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Just how powerful is Medicare as a political weapon? So powerful that for the past two election cycles it's been a favorite cudgel for both Republicans and Democrats.
And the election of Democrat Kathy Hochul to fill a traditionally GOP seat in upstate New York in May is just the latest demonstration.
Hochul and the national Democratic Party ran a campaign based on large part on the House Republican Budget passed in April that essentially would privatize the government program for the elderly and disabled. And their campaign worked.
Harvard political scientist and pollster Robert Blendon isn't surprised. "Older Americans tend to vote at much higher rates than other voters," he says. At the same time, he adds, "they are the group that most care about health care as a voting issue."
It was Republicans, however, who got the better of the Medicare issue last year. That's when, of all the hundreds of provisions in the massive health care overhaul law, they zeroed in on the fact that it would reduce Medicare spending by a half-trillion dollars over 10 years.
"Grayson and Kosmas — they betrayed the trust of Florida's seniors," proclaimed one ad that the conservative senior group 60 Plus ran targeting central Florida Democrats Alan Grayson and Suzanne Kosmas, both of whom voted for the health bill. "And this November, we'll remember," seniors say at the end of the spot.
Ads like that helped Republicans sweep Grayson, Kosmas and dozens of their Democratic colleagues out of office and the GOP into the House majority.
Now Democrats are ready to turn the tables, also using Medicare as their weapon. They're taking aim at the budget plan every House Republican voted for in April. That plan's major Medicare changes wouldn't affect current seniors, but you wouldn't know that to listen to Democrats and their advocates.
One of the most controversial ads, from a liberal group called the Agenda Project, shows an actor dressed to resemble House Budget Committee Chairman Paul Ryan, literally pushing a little old lady out of a wheelchair and over a cliff, while "America the Beautiful" plays in the background.
Another, from a group called Protect Your Care, features a senior named Julie who says, "You're looking for cuts. Why are you looking at us?"
'Sick Of The Political Demagoguery'
Despite the backlash, however, Ryan is not apologizing for the Medicare plan he put forward.
"I would do it just like this if I had to do it all over again," he said in an interview at NPR recently.
And Ryan says he's convinced that his plan to privatize Medicare won't pay off for Democrats come election day 2012.
"I really believe people are ready for these kinds of solutions; they want to see leaders tackle these challenges," he said. "And they are sick of the political demagoguery, and I think people are becoming more desensitized to all these attack things."
That's not how House Democratic leader Nancy Pelosi sees it, of course.
"Medicare for us is a pillar of health and economic security for our seniors," said Pelosi, who also sat down for an interview at NPR recently. "It's an ethic. it's a value ... and we intend to fight for it.
Pelosi is quick to point out that she understands there is a problem with Medicare. She acknowledges that Medicare is not financially sound enough to sustain the retirement of 78 million baby boomers who are beginning to join the program this year, and that Medicare costs are a major drag on the nation's debt and deficit problem.
She also says using Medicare as a weapon is not her first choice. "Would you rather have success with the issue, or would you rather have a fight in the election? Of course you'd rather have success," she said. "That's what you came here to do. That's what's important to the well-being of the American people."
Reining In Spending Again?
Still, there's another reason Medicare is such a potent political weapon, particularly for seniors, says Chris Jennings, who advised President Bill Clinton on health policy. When it comes to elections, fear beats hope.
"So fear of losing something is far more salient an issue than hope of something to be improved upon," he says.
But Jennings adds that there may be light at the end of the tunnel. A Democratic president and a Republican Congress did manage to rein in Medicare spending and balance the federal budget in the 1990s — though only after huge fights in the years immediately leading up to that. And those fights, he says, looked an awful lot like the ones taking place right now.
"At the end of the day, though, the pendulum swung back and forth until it got to the middle in 1997, where both sides concluded it was in both interests to step back and to negotiate an agreement," Jennings remembers.
If history repeats itself, that could happen again — in the year 2013.