-payer’s total was 8.5, or 61 percent of the 14 jurors.

The moderator’s second question asked whether the jurors would support universal coverage under a single-payer system if citizens had to pay $1,000 more in taxes that were offset by $1,000 in reduced premiums and out-of-pocket costs. (This is a conservative estimate of what would happen. It is likely that aggregate premium and out-of-pocket costs would decline more than aggregate taxes would go up under a single-payer system, and very likely that premium and out-of-pocket costs would decline substantially more than taxes would go up for lower- and middle-income Americans.) Eleven said yes to this question, and three abstained. If we treat this latter vote as the definitive vote for single-payer, then it would be accurate to say 79 percent voted for single payer. Finally, the moderator asked if the jury thought Congress had failed to give single-payer a fair hearing. Again, 11 (79 percent) said yes and three said no. (Glenn Howatt, “Canadian-style care starting to look more attractive to panelists,” Minneapolis Star Tribune October 9, 1996, A15)

Stay tuned for Part 3: “Informative polls show two-thirds support for single-payer.”

2 Comments

  1. NANCY EVANS on December 9, 2009 at 8:12 am

    we all need insurance, let the presdent do his job for us.



  2. Patrick Clement on December 18, 2009 at 10:48 am

    I know everyone has been very busy this last year and especially busy these last few months, except for me, getting ready for Christmas. As such, it is very easy — some say planned — for us to forget that as voters, we all went to the polls one year ago on November 4th and elected a new president. But he wasn’t the only person elected one year ago. There were also 435 members of the House of Representatives, along with all 6 non-voting seats, and 35 Senators of Class II elected, with special elections for two Senators in Class I to fill vacancies.

    One third of the Senate (Classes I, II and III) and all of the House are elected every two years.

    An interesting side note to the 2008 federal election: Arlen Specter switched from being a Republican, to being a Democrat. Guess he thought there there were already too many Independents in the senate, two, so there was no room for any more, so he had to become a Democrat?

    In reality there is only one actual Independent in the Senate, Bernie Sanders of Vermont. However, Joe Lieberman of Connecticut, claims he is also an independent, but caucuses with all his former Democrats, which he used to be.

    Maybe if you are a Democrat or a Republican really isn’t all that important, since Arlen Specter switched from being one to the other and was still re-elected? Maybe it only matters if you can still rake in the hundreds of millions of dollars being contributed by all the corporations and lobbyists, so you are re-elected, that matters?

    Bottom line is this, all 476 members of Congress and one president, were elected to serve from January 3, 2009 until January 3, 2011.

    Now, going back one year ago and to that same election, our nation was already in a deep recession and going deeper. However, Wall Street, which drove the bus that took all the rest of us into that secession and the very reason for the recession, got bailed out by the former president and a near unanimous majority of Congress. That would be almost the exact same Congress that the American voters re-elected to office after the bailout!

    Also a key issue was Healthcare Reform. Specifically, and according to a Harris Poll of all industrial nations, Americans are the least satisfied nation with their health care. Without boring you with mind-numimg facts, basically a vast majority of the American public, 75%, want a single payer or universal health care system, just like all of Congress, the military and the president have now!

    The latest sign is a poll published recently in the Annals of Internal Medicine shows that 59 percent of U.S. doctors support a “single payer” plan that essentially eliminates the central role of private insurers. Most industrial societies — including nations as diverse as Taiwan, France, and Canada — have adopted universal health systems that provide health care to all citizens and permit them free choice of their doctors and hospitals. These plans are typically funded by a mix of general tax revenues and payroll taxes, and essential health-care is administered by nonprofit government agencies rather than private insurers.

    In other words — in plain, everyday, simple English — it takes the “profit motive” out of healthcare, while still paying all the people who actually deliver healthcare to you, paid! The only people who will lose their jobs — someone will lose when anything is reformed — are the obsecenely paid healthcare executives and shareholders! These people are leeches on our helthcare system. They do nothing to improve healthcare, but do suck as much money and compassion — or haven’t you hade a bonafide claim rejected because a nameless clerk somewhere rejected your claim? — out of the system, their profit making system!

    So, what is your president — hey, I didn’t vote for either Obama or McCain, I voted for Ralph Nader and am proud I did — doing about healthcare reform, along with all of the Congress? Are they giving us what we want, a single payer healthcare system?

    No. Instead they are passing what laws that the healthcare corporations want, laws that make it illegal for you not to buy healthcare insurance from them, so they can make even more money off of sick & dying patients!

    Here’s the actual email I got from my Senator, Senator Kohl of Wisconsin:

    “Dear Mr. Clement:

    Thank you for taking the time to contact me regarding health
    reform. I appreciate your interest in this very important
    issue.

    Since you last contacted me, Congress has made great strides
    towards reforming America’s health care system. On November
    7, 2009 the House passed the “Affordable Health Care for
    America Act,” which has been placed on the Senate legislative
    calendar. In the Senate, Majority Leader Harry Reid unveiled
    the “Patient Protection and Affordable Care Act,” on November
    18, 2009. Both of these bills would expand coverage to the
    majority of Americans, curb the rising cost of health care,
    cut the deficit and improve the quality and efficiency of
    our health care system. Those who are satisfied with their
    current coverage would be able to keep it and insurance
    companies would be prohibited from denying or rescinding
    coverage from patients based on their health status or
    preexisting conditions.

    I was pleased that a number of my bills were included in the
    merged Senate package, including initiatives that would
    improve the health and long-term care of seniors and work to
    reduce the cost of health care. These include the Nursing
    Home Transparency and Improvement Act, the Patient Safety and
    Abuse Prevention Act, the Physician Payments Sunshine Act,
    Medicare Payment Improvement Act of 2009, as well as
    provisions from the Retooling the Health Care Workforce for
    an Aging America Act. My hope is that these are included in
    the final health reform bill passed by Congress.

    The time for reform is now, we cannot wait another ten or
    twenty years until health care costs consume an even greater
    percentage of our economy and the budgets of American
    families and businesses. I look forward to working with my
    colleagues in Congress to complete this important
    legislation.

    Again, thank you for your comments. I will be sure to keep
    your thoughts and concerns in mind as legislation progresses
    through Congress.”

    Senator Kohl, a muti-millionaire before being elected — ironically replacing William “Bill” Proxmire, who never spent more than $100,000.00 on any of his re-election campaigns — will be one long after he leaves office, if he ever leaves office! He now receives and will for the rest of his life, free single payer healthcare, paid for by you and me, the same as all of the rest of the Congress, President, Military, etc. About the only proposed law or act Senator Kohl didn’t name, would be the “Sticking it up the Patient’s Butt ACT,” which is really what he and all of Congress are doing to us, their so-called healthcare reform will actually do to us, cost us more so others can get even richer than they now are!

    Sorry if this dampens your Merry Christmas plans. But it’s Congress’ and the president’s Christmas gift to you and me; a colossial lump of coal called healthcare reform!