Wednesday, April 22, 2015

qotd: Why are the elderly reluctant to support health care for all?

The New York Times
April 22, 2015
Obamacare, Hands Off My Medicare
By Thomas B. Edsall

A number of factors underpin the anti-redistributionist shift in public
opinion that I wrote about last week.

First, and perhaps most important, is the emergence of significant
resistance to downward redistribution among the elderly, a major voting

The views of older voters deserve scrutiny. They "worry that
redistribution will come at their expense, in particular via cuts to
Medicare," Vivekinan Ashok, a Ph.D. candidate in political science at
Yale; Ilyana Kuziemko, a professor of economics at Princeton; and Ebonya
Washington, a professor of economics at Yale, write in a March 2015
Brookings Institution essay, "Support for Redistribution in an Age of
Rising Inequality"— an essay my Times colleague Neil Irwin also
discussed in a recent column that asked why Americans don't want to soak
the rich.

In the end, Ashok, Kuziemko and Washington conclude that "the elderly
have grown increasingly opposed to government provision of health
insurance and that controlling for this tendency explains roughly half
of their declining relative support of redistribution."

What the Brookings essay neglects to explore are the material
circumstances of over-65 voters that might affect their views on
redistribution. Over a third of retirees depend on Social Security for
90 percent or more of their annual income, according to the Social
Security Administration. In the zero-sum competition for federal
dollars, the cost of major spending programs like the Affordable Care
Act has to be made up by spending cuts elsewhere.

The Obama administration has reported that the Affordable Care Act will
be financed in part by $716 billion in Medicare cuts over 10 years.
Somewhat improbably, the administration also contends that cuts of this
magnitude will not reduce services to Medicare beneficiaries.

The decline in support among the elderly in the United States for
redistributive social spending stands in contrast to Britain, Germany,
Sweden and Australia where Ashok, Kuziemko and Washington found that
older people were more supportive of redistribution than those of
working age. In most European countries, health care is guaranteed
regardless of age, while in the United States, before the enactment of
the Affordable Care Act in 2010, only the elderly were guaranteed health
coverage through Medicare.

This lends support to the authors' conclusion that "seniors, a group
unique in having guaranteed health insurance during our sample period,
may increasingly feel that expansions of redistributive programs could
come at their expense."

Further increasing anxiety among the aged in the United States is the
shift from defined benefit pensions, which guarantee payments, to
defined contribution pensions, which do not.

"Our best assessment is that retirees are falling short and will fall
increasingly short over time," Alicia H. Munnell, Matthew S. Rutledge
and Anthony Webb, researchers at Boston College's Center for Retirement
Research, wrote in November 2014.

"The new demographic transition is a longevity transition: how will
individuals and societies respond to mortality decline when almost all
of the decline will occur late in life?" Karen N. Eggleston, director of
the Stanford Asia Health Policy Program, and Victor R. Fuchs, professor
emeritus of economics at Stanford write in a 2012 study. The combination
of longer lives and unreliable pension benefits increases retirees'
dependence "on transfers from the working population for living
expenses, including large consumption of medical care," Eggleston and
Fuchs note.

In his new book, "The Business of America Is Lobbying," Lee Drutman, a
senior fellow at the New America Foundation, provides insight into a
crucial element of this power shift.

Beginning in the early 1970s, just as support for redistribution began
to decline, "corporate America began to devote attention and meaningful
resources to politics," Drutman writes. "The 40-year trend has
overwhelmingly moved in one direction: growth. Corporate lobbying
expenditures now dwarf the comparable investments of unions" and public
interest or citizen groups.

From 1998 to 2012, the ratio of corporate/trade association lobbying
spending to union/public interest group spending went from 22 to one to
34 to one, Drutman found.

In a November 2014 article "The Ideological Asymmetry of the American
Party System," Yphtach Lelkes of the University of Amsterdam, and Paul
Sniderman of Stanford, both political scientists, develop an intriguing
argument on how Republicans have mobilized public opposition to
Democratic social policies that initially carried strong popular support.

The conservative strategy, they write, is to portray "social welfare
policies as benefiting particular interest groups rather than society as
a whole." The more the electorate sees a policy or program as
"particularistic" — as opposed to universalist — the less backing the
public will give the program.

On a broader scale, the political scientists Jacob Hacker and Paul
Pierson, in their chapter of the 2013 book "Representation: Elections
and Beyond," have sought to understand the logic of working-class white
"support for the G.O.P. in an era of runaway inequality."

Hacker and Pierson argue that not only has business mobilized for over
four decades now, but so, too, have conservative foundations, think
tanks and the religious right.

"There was a common theme linking these disparate trends: all of them
worked to diminish the presence of organized voices addressing the
economic concerns of ordinary Americans in Washington," Hacker and
Pierson write. "G.O.P. electoral inroads among less affluent voters have
occurred alongside declining public confidence in government and growing
perceptions that politicians are excessively responsive to 'special
interests.' "

The authors add, "In this context, calls for limited government and
self-reliance receive greater hearing, especially when there are few
contrary organizational signals pushing voters the other way."


Comment by Don McCanne

A half century ago, when the nation seemed ready to ensure health care
for everyone, it was decided instead to establish programs for the two
groups with the greatest needs: Medicare for retirees and Medicaid for
the poor. It was intended that Medicare eventually would be expanded to
include everyone.

As it turns out, these two programs have such strong political support
that they not only survived the half century, they will be perpetuated
indefinitely as a result of the decision to enact the the policies
contained in the Affordable Care Act rather than to expand Medicare, as
originally intended.

Thomas Edsall provides us with a background of understanding why our
seniors so passionately support Medicare while demanding that we keep
the government out of their Medicare. No matter how progressive a
person's views are, there is always an element of self-interest, and
quite appropriately so. Edsall, in expanding on his
anti-redistributionist article of last week, explains that seniors are
concerned that further redistribution to others risks reduction of
redistribution to themselves, though they might not think of it in those
terms. It is this fear that has contributed to declining support by our
seniors for health care for all.

Of course, conservatives, through massive lobbying efforts, have
leveraged this view to convert it into policy. Those who would suffer
the most through a reduction in redistribution have been particularly
tenacious in clinging to the idea that greater benefits for others would
reduce benefits for themselves. You know that's true because it's on Fox

In reality, a well designed system of redistribution would improve
benefits for everyone. The cost would be borne disproportionately by
those who are already spending massively to thwart programs of social

Thomas Piketty and others have shown us that disproportionate taxation
(progressive taxes) is precisely what we need, and the concentration of
income and wealth at the top is so great that the lifestyles of the rich
would not be impaired in the least. But just try to tell that to the
elderly lady carrying the picket sign stating, "KEEP GOVERNMENT HANDS

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