What Polling on Medicare and Paul Ryan’s Plan Really Tells Us

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One poll on health care policy can’t tell you much, but the Kaiser Family Foundation’s April tracking survey, conducted in wake of Paul Ryan’s proposal to remake federal entitlement programs and amid a stir of town halls unease, is pretty instructive. In this case, the usual caveats that accompany such data — question wording matters, policy is difficult if not impossible to poll, surveys only offer a partial snapshot in time, etc. — not only apply, but are actually central to understanding what the numbers are telling us on this issue.

First off, you can forget about any conclusions you’ve gleaned from the last few weeks of survey data.] Results from a bunch of reputable national polling outlets have varied wildly based on question wording. Things are just all over the map and provide no consensus whatsoever:

But examining the question wording tells us a few useful things.

The public responds more positively to Ryan’s plan when its Medicare changes are linked to the deficit. Respondents are noticeably affected by suggestions that the purpose of changing Medicare is to reduce deficits. In the broadest strokes, that’s the argument that most Republicans will be making in defense of their votes and it is one that people are willing to listen to.

Many people don’t realize Ryan’s plan won’t affect those 55 and older. Most poll questions aren’t including that very relevant caveat — Ryan’s proposal won’t ever apply to those currently aged 55 and older — and neither are Democratic communiques warning supporters of impending doom. Some questions note “future” changes or what Medicare could “become,” but the age detail really matters. The 65 and older crowd is seriously tipping the scales toward opposition to Ryan’s changes and they’ll tip them further in elections because a higher proportion of that age group votes.

People don’t like “vouchers” — even though they freely admit they don’t really know what “vouchers” are. What Democrats and some of the polls are mentioning is the word “voucher,” which, when dropped into survey questions, pushes down approval of Ryan’s plan. (Ignore semantic sparring over “vouchers” vs. “premium support.”) That basic negative reaction doesn’t necessarily reflect policy qualms though. Few people say they really understand what vouchers would really mean in the context of Medicare, and even fewer say they know anything about premium support.

However, when the basic idea of government-subsidized private insurance is explained in questioning, people are easily swayed by word choices like “help,” “choice” and “cost.”

People still have a lot to learn. That brings us to the most important thing to understand about recent findings, illustrated well by the KFF survey: public opinion on changing Medicare isn’t just malleable, it’s downright liquid.

In the tracking poll, a majority of respondents changed their answer after hearing a rudimentary argument against their originally stated position, no matter which one it was. That might mean that the “education phase” is key and people are easily being swayed by political argument.

But I suspect it shows something else: The public is not paying attention to, or strongly invested in, this debate. Sure, there have been some boisterous town halls and polling suggests the public has positive feelings toward Medicare, vague awareness of a deficit problem and a vague wariness of the word “vouchers.” And shifting some medical costs from government entitlement programs to individuals will never be massively popular. But there’s no evidence that Ryan’s plan or Democratic mobilization against it has changed anything yet. Of course, it goes without saying that the scrambling heat of August or a flood of anonymously funded attack ads could change all that.

All charts courtesy of the Henry J. Kasier Family Foundation, which you should visit here.

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