by Yuval Levin
Democrats hoping to base their campaigns next year on the public’s fear of Medicare reform should take a careful look at the new Wall Street Journal/NBC News poll released today.
The poll’s sample doesn’t seem to lean right. Forty-two percent of respondents were Democrats and 34 percent were Republicans; 42 percent had voted for Obama and 32 percent for McCain; 49 percent of respondents approved of President Obama’s job performance while 46 percent disapproved; 51 percent thought that “government should do more to solve problems and help meet the needs of people” while only 46 percent thought “government is doing too many things better left to businesses and individuals.”
Respondents were asked a series of questions about Medicare. Their answers to one of these suggest the public is uneasy about the Medicare reform proposal in the House Republican budget. They were asked:
There is currently a proposal to change how Medicare would work so seniors being enrolled in the program ten years from now would be given a guaranteed payment called a voucher from the federal government to purchase a Medicare approved coverage plan from a private health insurance company. Do you think this is a good idea, a bad idea, or do you not know enough about this to have an opinion at this time?
Paul Ryan argues that his plan doesn’t involve vouchers, since it calls for a direct premium-support payment from the government to an approved insurer chosen by each senior, but this is nonetheless a relatively reasonable description of the plan. Twenty-two percent of respondents said it was a good idea, 31 percent said it was a bad idea, and 45 percent had no opinion. That doesn’t suggest huge opposition, but it certainly doesn’t suggest significant support. But then, respondents were asked about the subject this way:
Which of the following statements do you agree with more?Supporters of this proposal say the current Medicare system is financially unsustainable and this proposal will give seniors more health care choices while reducing costs by promoting greater competition in the health care system.
Opponents of this proposal say the current Medicare system provides health insurance to seniors with much lower administrative costs and this proposal will result in less coverage and more out of pocket costs for seniors.
Thirty-seven percent agreed with the supporters, 38 percent with the opponents, and 25 percent either were not sure or volunteered that they agreed with some elements of both arguments. In other words, the faintest hint of an argument in favor of this proposal brought about some movement in its favor.
Then respondents were asked how all this would influence their voting decisions. The premise of the Democrats’ campaign, after all, is that the Ryan plan will drive hordes of voters their way. Respondents were asked if they would be more or less likely to vote for a candidate if they found out that person “supports changing to Medicare for those under 55 to a system where people choose their insurance from a list of private health plans and the government pays a fixed amount, sometimes called a voucher, towards that cost.” Thirty-eight percent said they would be more likely to vote for that person if they discovered that, 37 percent said they would be less likely to do so, and 18 percent said it would make no difference.
By contrast, when asked if they would be more or less likely to support a candidate they found out “supports instituting an individual mandate requiring nearly all Americans to either have or purchase health insurance,” 31 percent said more likely and 50 percent said less likely, while 17 percent said it would make no difference. And when asked if they would be more or less likely to support a candidate who “supports repealing the health care reform law,” 47 percent said more likely and 35 percent said less likely.
At the very least, this suggests that at this point the Republican Medicare proposal is far less of a problem for Republicans than Obamacare is for Democrats. Like a slew of other polls, it also suggests that public opinion about Medicare reform is undefined and malleable. Maybe that means the Democrats will be able to work people up into a rage about premium support, but that certainly doesn’t seem all that clear so far.
This poll and others like it also suggest that a Republican presidential contender who proposed a Medicare reform plan built around premium support (especially if it avoided some of the main lines of criticism against the House Republicans’ particular approach—that benefits would not keep up with costs and that traditional Medicare would not be an option) could have a real chance of persuading a sizeable chunk of the electorate. That’s a good thing, since some reform along those lines is absolutely essential if we are to have any chance of getting our deficits and debt under control in the long run.