The Revolt Of The Septuagenarians

Ezra Klein had a column in the Washington Post over the weekend explaining why senior citizens, who favor Medicare, oppose a government-run health insurance program for people other than them. They think Medicare will be diluted by expansion and reform. That's a fairly simple "I got mine" theory of why seniors don't support health care reform. I don't necessarily think of Grandma as a selfish bastard, however. They are as caring and compassionate as anyone else on this rock we call home. They may fear the rug being pulled out from their coverage - and on this, Democrats haven't made the sell about how seniors stand to gain big from reform, particularly through lower prescription drug spending - but I think a simple campaign showing how the grandkids won't have any hope of getting medical care under the status quo would theoretically undermine the selfishness argument. And AARP has been making their own sell to seniors. I think Klein's secondary point hits the mark a little more:

Seniors are also the most conservative segment of the population and are getting more so. They constitute not only the sole age group that Obama lost in last year's election, but also the sole age group in which his results were worse than those of John Kerry in 2004. And both Obama and Kerry underperformed Al Gore's 2000 results.

"The Roosevelt seniors are being replaced by the Reagan seniors," says Paul Begala, who helped run Clinton's 1992 campaign. A May poll by the Pew Research Center found that for the first time in 20 years, the GOP is now an older party than the Democrats.

The June Post-ABC poll asked whether respondents would prefer a smaller government with fewer services or a larger government with more services. Seventy percent of seniors -- the segment of the population with government-run health care and a government pension, also known as Social Security -- preferred a smaller government, compared with 37 percent of people 18 to 29. Seniors are the age group most solidly opposed to the public option. In fact, in the August Post-ABC poll, they were the only age group in which a majority opposed it. "Seniors are like the American West," says Julian Zelizer, a Princeton historian. "They depend on government and then say they hate it."

The age divide has animated most of the anger in town hall meetings and tea parties, which is not about health care reform but about Obama. He had a similar problem attracting senior support during the Democratic primary. Seniors as a demographic are simply more easily targeted by smear campaigns from the right, and more receptive to them. Nobody wants to talk about the role of race in all this, but I don't think it's hard to figure it out. Fear of a black President still runs deep over a generation that's more conservative in their thinking. I think Matt Bai is correct to look on the bright side:

The good news for Obama and his party, of course, is that they still enjoy an enviable level of support among voters just breaking into the work force and among those now drifting into middle age. And that means that if reigning Democrats can manage to get health care policy right this time, and maybe even add some fundamental energy reforms, they might still be able to cement more hopeful attitudes about government for generations to come, much as Roosevelt did in his day. Today’s younger voters might never be as party-affiliated as their grandparents were, but neither may they turn out to be as cynical about their leaders as their parents often seem to be. If the president has his way (which is to say, if the worst nightmares of Republicans come to pass), those voters may someday live out their retirements in Arizona or Nevada, spinning stories for their grandchildren of the days when Barack Obama was twice elected president, when government managed once again to make things better instead of worse and when politicians still bothered with these things called town halls.

But it's going to be a hard slog, because of the people who most commonly vote in elections, particularly midterm elections, today.

Freedom Riders

Turns out that the teabaggers at one town hall meeting in Texas weren't from the area:

Last night, Rep. Gene Green (D-TX) hosted a rowdy town hall meeting to discuss health care reform. Fox’s local Houston affiliate reporter, Duarte Geraldino, reported that he talked to the participants and found that “some attendees admit they don’t live in the district.” How did they get there? Geraldino noted “an internet campaign” by far right activists urging their allies to attend and heckle Democratic Representatives. Geraldino then aired a clip showing one participant acting disrespectfully towards Rep. Green. “Pay close attention to the man behind the congressman,” Geraldino says in this clip, “he seems to have forgotten the part about respect.” Watch it:

Here's my favorite part:

During the town hall, one conservative activist turns to his fellow attendees and asks them to raise their hands if they “oppose any form of socialized or government-run health care.” Almost all the hands shot up. Rep Green quickly turned the question on the audience and asked, “How many of you have Medicare?” Nearly half the attendees raised their hands, failing to note the irony.

Decades of conservative message dominance has convinced a healthy portion of the public that a government-run program isn't run by the government. Failure to counteract that message 30 years ago is deeply affecting this debate today. Paul Waldman writes:

After decades of being told that the federal government is a sinister, rapacious beast with nothing but evil intents, the idea that a complex bill might contain a Soylent Green provision isn't too far a stretch. Nonetheless, it remains entirely possible that before long, health reform will no longer be a debate but will become an actual policy, one that will succeed or fail on its own merits. As both sides have understood (the Republicans more so than the Democrats, however), this battle is so critical because the stakes go to the heart of each party's approach to the role of government.

Both parties hope that the successful implementation of their favored policies will lead to a broader acceptance of their ideology. Republicans want to privatize government services not only as an end in itself but to show people that the private sector works better than government. In the same way, Democrats advocate for effective government services not only to solve an immediate problem but to demonstrate that government can in fact do some things very well.

