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Wednesday, August 22, 2012

Ryan, Medicare and those damned polls

A lot of people are talking about this poll, which presents evidence that Romney's choice of Paul Ryan may help the GOP paint Wisconsin red.
Asked if the selection of Ryan made them more likely to vote for Romney, 29 percent said more likely while 16 percent said less likely and 53 percent said it would not have much effect.
What intrigues me is the Medicare factor. Quite a few news stories have publicized Ryan's scheme to reform the popular program. Since the reforms are unpopular, why isn't Ryan more widely disliked?

Even though this poll was published on Kos -- sorry about that! -- a numerical incongruity demands our attention.
Q: Do you support or oppose Paul Ryan's proposal for reforming Medicare?

Support 36%
Oppose 45%
Not sure 18%

Q: Do you believe traditional Medicare insurance for seniors should be replaced with vouchers to allow the elderly to buy private insurance if they want health care coverage, or not?

Traditional Medicare insurance for seniors should be replaced with vouchers 19%
It should not 63%
Not sure 18%
Dig: 45 percent say they oppose the Ryan reform plan. Yet 63 percent say they oppose vouchers -- which is the key component of the Ryan reform plan. That means 18 percent of the population is willing to stand up and say "Yeah! Gimme that there Ryan stuff!" -- even though they have no damned idea what the Ryan plan entails.

Propaganda triumphs again!

Of course, vouchers would do nothing to reduce cost. Inevitably, costs would go up, since the profiteers would take their cut.

Vouchers have a very dubious history. They played a key role in Boris Yeltsin's "shock therapy" reform of Russia -- described by many as "all shock and no therapy." Voucher were used to sell off public property. Of course, only a few well-connected oligarchs were able to snap up these vouchers en masse. Vouchers, in short, paved the way for history's most brobdinagian burglary.

Granted, the Russian example isn't directly relevant to the Ryan plan -- but it does prove that oligarchs have, in the past, used sweet talk about vouchers as a means to pick the working person's pocket. About the Ryan plan per se, Mark Thoma says:
The Ryan plan would reduce Medicare payments far below what is currently available, and this would leave many without the means to obtain the care they need. But even if the vouchers were adequate, I would still not be in favor of a voucher system for health insurance.
(Emphasis added.) Thoma goes on to argue that insurance companies have a very poor history of controlling health care costs. Those costs are much higher in the U.S. than in those countries where a more socialized insurance system rules. That wouldn't be the case if privatization worked as magically as the Libertarian ideologues claim.

From a Center for American Progress report:
No version of premium support achieves savings without adverse consequences for beneficiaries. Some versions impose an arbitrary cap on the amount of the voucher, significantly shifting costs to beneficiaries, regardless of their choice of plan. Other versions make many of those who wish to remain in traditional Medicare pay sharply higher premiums. For these beneficiaries the choice of traditional Medicare would be a false one in reality.

Moreover, no version of premium support fully prevents private health insurance plans from attracting healthier beneficiaries, driving up premiums for those who remain in traditional Medicare. In addition, no version of premium support creates a level playing field between private plans and traditional Medicare. As a result of these two factors, more and more beneficiaries would gradually shift to private plans over time.

These risks are too great. Medicare coverage costs less than comparable private coverage and Medicare is more successful at containing costs per enrollee than private plans. While diluting traditional Medicare would sacrifice these advantages, premium support would provide little benefit in savings because the Affordable Care Act already created a mechanism to limit the growth in Medicare costs.
During the cold war, nearly everyone in this country agreed that the "magic of the market" works well in many areas of the economy and not so well in other areas. Only a nut would want to see government-run dog groomers or car washes or burrito joints. But if you're going to send a snail-mail letter (which is not terribly time-sensitive), do you want to pay USPS rates or Fed-Ex rates? If you lived in a small town with only one privately-owned firefighting brigade, how much would you have to pay that company each year? Were you overjoyed when private companies with GOP connections got contracts to clean up after the Katrina disaster, then subcontracted the actual work after pocketing a hefty percentage of each taxpayer dollar? Were you pleased when Haliburton provided services to the military in Iraq that the military itself used to provide for much less money?

Bottom line: If you're not well-off, would you rather be sick in France or the U.S.?

My mind keeps drifting back to that bizarre 18 percent slice of the electorate -- to the folks who simultaneously support and oppose the Ryan plan. Perhaps we should call those people the Schrodinger voters. Where are they getting their information, and how can we push these people out of their state of indeterminacy?
I've never understood the low/middle income types who identify as conservative.

Wisconsin voters have withstood a nasty recall campaign, and they are tired of negative ads.

I hope this is not a harbinger of more reactive polls Nationwide. The schizophrenia of poll respondents as to disfavoring negative campaigns, is my hope.

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