One thing Republicans and Democrats have learned in recent years is how to use Medicare to attack the other party. Republicans say Democrats will ruin the program by letting it go bankrupt, while Democrats say the GOP wants to abolish the program altogether.
It's hard for voters to sort out who's telling the truth, and even harder to tell which party will have an advantage on the issue in 2012.
Next week, we'll have the results of a political test case — a three-way congressional election in New York, where Medicare has become a central issue. The focus is on the Republican plan to replace Medicare in the future with vouchers for beneficiaries to buy private insurance.
House Minority Leader Nancy Pelosi (D-CA) says that plan is a political boon to her party.
"It has served us well politically because of a race in upstate New York," she says, "a race we should not have had any prospects in — but Medicare has changed that whole race."
An Unexpectedly Competitive Race
New York's 26th Congressional District is one of the 10 most heavily Republican districts in the country. But the race has become competitive since Democrats began using Medicare to hammer Republican Jane Corwin and the independent, Jack Davis, who claims to be the Tea Party candidate.
"You've earned it, worked your whole life for it," says the Democratic ad supporting candidate Kathy Hochul. "Unfortunately, Jack Davis said Social Security benefits may have to be adjusted down. Worse, Jane Corwin supports a budget that essentially ends Medicare."
Republicans are firing right back with their own ad, which, just as in 2010, accuses Democrats of cutting Medicare: "Kathy Hochul — a false campaign about Jane Corwin's position on Medicare, when the truth is, it's Hochul who says she would cut Medicare and Social Security."
The prize here is the votes of those who are retired or soon to retire.
In 2010, voters older than 60 were one-third of the electorate, and Republicans won their biggest share of them since the Reagan years. That's a big reason why Democrats lost the House. Now, Pelosi is determined to get those seniors back — and with them the House majority.
"We won the House of Representatives in 2006 because in 2005, President Bush thought it was a good idea to privatize — or partially privatize — Social Security. [That was] deadly, politically," Pelosi says. "This is what is in our DNA as Democrats, and the same thing with Medicare. So if they want to mess with Medicare, we're here for the fight."
Pelosi says she and President Obama are open to making some changes to keep Medicare solvent, but are opposed to anything that would alter the basic structure of the program.
A Change In The Political Dynamics
Still, the politics of Medicare aren't as simple as in the past, says Bob Blendon of Harvard University, who tracks public opinion on health care.
"The thing that has changed the political dynamic is that though people oppose the cuts for Medicare, they're very anxious to see something done about the budget deficit now and the national debt," Blendon says.
That's why Republican Rep. Paul Ryan of Wisconsin, the author of the controversial Medicare plan, says he is heartened by polls showing Republicans have an edge with voters concerned about the debt.
"My town halls were phenomenally, overwhelmingly supportive; they were 80/20 crowds," Ryan said recently. "Clearly, an issue like this is going to be controversial, but the vast majority of crowds that members experienced were overwhelmingly positive."
Every House Republican but four voted for Ryan's Medicare plan. But in the Senate, Republicans have no plans to take it up. The Republican presidential hopefuls have been lukewarm, and one — former House Speaker Newt Gingrich — said on Meet the Press that he opposes the Ryan plan because it was "too big a jump."
"I don't think imposing radical change from the right or the left is a very good way for a free society to operate," Gingrich said. "I think we need a national conversation to get to a better Medicare system with more choices for seniors."
There's a reason for the split among Republicans, Blendon says. "If you are running for president, I don't think that you want to find yourself in a position that could be unpopular among people who have been voting Republican in repeated elections."
But he says Republican House members may have a different set of political calculations.
"If I'm somebody who won a really aggressive primary in a Tea Party-type conservative fiscal point of view," Blendon says, "I could be challenged if I don't do something right now about this budget deficit."
But doing something about the deficit means doing something about its biggest driver, Medicare, which is still political quicksand. That's why it's unlikely any big progress on the deficit will be made before the next election.