The Political Consequences of “My Medicare”

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.

Vinik goes on to argue that making government redistribution more visible–e.g., providing it via expenditures rather than tax benefits–to its beneficiaries would make it more politically sustainable. I tend to agree, though one source of massive confusion about who pays for and benefits from “social programs,” our maddeningly complex system of federal-state-local relations, will be very difficult to untangle.

But more fundamentally, Democrats need to understand why programatically unhelpful and even counter-productive “personal responsibility” measures offered by Republicans to discourage, punish or stigmatize recipients of “welfare” programs are so popular. I earned my Medicare, a lot of old folks surmise. Those people need to pony up, too.

Ed Kilgore

Ed Kilgore, a Monthly contributing editor, is a columnist for the Daily Intelligencer, New York magazine’s politics blog, and the managing editor for the Democratic Strategist.