The Republicans' Senior Moment

One reason the electoral map turned red in November was that the electorate turned gray. Older Americans went to the polls in droves to vote Republican, while young people stayed home. And one big question about 2012 is whether the elderly will still vote Republican if the GOP can be forced to spell out the implications of its political agenda for Medicare and Social Security.

The magnitude of the age shift and the degree to which it favored Republicans in 2010 were remarkable. In 2008, voters 65 years of age and older represented a smaller share of the total (16 percent) than did voters aged 18 to 29 (18 percent). But in 2010, elderly voters outnumbered the young by more than 2-to-1 -- 23 percent compared to 11 percent. While the young still favored Democrats, the old swung massively to the Republicans, voting for them by a 21-point margin, 59 percent to 38 percent.

Throughout the year, polling found that of all age groups, the elderly leaned the most toward the Republicans and were the most hostile to health-care reform. No other age group depends more on federal spending, particularly for health care, but that did not deter a majority of seniors from voting for candidates who deplored "big government" and "socialized medicine."

At the root of this phenomenon is a psychology of self-exemption. Because it's piggybacked on Social Security, Medicare invites the elderly to believe they have earned its benefits, while other programs drain money from the taxpayers. In fact, the value of Medicare coverage far exceeds what seniors have earned through payroll taxes, but many nonetheless do not see themselves as being implicated in the evils of dependency on big government.

Right-wing campaigns have also played on the fears of the elderly that health-care reform will come at their expense. One study of the 1993-1994 health-care battle identified below-the-radar direct mail aimed at the elderly as the source of the most flagrant misrepresentations of the Clinton plan. These past two years, beginning with Sarah Palin's "death panel" scare, conservatives again sought to raise anxiety among the elderly -- and they apparently succeeded. A Gallup poll in June found 60 percent of seniors saying the adoption of reform was a "bad thing," while 57 percent of 18- to 29-year-olds and a plurality of other age groups said it was a "good thing."

In this fall's campaign, the big claim of Republican front groups like "60 Plus" was that Democrats were cutting Medicare by $500 billion. The health-reform legislation does not cut Medicare benefits -- it expands coverage of preventive services and closes the "donut hole" in the Medicare prescription-drug program (not to mention substantially extending the life of the Medicare hospital trust fund). The legislation, however, does cut payments to private Medicare Advantage plans that the government began overpaying as a result of legislation passed under George W. Bush.

The original justification for the private Medicare plans was that they were going to save money; instead, the federal government has been paying those plans more than what their enrollees would cost traditional Medicare. Cutting those subsidies was the right decision, but the private plans have had their revenge, telling their members -- about one-fourth of all Medicare beneficiaries -- that because of the new legislation, they'll lose benefits. Republicans went to town on all this, and Democrats didn't mount an effective defense.

The new legislation also reduces future updates to Medicare payment rates for hospitals and other providers. The provider groups accepted these reductions because the legislation will give them millions of additional paying patients who will now have insurance. Most people don't understand that for decades, Congress has used Medicare to subsidize hospitals for a variety of purposes, including medical education and charity care. It is perfectly appropriate to scale back those subsidies as providers get new revenue.

But though the Republicans said they'd restore these cuts, what are the real implications of their commitment to cut taxes and balance the budget? There is no way that Medicare can be sustained in the long run on the Republican fiscal regimen. If that regimen prevails, the elderly would face serious cuts in benefits -- real ones, not fictions. Soon enough, we'd be hearing again about the proposal that Republicans tried to pass in 1995 after they won control of Congress: cutting federal costs by turning Medicare into a voucher that wouldn't keep pace with medical inflation.

In 1995, the Republicans did themselves in on Medicare, and Democrats took advantage of it the next year. Whether Democrats can now force Republicans to show their hand on Medicare will be a big factor in what the electoral map looks like in 2012.

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