A couple of pieces of interest from the Sunday papers:
–A common, but very bad mistake. The WaPo writes:
Ryan’s plan leaves Medicare benefits untouched for current retirees but, over time, would shift the program from an open-ended guarantee of care to a capped payment to seniors for them to use to purchase private insurance.
This is wrong both in the short term for sure, and likely wrong in the longer term as well.
In the near term, by repealing the Affordable Care Act, Rep Ryan (and Gov Romney) would:
–take away prescription drug benefits currently enjoyed by Medicare beneficiaries by re-opening the “donut hole,” the gap in prescription drug coverage that shifts drug costs back onto seniors.
–since the ACA covers co-payments for preventive care visits, ending it would shift these costs back to beneficiaries as well.
–it would reduce the life of the hospital insurance trust fund by eight years, thus weakening the program for all beneficiaries, present and future.
In the longer term, turning Medicare into a voucher program, as Ryan and Romney have both endorsed, raises the specter of “adverse selection.” The risk here is that younger, healthier seniors who would otherwise have been in Medicare will opt for cheaper, private plans leaving sicker and more expensive patients for Medicare. That means Medicare premiums will have to continuously rise relative to private premiums, increasingly exacerbating the problem.
A key ingredient to efficient health insurance is the risk pool (you see this also in the ACA exchanges) but the R/R plan dilutes that pool. And ultimately, that will screw things up for everyone, including the 55+ crowd.
–When Poll Questions Are Dog Whistles, as Opposed to Informative: The WaPo has an interesting piece showing poll results on the existing political divide, but a key question in the poll struck me as uninformative, if not misleading.
It asks respondents whether they want “smaller government with fewer services.” Full question: “Would you say you favor a smaller federal government with fewer services, or larger federal government with many services?”
The problem is the vagueness of the question, and really, I wouldn’t get wound up about this—it’s a typical poll question—except for the fact that this kind of sentiment is very much linked to the current debate we’re having around the election.
If you ask this question broadly, you’re invoking anxiety about “big government,” intrusive regulations, taxes, and budget deficits, all big negatives to many center/right respondents. But if you ask those same respondents about specific programs and policies—about Medicare, infrastructure, education, medical research, defense (!), even certain aspects of the safety net (e.g., nutrition support for the poor, supported by a majority of Ds, Rs, and Is!), you get a much more positive response.
I became sensitized to this problem during the Recovery Act, which polled terribly when you asked about it as a whole, but generated completely opposite—highly favorable results—when you asked about its component parts (tax cuts, infrastructure, preserving teachers’ jobs).
There’s a larger theme in here as well. A spate of articles in recent weeks have noted the government programs, including stimulus measures, that Rep Ryan advocated for in his WI district, and of course, Gov Romney’s health care plan in MA looks a whole lot like the ACA. Yet these two are loud advocates for “smaller government” (though even this gets quickly complicated—e.g., they want to keep subsidies for oil companies, and Gov Romney now says he wants to repeal the $716 billion cut to Medicare in the the Obama and Ryan budgets).
The WaPo itself gets at this contradiction in a slightly more nuanced question about the provision of goods and services through government intervention, supported by two-thirds of respondents, 55% of R’s, 30% of Tea Partiers (!), and 70% of religious R’s.
This type of nuance is essential for a more well-informed debate over the next couple of months, and so I’d ask pollsters and poll-readers to avoid the 40K-feet-up questions that are too vague to provide useful information—we know things are polarized at the that level—and get beneath the surface to learn more about how people really feel about the role of government in their lives.