As any pollster worth his salt would tell you, the only words that matter in the question used by the Times are the first words of each description: “Medicare should continue as it is today” vs. “Medicare should be changed.” That is the essence of the poll’s deception, since obviously “Medicare should continue as it is today” is not an option, and is not what the Democrats are proposing. Republicans propose to have the program continue as it is for current seniors and near retirees, Democrats propose to have it continue as it is for no one, and both of them want to change it for future seniors. The question is how. And the answer is basically that the Democrats want to test the idea that yet more price controls and central planning will make the system more efficient while Republicans want to test the idea that intense competition for customers among providers will make the system more efficient. The Democrats’ idea has been tried for decades, it is the organizing principle of Medicare’s fiscal design, and it has gotten us to our current predicament. The Republican idea has been tried only in limited ways and in limited parts of the program and has shown some promise — as Medicare’s chief actuary, who works for President Obama, has said, there is evidence about premium support in Medicare of the sort Romney is proposing, and that evidence leads him to conclude that this approach “can get you to the lowest cost consistent with good quality of care.”

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