Does Medicare Improve More than Health?Policy Feedback Effects & Public Learning

• In Event: Policy Feedback and Health Inequity in America

Abstract

Political feedback effects have been well documented with various forms of political participation. For instance, citizens vote more and take other political actions when they benefit from programs such as Social Security, Medicaid, or the GI Bill. However, feedback patterns are relatively unexplored and less clear with other public opinion outcome measures, particularly political knowledge. This is odd because scholars have argued for years that “learn” from public policies, but few have demonstrated program-driven variations in knowledge of objective facts. Using data from nationally representative sources (e.g., American National Election Study [ANES] surveys), this paper leverages the age eligibility threshold in Medicare with a regression discontinuity design to reveal dramatic evidence of learning upon attaining benefits at age sixty-five. More specifically, citizens who are 63 or 64 years old are notably less well informed on programmatic facts relating to Medicare than those a year or two older. The effects are unmistakably large (i.e., double-digit) and highly statistically significant. However, the effects are concentrated on policy-specific facts as opposed to other civics-style knowledge measures serving as placebo outcomes. Importantly, these learning effects are seen across time and across different survey organizations with thousands of survey respondents. The second half of the paper explores programmatic beliefs and policy preferences. While mediational pathways—i.e., from policies through knowledge to opinions—are less clear and come with potential alternative interpretations, the overwhelming conclusion is that America’s largest universal health policy program transforms citizens well beyond improving health outcomes. More broadly, the results fill in a missing piece in the literature on policy feedback effects, and they are substantively important because of contemporary proposals to extend “Medicare for All” to other age groups (i.e., 50 to 64 years old) or potentially the entire nation. Thus, universal health care programs may do more than keep people healthy by informing citizens and altering the political landscape.

Author

• Jason Barabas, Dartmouth College