The PolitiFact guide to Medicare attack lines

Barack Obama has slashed Medicare by $500 billion. Mitt Romney and House Republicans want to end Medicare. And a new board is going to ration care so Washington can waste more money. 

Believe any of that? You shouldn’t. 

But it’s what the political ads likely will be saying between now and Election Day in November.

We have some advice for voters sorting out the claims: Believe nothing you hear in a 30-second TV ad. 

Here are a few facts about Medicare:

• It’s the government-run health insurance for Americans over age 65. 

• It’s a Canada-style, single-payer system. Liberals love that; conservatives don’t.

• It has approximately 50 million people on its rolls.

• That 50 million will grow to 80 million as baby boomers retire. Paying for that will be a challenge.

Those realities about Medicare have sparked a full-fledged political brawl for 2012. 

On one side are House Republicans, inspired by a Medicare plan from Rep. Paul Ryan of Wisconsin. The Ryan proposal moves the program toward private insurance. In the future, seniors would get money from the government to shop for new health plans — a dramatic departure from the current system. 

Democrats have said a vote for the Ryan plan was a vote to end Medicare, making the charge over and over again in special elections across the country. PolitiFact rated the statement Pants on Fire, because changing a program is not ending it. We saw the charge so often that we named it our 2011 Lie of the Year.

On the other side are President Barack Obama and Democrats who supported the 2010 health care law. It reins in future Medicare spending in a variety of ways — none of them easy to explain in 30-second ads. Generally speaking, the Democratic proposals would move Medicare away from paying for each treatment (called "fee for service"). Instead, Medicare would pay doctors and hospitals for improving patient health. 

Republicans and super PACs have attacked on two seemingly contradictory lines: that Democrats have slashed Medicare spending, and that Democrats are ignoring Medicare’s spiraling costs. 

To sort out today’s political attacks on Medicare, it helps to understand how long we’ve been fighting about it.

• • •

President Lyndon B. Johnson signed Medicare into law in 1965, but the sparring started even before that.

In the 1964 election, Johnson launched a TV ad against Republican Barry Goldwater showing yachts and jet planes: 

"On Sept. 1, 1964, Sen. Barry M. Goldwater interrupted his vacation cruise and headed for shore in a big hurry. Destination: Washington, D.C. He arrived just in time to cast his vote — NO! Then he turned around and headed back. Sen. Goldwater flew across the continent twice, almost 6,000 miles, to vote against a program of hospital insurance for older Americans."

Four years later, Johnson’s vice president, Hubert Humphrey, took credit for the new law. Humphrey’s ad showed a voter thinking hard, asking himself what Richard Nixon had done for him. 

"What has Richard Nixon ever done for me? Uhh ... Medicare? No, that was Humphrey’s idea." (Humphrey had worked on early legislation as a senator.)

Later elections turned to accusations of cutting Medicare. In 1984, Democrat Walter Mondale charged President Ronald Reagan with "trying to slash the program" while Mondale pledged to protect it.

In 1992, a Republican president turned the tables on the Democrats. President George H.W. Bush launched an ad calling out Arkansas Gov. Bill Clinton. Bush’s campaign said Clinton’s health plan was "socialized medicine" and "would require $218 billion in Medicare and Medicaid cuts in the next five years."

For the past 20 years, Medicare has popped up regularly in political ads. Usually, Democrats attacked Republicans for failing to support the program.

Then came Obama’s health care law in 2010. That fall, Republicans and conservative groups unleashed a storm of ads accusing Democrats of cutting the program. 

It was unusual, but not entirely unexpected. 

"Democrats always go after Republicans on Medicare, and it often works," Larry Sabato, director of the University of Virginia’s Center for Politics, told PolitiFact in 2010. "Why not neutralize and short-circuit the attack by getting in the first licks?"

After winning control of the U.S. House of Representatives, Republicans put forward the Ryan plan to largely privatize Medicare. And that’s put Democrats back in attack mode. Democratic strategists believe the issue helped them in several tough special elections last year. 

Which brings us to 2012. 

• • •

The Ryan plan will be a central part of this year’s Medicare debate, both sides agree. The plan received overwhelming support from Republicans in a 2011 House vote on a budget blueprint.

Future beneficiaries could opt to receive "premium support payments" from the government to help pay for the private insurance starting in 2023. 

The nonpartisan Congressional Budget Office found that the idea would save the government money. But it does so by asking future beneficiaries to pay more for the same benefits.

Robert Moffit, a health care analyst with the conservative Heritage Foundation, said the Republican plan has the virtue of recognizing it’s not fiscally sustainable for Medicare to keep promising benefits that are not paid for. If anything, he criticizes the plan for exempting people near retirement and not kicking in soon enough. 

"We don’t exist in an alternative universe where you can have it all and have 80 million people in the system, including the baby boomers," Moffit said.

If 2011 was any indication, Democratic attacks will focus on the Ryan plan, warning seniors that the plan will make dramatic changes to Medicare. That’s a fair charge, but where Democrats go too far is when their ads claim Republicans intend to eliminate or abolish Medicare entirely. PolitiFact has consistently rated those statements Pants on Fire.

Ryan put forth a modified proposal at the end of 2011: He now supports leaving traditional Medicare as an option. 

• • •

Obama and the Democrats, meanwhile, have offered changes to Medicare aimed at treating more people while reducing overall costs. Many of their ideas are now law through the 2010 Affordable Care Act. 

One idea you may have heard of — because it’s been featured in ads with 1950s crooner Pat Boone — is the Independent Payments Advisory Board. In Florida, an ad from the conservative 60 Plus Association featured Boone attacking Sen. Bill Nelson, D-Fla., for voting for the health law. 

The IPAB, Boone said, will "ration care and deny certain Medicare treatments so Washington can fund more wasteful spending." In reality, the board is charged with making system-wide recommendations to rein in spending, and it makes those recommendations within limited parameters. Congress can override the recommendations as long as it institutes other cost-cutting measures. PolitiFact Florida rated Boone’s statement Pants on Fire. 

The health care law, though, is loaded with other changes to Medicare. Most notably, Democrats found ways to reduce projected spending by $500 billion over 10 years, which they then counted as deficit reductions against new spending in the health care law. 

The idea is to steer Medicare away from paying for each treatment (called "fee for service") and toward a system that pays doctors and hospitals based on improving patient health.

The savings came from reducing payments to Medicare Advantage and to hospitals, nursing homes and other skilled nursing facilities and home health agencies. The reductions are part of programs intended to improve care and make it more efficient — for instance, by lowering payments for preventable hospital readmissions.

In a campaign memo, the Romney team said that all those changes taken together are dramatic enough to say that it’s actually Obama who is "ending Medicare as we know it." 

PolitiFact’s rating for that statement? Pants on Fire. 

Other political ads have said simply that Democrats had "cut" Medicare by $500 billion, wrongly implying that the current program was receiving less funding. 

Romney recently said Obama "is the only president to ever cut $500 billion from Medicare." PolitiFact rated that False: It wasn’t a straightforward cut but a reduction in future growth. And other presidents have trimmed future Medicare spending, too.

While Republicans run ads saying Democrats have cut Medicare, they will also accuse them of ignoring Medicare’s fiscal imbalances.

Yet the health care law is loaded with ideas to make Medicare more cost effective, said John Rother, president of the National Coalition on Health Care, which represents unions, churches, medical societies and consumer advocates. 

But the ideas take time to explain to voters and don’t fit into easy sound bites.

"There’s no one word that captures it the way that vouchers or privatization captures the Republican plan," Rother said. "So it is more complicated to talk about. But Democrats haven’t even made the effort, and they’re paying the price for it now."