Even before the COVID-19 pandemic, health care was at the forefront of Americans' minds. A Gallup poll released January 13, 2020, placed health care at the top of issues important to voters in the upcoming election. Moreover, a recent survey conducted by Public Agenda in partnership with USA Today and Ipsos found that Republicans and Democrats agree about the need to fix the nation's health care system.

But is a single-payer system the way to go? A recent study shows that American small business owners, at least, have strong—but decidedly mixed—opinions.

Employment web site SimplyHired conducted a survey of 543 Americans who were running their own business, self-employed in their own incorporated or unincorporated business, or currently engaged in entrepreneurship. The survey defined single-payer health care as "a type of universal health care financed by taxes that covers the costs of essential health care for all U.S. citizens."

The study revealed 70% of business owners either supported or strongly supported a single-payer system. That support was nearly unanimous among Democrats, at 96%, compared to 37% of Republicans.

Employer-sponsored health care was hardly left in the dust: 67% of respondents either supported or strongly supported that system, with 74% of Republicans and 62% of Democrats throwing in with the familiar plan.

Single-payer came in for slightly more opposition than employer-sponsored plans, with 27% either opposing or strongly opposing. Employer-sponsored plans were opposed or strongly opposed by 18% of respondents.

The most common perceived benefit of single-payer was lower expenses, while the most common concern was increased business taxes in order to fund the program. One respondent, a 62-year-old woman with six years' experience as a business owner, said, "I am not equipped to handle higher taxes. I would have to let employees go. I pay a very good wage. That is important to me, and if I were taxed much more, I would have to make cuts."

Similarly, a 38-year-old woman with 12 years' experience as a business owner opined, "Single-payer is bad for everyone, both private citizens and businesses alike. We pay more taxes, get less done, have longer waits for doctors and procedures, and much less personalized care."

Overall, nearly three-quarters of business owners felt the advantages of a single-payer system would outweigh the disadvantages.

"Honestly, as the owner of a very small business, it probably would increase the business taxes a bit," said a 46-year-old woman with six years' experience as a business owner. "I believe that disadvantage to me is far outweighed by my employees (and myself!) being able to get affordable health insurance."

If expenses for business owners were to fall significantly under a single-payer program, 57% of those surveyed said they would use the extra money to increase their employees' wages. Respondents also considered transferring money into savings or putting it toward employee benefits, at 36% and 35% respectively.

According to the study, 43% of business owners and entrepreneurs said health care would play an extremely important role in how they would vote in the 2020 election.

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Instant Insights /

Single-payer or business-as-usual for health insurance? Business owners have opinions.

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