A lot of Democrats seem to think making seniors think about Medicare every time they are asked to think about any social programs is a silver bullet. This is why some Democrats did and still do think “Medicare for All” is the right model and message for universal health care, and why others think Republican efforts to play off Obamacare against Medicare are obviously absurd.
But there’s a problem with this approach, as I wrote about here at TDS in 2011, and discussed today at the Washington Monthly:
At TNR Danny Vinik takes a long look at a provocative new Brookings Institution report that indicates support among African-Americans and seniors for “government redistribution” programs has been declining gradually for decades. There’s a lot of interesting stuff in Vinik’s article, and probably even more in the report. But I want to zero in on one point that some of us have been trying to make for years to Democratic strategists who think Medicare is the perfect model for every social program:
Democrats can learn a lot from the elderly’s declining support for redistribution. As [the report’s authors] note, it’s a bit strange that the elderly have become less supportive of government health insurance. “One might ask how,” they write, “by the end of our sample period, seniors can be less supportive of the idea that government cover medical bills given that they, uniquely, are categorically entitled this coverage.” There’s a simple explanation: Seniors don’t think the government helps them pay for health insurance. A recent Economist/YouGov poll found that 93 percent of Americans over the age of 65 said they don’t receive a government subsidy to pay for health insurance. (Nearly all seniors receive a subsidy via Medicare.)
Ding! Ding! Ding! Jackpot! Democrats are forever trying to suggest that senior think about their Medicare benefits when forming opinions about “the social safety net” or “redistribution” or the moral qualities of Big Government. But to a remarkable extent, seniors view Medicare (like Social Security) as an earned benefit–a literal entitlement. In part that’s because, as Vinik notes, they erroneously think their own payroll deductions and premium payments finance their benefits (actually nearly one-half of Medicare benefits come from general revenues). But they also distinguish themselves from those people on welfare by virtue of considering themselves entitled to a comfortable retirement via a lifetime of work. This is why so many of them can simultaneously bridle at Republican efforts to reduce or means-test Medicare benefits while opposing similar benefits for others.
This is why making a moral and economic case for social programs targeted to poor and sick people–including Obamacare and the Medicaid program it builds upon–is essential. Just saying to seniors “everybody should get the same benefits you’ve been given” will make many of them furious.