Progressive Programs Don’t *Have* to be Universal to be Popular

The Medicaid expansion is extremely and broadly popular:

In collaboration with Indivisible and Data for Progress, Civis Analytics produced estimates of legislative district level support for Medicaid expansion among 2018 likely voters in Virginia.

Key Findings:

• In every House of Delegates and State Senate district in Virginia, likely voters support Medicaid expansion by an overwhelming margin. Two-way support (meaning “don’t knows” were excluded) for Medicaid expansion is 66 percent in the median House of Delegates district and 67 percent in the median state Senate district.
• Medicaid expansion carries little risk of backlash. In the median House of Delegates and State Senate district, two-way support among likely Republicans is 43 percent.
• Voters support Medicaid expansion even using partisan language and attached revenue pay-fors, in this case, a tax on hospitals.
• Medicaid expansion is popular even in red districts. Two-way support in the median Republican-held House of Delegates district is 60 percent and is 61 percent in the median State Senate district.

This reminds me of a point Krugman made recently in an interview with Ezra:

Ezra Klein

To argue about the underlying principle rather than the details, the debate I heard about the free college proposals has a lot to do with whether you should prioritize universality or progressivity in your proposals. Hillary Clinton would say, “Look, it might sound nice, but then we’re using our resources as a country to help Donald Trump’s kids potentially go to college for free, and they don’t need it. We should focus our resources on the kids who need it most.”

Bernie Sanders would say, both as a matter of societal values but also as a matter of political stability, making something universal makes it stronger, makes it easier to protect, gives everybody a stake in its continuation in the way Medicare has versus, say, Medicaid.

How do you think about that universality versus progressivity debate?

Paul Krugman

I was more sympathetic to the Sanders-type position a few months ago than I am now. This is an old line that poverty programs are poor programs, that if you make something dependent on family resources, that diminishes the support. One of the things that’s been startling about the health policy debate has been that it turns out that Medicaid is a very popular program. We used to just assume that Medicare was untouchable because everybody gets it, but Medicaid, which is for the poor, would have a lot less popular support. Polling suggests that Medicaid actually has a lot of popular support and that threatening to take it away was a big liability for Republicans during that health care debate.

But the “do we want to be giving free college to Donald Trump Jr.?” arguments almost always, when you actually do the math, turn out to be pretty trivial. It’s like, “Well, why should we be providing Medicare to wealthy people,” and the answer is that any kind of attempt to means-test Medicare ends up saving you very, very little money. There are just not many people up there.

I think the political case for universality looks a lot weaker to me now than it did a year ago. The financial case for non-universality I think is also pretty weak.

There’s an oft-repeated argument on the left that programs have to be universal to be popular and enduring. There is, as far as I can tell, no evidence for this. Medicaid is very popular. SNAP is popular. Social Security is often cited as the counterexample, but of course it has endured despite being very far from universal when it was first enacted.

As Krugman says, there’s also no good reason to means-test programs for often trivial savings. And in the specific case of healthcare, universality is the most desirable destination on the policy merits. But 1)programs don’t need to be made more universal than the policy merits require, and 2)non-universal programs can be popular and be built on to create more universal programs. It’s simply not true that being targeted makes programs inherently unpopular or easy to repeal.