Unfortunately, the successful implementation of a government program doesn't necessarily convince people that government can successfully implement programs. Antipathy toward government even among many who receive both Medicare and Social Security -- two of the most successful government programs in history -- is remarkably strong. In fact, by some measures, the elderly have the most skeptical views of government. For instance, in the latest version of the Pew values survey, 64 percent of those over 65 -- who are either on Medicare and Social Security or know that they will be soon -- said that "when something is run by the government, it is usually inefficient and wasteful" (see page 34 here). That compares to only 43 percent of those age 18 to 29.

Part of that is just the tribal identity with conservatism (which is stronger in those over 65, based on most surveys) trumping the shared knowledge of government programs like Medicare and Social Security. Because these same people generally really like those programs; they've just convinced themselves, in a supreme case of cognitive dissonance, that government doesn't work well (except for whatever it is they're getting). And mainly, that's because they've heard this repeated from the conservative noise machine for thirty years, virtually unchallenged and sometimes enthusiastically endorsed by Democrats.

Or perhaps there's another answer. The polls are showing that people under 50 support health care reform at much higher levels than people over 50. It's no accident that the strongest smears against the plan have to do with killing grandma or taking things away from Medicare. They like what they have and are wary of extending it to the rest of the population, mainly because of how it might impact them.

But this is a funny type of skepticism. Seniors don't oppose government-run health insurance. They like it too much. Americans over 65 live in a welfare state that most Europeans could only dream about. They have single-payer health care and government-run pensions. Most of their political activity is either an effort to expand those programs or a defense against anything that could in any way harm them. That includes not only direct changes, like cuts to Medicare, but indirect changes, like health-care reform that would focus new resources on the uninsured.

This is a reversal of the normal politics of opposition. Generally speaking, people who oppose health-care reform are worried we're going to end up with something like what Canada has. Not seniors. They have something like what Canada has (Canada, in fact, also calls their health insurance program "Medicare"). And they like it. They report higher rates of satisfaction with their health care than do people in employer-sponsored insurance. They're worried, rather, that they might end up with something like what the rest of America has. And having spent time in both Medicare and private health insurance, they don't want that. They don't want that at all.

The fight to get successful government recognized is an ideological fight. To those who already have evidence of successful government, the fight is somewhat different. They still echo the conservative line of "government is teh suck," but they don't want their government programs tampered with. How do you thread that needle?

Filling The Doughnut Hole

Insurance companies are not the only bad actor in the health care industry. To a degree all of them are. Some doctors overtreat and order up unnecessary tests. The medical device industry pushes their products even if they have no utility. Hospitals charge exorbitant rates. The incentives in the system are entirely wrong. And of course, then there's the pharmaceutical industry. And in 2002, they negotiated with President Bush and the Republican Congress to put the doughnut hole into the Medicare Part D bill. What was that? Well, your prescriptions were covered up to the first $2,700, and then you had to pay full price until you hit $6153.75, essentially offering no benefit to the elderly who consume enough drugs to meet that lower bound. It was a forced gap put in by an industry looking to make a buck, since the consumer has no bargaining power in that doughnut hole, while the government does. And under the current President and the Democratic Congress, they returned to the negotiating table and said end this now. So the industry will.

Drug manufacturers have tentatively agreed to provide as much as $80 billion worth of discounts on medicines purchased for government programs such as Medicare, providing a bit of cash for President Obama's expensive and ambitious attempt to give health coverage to every American.

The accord, approved yesterday by the board of the Pharmaceutical Research and Manufacturers of America (PhRMA), is a voluntary pledge by the industry to reduce what it charges the federal government over the next 10 years, according to a source close to the negotiations who spoke on the condition of anonymity because of White House sensitivity about the talks.

If health-reform legislation is enacted, the agreement would bring financial relief to about 3.4 million elderly and disabled Americans who currently fall into a coverage gap known as the "doughnut hole." Medicare recipients must now pay the full price of brand-name medications after they have incurred a total of $2,200 in drug expenses, until reaching an outer limit of $5,100.

Under the proposal, U.S. drug companies would provide half-price discounts to Medicare recipients in the "doughnut hole" and provide other unspecified discounts and rebates for a total of $80 billion in savings to the government.

"This is real money on the table," the source said.

The White House put out slightly different numbers for the doughnut hole, but basically it means that Medicare would purchase those drugs in the middle, and they can get more for their money. This leads to lower costs. The President released a statement, and here's part of it:

"As part of the health reform legislation that I expect Congress to enact this year, pharmaceutical companies will extend discounts on prescription drugs to millions of seniors who currently are subjected to crushing out-of-pocket expenses when the yearly amounts they pay for medication fall within the "doughnut hole" - any payments by seniors not covered by Medicare that fall between $2700 and $6153.75 per year. The existence of this gap in coverage has been a continuing injustice that has placed a great burden on many seniors. This deal will provide significant relief from that burden for millions of American seniors.

