A vote for Republicans or Democrats in November is a vote for politicians who plan to limit growth in Medicare spending.
Both sides agree Medicare's soaring expense must be slowed as medical costs rise and baby boomers retire. Each side abuses the truth when they say the other side's method abandons seniors.
The reality is both sides risk eroding seniors' benefits as they seek savings. But the risks aren't equivalent. If efforts to trim spending fail, Republicans are more likely than Democrats to let beneficiaries, rather than taxpayers and care providers, take the hit.
President Barack Obama's health care law reins in traditional Medicare through regulations, incentives and stronger oversight of payments to doctors and hospitals. That could limit some seniors' access to care if their doctors or hospitals can't stay afloat on reduced payments.
The Republican approach, authored by U.S. Rep. Paul Ryan of Wisconsin and embraced by presidential candidate Mitt Romney, seeks to bring more private insurance companies into Medicare. They believe market pressures will push down costs.
If that doesn't work, Ryan's plan doesn't say what it would do to meet its spending cap. That leaves it open to criticism that beneficiaries would end up paying more for their Medicare — and maybe not be able to afford it at all.
But campaign rhetoric rarely acknowledges these complex realities. Instead, it's, "The other guy wants to end your Medicare!"
Here's a PolitiFact roundup to help you stay on top of the most common campaign lines.
Democrats have been chanting "Republicans voted to end Medicare" since an April 2011 vote on a proposed budget from Ryan, now the GOP vice presidential nominee. The claim — often made bluntly and with no qualifiers — was so pervasive, PolitiFact chose it as our 2011 Lie of the Year.
Ryan's most recent plan keeps Medicare intact for people 55 or older but changes the program by providing government subsidies for people to buy either private insurance or a traditional Medicare option.
A 'voucher' plan?
Democrats have repeatedly criticized Republican privatization proposals as "vouchers." Republicans don't like the word and try to avoid it. They prefer to call Ryan's Medicare plan "premium support," which evokes a history of proposals that offer a set payment for seniors to buy insurance policies with a defined set of services. Payments were designed to grow along with health care costs.
We found that Ryan's plan hovers somewhere between the two concepts — while pretty much fitting the dictionary definition of "voucher." Obama said that Romney and Ryan "want to turn Medicare into a voucher system." We rated that Mostly True.
The $700 billion
Democratic and Republican plans for Medicare seek to slow Medicare's growth over a decade by more than $700 billion. An Obama staffer claimed that Ryan's plan, put forward in Congress earlier this year, included such savings. We rated that True.
But Romney went too far when he claimed that the president's plan "takes that money out of the Medicare trust fund and uses it to pay for Obamacare." That gives the impression that the law takes money that was already allocated to Medicare and funds the new health care law with it. In fact, the law uses a number of measures to try to reduce the rapid growth of future Medicare spending. Those savings are then used to offset costs created by the law — especially coverage for the uninsured — so that the overall law doesn't add to the deficit. We rated Romney's statement Half True.
We were even less impressed when Romney said Obama "robs" Medicare of the same amount, and gave that claim a Mostly False.
Will it hurt seniors?
Obama has said Republicans will stick seniors with higher Medicare costs, while the Romney team says Obama's board of bureaucrats will deny them care. Ryan likes to say his plan won't affect current seniors. All of these claims stretch the truth.
Obama's been guilty of referring to an older, harsher version of Ryan's plan when he claims it "could raise future retirees' costs more than $6,000." We simply don't have enough details to know how much extra money seniors might have to pay for traditional Medicare under the current Ryan plan, the one Romney supports. We rated the president's claim Half True.
Meanwhile, Ryan claimed that "unelected, unaccountable bureaucrats" will make decisions that will "lead to denied care for current seniors." Members of Medicare's new Independent Payment Advisory Board are appointed by the president and approved by the Senate. But the president can fire them for neglect of duty or malfeasance, and Congress can overrule their recommendations.
And "denied care" is a strong way to phrase the board's possible effect. The board oversees only a small percentage of the Medicare savings in the health care law. It's expected to recommend cutting provider payments, with an eye on getting rid of waste and inefficiency. That could restrict some seniors' access to care if some providers find they can't cope with lower reimbursements.
But the board is required by law to pay attention to issues such as access to care in rural areas and explicitly isn't allowed to engage in rationing or changing benefits. Ryan creates the specter of an unaccountable board making all of Medicare's spending decisions. That's scarcely the case. We rated his claim Mostly False.
Ryan's on somewhat stronger ground when he says his plan for Medicare "does not affect your benefits." That's the case for his Medicare reform ideas, which would not affect people now 55 and older.
But it ignores Republicans' promises to "repeal and replace" the federal health care law. Repealing the law would take away benefits for current enrollees — such as reducing the cost of prescription drugs, which saved Medicare beneficiaries $2.1 billion last year. Until it's clear just what benefits Republicans would "replace," we have to assume enrollees' benefits could be affected by the law's repeal. We rated Ryan's claim Half True.