"Do you think the government should stay out of Medicare" is a badly designed survey question for two reasons. First, it implies that the government is currently "out of Medicare," thereby suggesting the conclusion that so disturbs Noah.

Second, it can be understood simply to mean, "Do you think the government should leave Medicare unchanged," and plenty of people have a reason to answer "yes" to that.

Noah seems to think that understanding of whether Medicare is a government program is relevant to whether one believes that government-paid health care is a good thing for all. Nonsense. Medicare is a government program that benefits one segment of the population. It is perfectly rational, though self-interested, for Medicare's beneficiaries to believe that extending similar coverage to others is undesirable if it means that their benefits will be in any way curtailed.

Jack, you write:

Noah seems to think that understanding of whether Medicare is a government program is relevant to whether one believes that government-paid health care is a good thing for all. Nonsense. Medicare is a government program that benefits one segment of the population. It is perfectly rational, though self-interested, for Medicare's beneficiaries to believe that extending similar coverage to others is undesirable if it means that their benefits will be in any way curtailed.

But, understanding of whether Medicare is a government program is relevant—highly relevant—to whether one believes that government-paid health care is a good thing for all. How could it not be?

And, yes, Medicare is a government program that benefits one segment of the population, and so it is perfectly rational, though self-interested, for Medicare's beneficiaries to believe that extending similar coverage to others is undesirable if it means that their benefits will be in any way curtailed. But that’s a separate issue.

You can be a Medicare recipient, love the program, know it’s a government program, and fear that if a similar program is made available to everyone, it will negatively impact Medicare as the program exists today—while still thinking that government-paid health care would be a good thing for everyone who doesn’t yet qualify for Medicare, because, after all, Medicare has been a good thing for those old enough to qualify.

But the GOP Medicare argument is entirely an appeal to the narrow self interest of current Medicare beneficiaries by raising the fear that broader coverage will be paid for by some kind of curtailment of Medicare benefits. The politically relevant point is simply, "this is yours, and they want to take some of it away from you." Whether the "yours" is a tax funded program or something else may be relevant at some philosophical level -- having created Medicare, Congress has the power to modify it as it sees fit. But the long time recipients of any kind of government payout tend to view it as a vested right, and it is the defense of that so-called right to which the Republicans are appealing. Telling Medicare beneficiaries that they have no or less more right to the current level of coverage than anyone else is legally true, but it as politically irrelevant as telling Iowans that they have no right to farm subsidies or teachers that they have no right to tenure.

Medicare is not a government program that benefits one segment of the population. It benefits all of the population which is why everyone pays in to it. True you currently have to reach age 65 or become disabled to get coverage but saying it only benefits one segment of the population is like saying auto insurance only benefits some drivers (those who have accidents) or life and disability insurance only serves some beneficiaries (those who die or become disabled) but i that is the nature of insurance (those who use it aren't generally the lucky winners ) and frankly it is a blessing that we don't know in advance who is going to need it (though it is a private insurance companies dream).

The benefit to those currently over 65 is actual. The benefit to younger taxpayers is prospective and contingent. It depends on both the future solvency of the system and on the continuing political will of future generations of younger workers to be taxed for the immediate benefit of their elders.

True but pretty much all the Medicare beneficiaries were once younger tax payers whether they are elderly now or on disability. Once again saying insurance isn't a rel benefit unless you are using it now it is like saying life insurance has no benefit unless you die while it is still in effect or Social Security isn't real until you start to collect. I may die or not before I each Medicare or Social Security and will get either them or my life insurance will pay but they and my life insurance still exist until someone manages to cancel them or they expire. Medicare benefits will undoubtedly eventually need to be reduce in some ways just as they have had a tremendous expansion over the past decades but we can still expect some other areas of expansion and improvements in other ways. The only way insurance works is if everyone doesn't require maximum benefits but the benefits of valid insurance policies which aren't currently paying out or may never be collected on by some or most individuals exist, none the less, for all those who hold the policies and might collect on them. That is why it is called insurance.