"The agreement by pharmaceutical companies to contribute to the health reform effort comes on the heels of the landmark pledge many health industry leaders made to me last month, when they offered to do their part to reduce health spending $2 trillion over the next decade. We are at a turning point in America's journey toward health care reform.

It doesn't seem like much of a deal for the pharmaceutical companies, but if you add 30 million or so Americans to the rolls of the insured, that's a big ol' market for new prescription drugs. Plus, Medicare, the largest purchaser of drugs in America, has a certain amount of leverage. I don't mind them making a profit - but they must offer fair and equitable prices for their work and try to create products people need to alleviate pain and disease instead of hair growers and boner pills.

The doughnut hole has long been one of my biggest bugaboos about the power of industry, and I'll be happy to see it cut in half. That's a tangible benefit for seniors and something around which they can rally for comprehensive reform.

Reich Calls It A Depression

Thanks for blowing my whole weekend, Robert Reich.

The March employment numbers, out this morning, are bleak: 8.5 percent of Americans officially unemployed, 663,000 more jobs lost. But if you include people who are out of work and have given up trying to find a job, the real unemployment rate is 9 percent. And if you include people working part time who'd rather be working full time, it's now up to 15.6 percent. One in every six workers in America is now either unemployed or underemployed.

Every lost job has a multiplier effect throughout the economy. For every person who no longer has a job and can't find another, or is trying to enter the job market and can't find one, there are at least three job holders who become more anxious that they may lose their job. Almost every American right now is within two degrees of separation of someone who is out of work. This broader anxiety expresses itself as less willingness to spend money on anything other than necessities. And this reluctance to spend further contracts the economy, leading to more job losses [...]

This is still not the Great Depression of the 1930s, but it is a Depression. And the only way out is government spending on a very large scale. We should stop worrying about Wall Street. Worry about American workers. Use money to build up Main Street, and the future capacities of our workforce.

I agree with Tim Fernholz - this whole notion that employment is a "lagging indicator" of the economy is dangerously out of balance. 663,000 people had their lives turned upside down in the last four weeks. Fixing their situation and getting them working again is actually the MEASURE of the economy, in my opinion.

So how do we do it? Obviously, the stimulus funds already in the pipeline and just starting to make their way out to the public will help. But Reich argues we'll need much more. Brad DeLong has some macro-economic ideas, including additional government spending, central banks buying government bonds, and boosting financial asset prices. I don't know exactly what needs to be done, and I'm willing to wait to see how this initial stimulus affects employment before calling for a new one. But this is a very tough time in the economy, and with the lack of retirement savings leading our elderly to the want ads, I'm just very worried about how we're going to come back.

Social Security Privatization Is Back - Thanks To McCain

There's no question that Barack Obama is going to meet some resistance among older voters. I see it in my own family. And if this race were strictly personality-driven, I would expect that resistance to continue. But considering the fact that John McCain believes completely in Social Security privatization and gambling on the stock market with our seniors' future, I can't imagine how this resistance will hold.

Sen. John McCain didn't get the memo about the Republican charade to pretend their Social Security plans shouldn't be called "privatization".

Last Thursday, at the Loeb First Amendment Award Dinner in New Hamphire (aired on C-Span's "Road To The White House '08"), there was this exchange with an audience member:

Q: Will privatizing Social Security be a priority for you going forward? [...]

McCAIN: ...Without privatization, I don't see how you can possibly, over time, make sure that young Americans are able to receive Social Security benefits.

That was back in 2004, before Democrats successfully beat back Bush's efforts. McCain's on the trail now saying he won't privatize the program, but he's calling for younger workers to invest in "personal accounts," which is exactly the same thing.



Barack Obama is all over St. Maverick today on this, and it's a winning position for any Democrat.

"He said he supports private accounts for Social Security - in his words, 'along the lines that President Bush proposed,'" Obama will say in Philadelphia, according to pre-released excerpts. "Yesterday he tried to deny that he ever took that position, leaving us wondering if he had a change of heart or a change of politics."

McCain's starting to have a pretty serious flip-flopper problem. He's tried to shift on private accounts, he's completely incoherent on illegal wiretapping, he's gone around the bend on the estate tax, and as Steve Benen has amply demonstrated, this is just part of an ever-expanding list.

McCain's core principles include endless military action and occupation. On other issues, he'll say whatever he can to get elected.

Stimulus News

Well, the green energy package didn't get included, but the Senate will move a bill that adds $300 tax rebates for seniors and disabled veterans. The full bill doesn't help a whole lot. It doesn't give the help to those who need it the most. It doesn't use the opportunity to invest in our future rather than an ephemeral attempt at boosting consumer spending. But it does give a few bucks to my grandmother.

Progress!

...Just to add, most taxpayers, many of whom don't need this stimulus, get $600 to $1,200 dollars. The poor, the elderly and the disabled, most of whom would actually use this money, get $300.

Bushonomics.