There is an awful lot of rampant speculation right now, much of it masquerading as confirmed fact, about how well the House Republican’s proposed Medicare reforms are going over with the American public. But there is very little hard evidence. There have only been two polls, to my knowledge, that have described and then asked about the Paul Ryan-authored Republican plan since President Obama invited Ryan to sit in the front row for his April 13th deficit reduction speech, during which Obama lambasted Ryan’s proposal.
That was the same speech in which Obama offered a “framework” to save “$4 trillion” in deficit spending. But his “framework,” were it actually a budget, would actually increase deficit spending over the next decade by about $1 trillion more than under current law — and current law already puts us on course to spend about $7 trillion that we do not have. His proposed deficit spending, moreover, is on top of the $14 trillion in national debt that we already have on the books, roughly a third of which has been accrued since Obama’s election.
The House Republicans’ proposed Medicare reforms are part of their 2012 budget, which would reduce deficit spending by $4.4 trillion — and 46 percent — in relation to Obama’s budget, according to the Congressional Budget Office (CBO).
The two polls that have summarized and then asked about the GOP proposal since April 13th appear to show, more than anything, that at this very early stage in a battle that will likely extend until the next election, the actual wording of the question makes a tremendous amount of difference.
Quinnipiac asks the question as follows:
“A) Medicare should remain as it is today, with a defined set of benefits for seniors. OR B) Medicare should be changed so that seniors who join Medicare in 2022 receive a fixed amount of money from the government each year that they can use to shop for their own private health insurance policy.”
Meanwhile, CBS News/New York Times asks the question as follows:
“In order to reduce the budget deficit, it has been proposed that Medicare should be changed from a program in which the government pays doctors and hospitals for treating seniors to a program in which the government helps seniors purchase private health insurance. Would you approve or disapprove of changing Medicare in this way?”
The differences between these two questions may appear subtle, but they are actually substantial. First, the CBS News/New York Times poll reminds respondents that the impetus for change is a desire “to reduce the budget deficit,” while Quinnipiac asks the question more or less in a vacuum. Second, a program “in which the government helps seniors purchase private health insurance” sounds different than a program in which seniors are left “to shop for their own private health insurance.” The former sounds like the government will oversee the process and provide assistance as necessary; the latter sounds like the government will cut a check and then send seniors on their way. Third, Quinnipiac’s reference to “a fixed amount of money” is more misleading than informative, as I will discuss later.
In this light, it is not overly surprising that 60 percent of respondents oppose the Republican proposal as Quinnipiac describes it, while only 41 percent oppose it as CBS News and the New York Times described it. And that’s true even though only 25 percent of the respondents in the CBS News/New York Times poll are Republicans. (Quinnipiac doesn’t say explicitly, but it looks like its sample is pretty evenly split by party.)
Perhaps the best evidence that the way in which Quinnipiac asks the question has a lot to do with the answers is this: The way Quinnipiac characterizes the proposed GOP reforms, fewer than half of all Republicans favor them.
In truth, CBS News and the New York Times describe the proposed reforms more accurately (although they could have mentioned the fact that anyone who is at least 55 years old wouldn’t be affected). Meanwhile, Quinnipiac slightly mischaracterizes the Republican proposal in a couple of different ways. First, it is actually incorrect to say that, under the proposed reforms, seniors would “receive...money from the government.” That would describe a voucher program, which, as the CBO notes, the Republican proposal is not. (For those who doubt the significance of this distinction, look at the pains that the Democrats, including Health and Human Services secretary Kathleen Sebelius, have taken to describe the GOP proposal as a “voucher” plan.) In truth, the proposal calls for seniors to choose their preferred plan and for premium support to be paid, by the government, directly to the insurer — which fits with the CBS News/New York Times description.
Secondly, Quinnipiac refers to giving seniors “a fixed amount of money.” While this is true for a given senior in a given year, on the whole it is inaccurate. The amount of premium support that the government would provide for each senior would not in fact be fixed but would be based on each senior’s income and health status, with poor seniors getting every bit of their care provided at taxpayer expense. Also, the amount of premium support would not be fixed over time but would rise each year, with inflation.
Further polling is surely needed to see how the American public is responding to this bold new proposal advanced by Paul Ryan and the House Republicans, and such polling will no doubt change over time. So far, however, when a description accurately summarizes the Republican proposal, people seem to like it. It’s no small thing that Americans like the sound of a program in which “the government helps seniors purchase private health insurance” more than they like the sound of a program in which “the government pays doctors and hospitals” directly — and that this is true even when Republicans are greatly underrepresented in the poll.
This, along with the widespread opposition to Obamacare, further reflects the fact that, when it comes to reducing health costs, Americans trust competition among private insurers — fueled by cost-conscious individuals with a stake in the game — more than they trust additional government regulation.