Framing effects matter a lot in polling, so it’s certainly interesting to see that The New York Times’ pollsters have devised language under which the Republicans’ Medicare plans are non-toxic, though I think the contortions they went through to get that result are misleading. But from the same poll, I think the really telling point for the long term is that Democrats and Independents are joined in favoring government health care guarantees that Republicans oppose:
For decades now the government has, in line with public opinion, undertook to guarantee that everyone gets health care. That’s been done through Medicare, Medicaid, and a complicated series of regulations and subsidies to ensure that most non-elderly people get health care through their employer. Over time, the efficacy of the complicated series of regulations and subsidies has tended to decline, and the government has responded with new regulations (think Kennedy-Kassebaum), expansions of Medicaid eligibility, and new programs like SCHIP. One important element of the Affordable Care Act is to continue those trends.
But this whole undertaking is increasingly costly, in a fiscal sense, over time. The progressive response to that has been to increase taxation on other sectors and also to try to imply technocratic management tools to reduce genuine waste from the system. Another important element of the Affordable Care Act is to deploy those ideas. This is an agenda about which the public has mixed feelings and that prompts ferocious interest group opposition. But the only workable alternative to this agenda over the long run is simply to repudiate those guarantees. The House Republican plan to control health care costs is to try to create a situation in which non-wealthy people will be routinely denied access to genuinely useful health care services on the grounds of price. This will initially reduce health care costs by reducing utilization of health care services, and will further reduce costs over time by creating incentives for health care service providers to focus energy on cutting prices to increase market share. In a political rhetoric sense, you can try to sneak this agenda past the voters with sly verbal formulae and smoke and mirrors around “block grants” and delayed phase-ins but in practical implementation terms it flies in the face of overwhelming existing public consensus.