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No Government Health Care! (Except for Mine.)

By Ezra Klein
Sunday, August 30, 2009

"We need to protect Medicare," Republican National Committee Chairman Michael Steele exhorted last week, "and not cut it in the name of 'health-insurance reform.' " It was a rousing defense of government-run health care from the . . . conservative chairman of the GOP. But incoherence doesn't necessarily make for bad politics. In this case, Steele was aiming his message directly at America's seniors. Lucky for him, they share his incoherence in full.

In late July, President Obama recounted a letter from a woman who told him, "I don't want government-run health care, I don't want socialized medicine, and don't touch my Medicare." The president chuckled. "That's what Medicare is," he protested at an AARP town hall. "A government-run health-care plan that people are very happy with."

Jokes aside, the White House is struggling to attract seniors to health-care reform. No age group is as solidly opposed to the project as the over-65 set. But that's the same set that relies on government-run health care and loves it.

That's not how it's supposed to work; successful government programs are supposed to create constituencies for their expansion. But the happy experience of Medicare has made seniors less, not more, open to a generous welfare state. It hasn't created advocates for more single-payer health care; it has created advocates just for Medicare. And they fear that health-care reform will endanger Medicare.

Resolving this tension could decide the future of Obama's make-or-break domestic policy push. The opposition of seniors matters. Older people vote in bigger numbers than younger people do; they're more likely to call their representatives or attend a town hall meeting. Most important, says Robert Blendon, a Harvard scholar who studies public opinion on health care, "they make off-year elections. The secret about Congress and health policy is that in 2010, there will be a lot more seniors at the polls than there were in 2008."

Just ask Bill Clinton. In September 1993, the strongest supporters of his plan to reform the health-care system were seniors. A solid 62 percent approved of his efforts. By April 1994, the president had lost 25 points among seniors, and they were his weakest backers. "In the Clinton plan, it didn't come out till later that the financing came substantially from Medicare," Blendon says. But once it did, seniors revolted. In that fall's midterm elections, Democrats lost more than 50 seats in the House. Seniors were a big part of the reason -- giving Republicans 51 percent of their votes.

Seniors are moving in a similar direction this year. A Washington Post-ABC News poll this month found that only 35 percent of people 65 and older approved of Obama's handling of health care. Compare that with 44 percent of respondents between the ages of 30 and 64, and 57 percent of 18- to 29-year-olds. More telling, only 8 percent of seniors thought reform would improve their health care, while 42 percent thought their care would get worse. All this despite the fact that a staggering 94 percent of seniors are satisfied with the quality of care they receive, and Medicare polls much better than the private health insurance market.

What are seniors so afraid of?

From the beginning, Medicare has been named as one of the potential sources of savings that would fund subsidies for the uninsured. That sounds like service cuts, even if the specific changes don't involve anything of the kind (most of the savings would come from reducing overpayments to the private insurers that participate in the Medicare Advantage program).

So the fear is not of a welfare state but of changes in their welfare state. The result is that the coalition against reform is an odd union between people opposing government-run health care and people defending government-run health care. It's a potent combination.

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."

But taken as a whole, the attitudes seniors express on health care are arguably the greatest vote of confidence anyone has offered reform. Seniors live in America's version of Canada. They have single-payer health care. And they love it. They love it so much that they've got the chairman of the RNC swearing to protect it.

kleine@washpost.com

Ezra Klein reports on domestic and economic policy for The Washington Post. He blogs at washingtonpost.com/ezraklein.

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