Medicare in focus as President Obama, Paul Ryan trade charges

THE VILLAGES, Fla. — Who loves Medicare more? President Barack Obama and Mitt Romney's running mate vied for that distinction Saturday as Medicare became the latest flashpoint in a presidential campaign of flying elbows.

The issue is dicey for both sides: Obama is steering billions from the entitlement to help pay for the expansion of coverage under his health care law; Ryan is a champion of overhauling Medicare to make the traditional program no longer the mainstay for tomorrow's seniors — just one of many old-age health insurance choices.

But that didn't stop them from going head on.

On a day Romney devoted to raising campaign cash in Massachusetts, Ryan accused Obama of raiding the Medicare "piggybank" to pay for his health care overhaul and he warned starkly that hospitals and nursing homes may close as a result. The Wisconsin congressman introduced his 78-year-old mother to an audience of seniors in Florida and passionately defended a program that has provided old-age security for two generations of his own family.

"She planned her retirement around this promise," Ryan said as Betty Ryan Douglas looked on. "That's a promise we have to keep."

Campaigning in Windham, N.H., Obama said it's a promise that the Republican ticket would tear up.

"You would think they would avoid talking about Medicare, given the fact that both of them have proposed to voucherize the Medicare system," he said. "But I guess they figure the best defense is to try to go on offense.

"So, New Hampshire, here is what you need to know: Since I have been in office, I have strengthened Medicare."

Said Ryan in Florida: "You want to know what Medicare is saying about this? From Medicare officials themselves: One out of six of our hospitals and our nursing homes will go out of business as a result of this," meaning Obama's Medicare cuts.

That was a far from exact reference to a 2010 analysis by Medicare chief actuary Richard Foster. He said then that roughly 15 percent of hospitals and nursing homes that provide Medicare services could "become unprofitable" over a decade — not necessarily go out of business — thanks to cuts in payments from the government under the health care law.

But Foster's analysis also said the law would improve key Medicare benefits, solve the "doughnut hole" gap in coverage for seniors, expand health insurance to millions more people, reduce the federal budget deficit and extend the solvency of the government's hospital insurance trust fund by up to 12 years. Hospitals remain largely on board with the health care law, without apparent fear of closing.

Ryan, a deficit hawk and the House Republicans' chief budget writer, has stood out in Washington for laying out tough spending choices that many lawmakers in both parties avoid. So it was almost inevitable that his selection as running mate would vault Medicare to the top of the campaign debate.

Democrats say it's a debate they are glad to have because voters tend to trust them more than Republicans on the big social entitlements. But Obama has vulnerabilities, too, given the Medicare cuts he pushed to expand health insurance for the nation and to keep the costs of doing so in line.

The Obama campaign recognizes that Romney and Ryan have been pre-emptive and tried to neutralize the usual Democratic on Medicare by advantage by striking first with a Medicare ad and with their criticism of Obama's health law. "They are being dishonest about my plan because they can't sell their plan," the president said.

Ryan's proposal in Congress would encourage future retirees to consider private coverage that the government would help pay for through a voucher-like system, while keeping the traditional program as an option.