Medicare: The Hard Issue Just Around the Corner

National Journal

LAS VEGAS — People like 31-year Army veteran Herb Randall could decide the 2012 presidential election.

Randall, like many 69-year-olds, is torn between protecting a benefit he thinks he and other seniors earned — Medicare — and the taming of a soaring national debt that could one day cripple the government program. He’s not sure which presidential candidate offers the better solution.

“The Republican position is nobody is going to have it if we don’t reverse the spending,” he said in between sips of coffee at a casino café adjacent to the Vegas strip. “You gotta say, ‘Whoa, they got a point when you’re talking about $16 trillion [in debt].’”

But a breath later, Randall expressed just as much anxiety about the plan by GOP nominee Mitt Romney and running mate Paul Ryan to convert Medicare into a premium support program for those younger than 55.

“First thing that comes to my mind, and I might be totally wrong, is when President [George W.] Bush talked about privatizing Social Security,” said Randall, an independent voter who helps run a national nonpartisan senior advocacy organization, the National Silver Haired Congress. “I don’t know if the voucher system is like that, but if it is, it scares the hell out of me.”

For now, Randall, who lives in Clark County, the largest one in this swing state, isn’t sure whether he’ll back Romney or President Obama. But he’ll be watching closely to see what both have to say about the giant entitlement program for the elderly in the four remaining weeks until the election.

The debate over Medicare, which simmered quietly during much of September as the campaigns focused on taxes, is about to reemerge in the presidential campaign. Earlier this week, the Obama campaign released a new ad focused on it, its first since August, and the president and Romney tangled over the subject during their first debate. The future of Medicare also will likely play a major role on Thursday night during the sole debate between Vice President Joe Biden and Ryan, whose eponymous budget proposal -- including its transformation of Medicare into a voucher program -- has been embraced by the Republican mainstream.

“I really think Biden, or I would hope, is absolutely going to go after Ryan very specifically,” said Jay Campbell, a Democratic strategist. “Ryan knows his stuff and can push back very well, but the vice presidential debate is a fantastic opportunity for the Obama campaign to restart the campaign against the Ryan Medicare plan.”

How the debate plays out in the race’s final month, and which side undecided voters like Randall will ultimately choose, could make a difference in closely fought, senior-heavy swing states like Florida, Iowa and Nevada, which has lately seen a surge in its older population.

So far, each campaign can claim the argument has broken in its favor.

Traditionally on the defensive on entitlements, Republicans have aggressively confronted Obama and the Democratic Party over Medicare in the campaign. The main attack, one Romney echoed effectively in last week’s debate with Obama, focused on the argument that the president’s health care bill weakened the program for current beneficiaries.

“I can’t understand how you can cut Medicare $716 billion for current recipients in Medicare,” the former Massachusetts governor said. “Now, you point out, ‘Well, we’re putting some back, we’re going to give a better prescription program.’ That’s $1 for every $15 you’ve cut.  They’re smart enough to know that’s not a good trade.

“The idea of cutting $716 billion from Medicare to be able to balance the additional cost of Obamacare is, in my opinion, a mistake.”

Though fact-checkers have some problems with it, that argument seems to have been internalized among many Republican-leaning seniors. Scores of older voters filled a midday rally earlier this month in Las Vegas headlined by GOP Sen. Marco Rubio of Florida — so many attended, in fact, that the campaign had to bring in extra rows of chairs.

One of those on hand to listen to Rubio, 81-year-old Las Vegas resident Edith Garley, said Romney is just telling the truth when he says Medicare isn’t sustainable in the long run.

“If you have to take a pill to get through it, you have to do it,” she said. “Everyone has been putting it off for 30 years.”

She adds quickly that she thinks Obama is lying when he says Romney wants to change the program for currently enrolled seniors (although his intention to repeal the new health law would result in some changes).

Rubio, notably, didn’t mention reforming Medicare when he listed the four top goals of a Romney administration. That’s instructive, because it’s doubtful the Romney campaign wants to bring up a subject on which, polls show, voters still trust Obama more. But a détente, as seemed to exist for much of September in the presidential race, would be a victory for a party typically on the losing end of the entitlement debate.

Ads from the Obama campaign, shown endlessly in Las Vegas, focused not on Medicare but on the infamous “47 percent” video, in which Romney was secretly recorded disparaging people who get government benefits. The only ads, in fact, to mention the entitlement program were for local congressional or Senate races.

Even some Democrats acknowledge the Obama campaign’s best attacks might lie elsewhere, particularly in criticizing Romney’s tax plan.

“The battle over Medicare has devolved into a classic ‘he said-she said’ battle over who ‘cut’ what that does nothing but confuse the voters, though President Obama is overwhelmingly seen as the one who is best to handle the issue,” said a senior Democratic strategist, who requested anonymity in order to speak candidly. “In the closing weeks, it feels as if the campaign will want to have a contrasting message that is a clear, like the tax burden the middle class will feel thanks to Romney’s tax plans.”

Of course, the Obama campaign’s new Medicare ad — paired with a spot that criticized Romney’s plan to convert Medicaid, a program that funds long-term care for seniors, into block grants to the states — suggests they still see room to attack. The spot is a smart move because of its resonance with seniors, according to the Democratic operative Campbell. That group, particularly white seniors, leans heavily toward the GOP: 58 percent of them backed presidential nominee John McCain in 2008. But Medicare is the one issue on which they appear to trust Obama more than his Republican counterpart.

“It’s seniors he needs, not to win, but to make inroads into Romney’s totals with,” said Campbell, who called Medicare a “still potent” issue. “They’re less happy going forward if they’re going to make major changes to program like Medicare.”

A Wall Street Journal/NBC News poll released the day before the presidential debate found 48 percent of voters thought Obama was better on dealing with Medicare; just 36 percent said so of Romney.

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