WEST PALM BEACH, Fla. (AP) — For Bruce Cargill, an 87-year-old retiree, Medicare is a “glorious program” that, along with Social Security, keeps millions of older Americans out of poverty.
But he’s also quick to note that he forks out premiums and co-pays: “It’s government insurance. But it’s insurance.”
Mike Manning, 64, accuses President Barack Obama of “cutting Medicare” through the federal health care overhaul “then lying about it.” He also says the country is headed for fiscal ruin unless it curtails spending.
“How do you know who to trust in this?” frets Ed Galante, also a few months from Medicare eligibility. He declares the entire debate to be poisoned by craven politicians.
In Florida, where legions of retirees are so important to election outcomes, voters from seniors to young people express strong feelings about the future of Medicare. The debate is playing out in the presidential campaign as well as House and Senate races that will help determine the balance of power on Capitol Hill.
The views expressed in a series of recent interviews with voters in this key battleground state were as varied as the solutions politicians have offered for the costly entitlement program.
This is where voters found common ground: None expressed confidence that government will provide new generations the benefits now granted to older Americans. And few said they believe that either Obama or Republican challenger Mitt Romney have a practical answer for sustaining an insurance program that accounts for nearly a fifth of federal spending and about 4 percent of the U.S. economy.
“I just assume Medicare won’t be there for me at all,” said Christine Pallesen, a 26-year-old business consultant in Fort Lauderdale.
The responses demonstrate how vexing the issue is for Americans across age groups, particularly baby boomers. That landscape makes it particularly difficult for campaigns to know just how their Medicare strategies will play in November.
Like Florida, swing-voting states such as Iowa and Ohio also have large numbers of seniors and older boomers. Obama won all three states in 2008, and Romney has no likely path to the White House if he fails to win Florida and Ohio.
The Medicare debate intensified when Romney named Wisconsin Rep. Paul Ryan, the House Budget Committee chairman, as his running mate. Ryan’s long-term budget blueprint would curtail government insurance in favor of vouchers to help individuals buy private plans.
Democrats say that’s proof enough that Republicans “will end Medicare as we know it.” The GOP counters that the 2010 health care law, which redirects about $700 billion in future Medicare spending, makes the president the real threat to existing beneficiaries.
Democratic strategists in Florida say Medicare is an issue that fires up the party’s liberal base while resonating with nonpartisans who believe government should establish a social safety net and reasonably regulate the marketplace.
Their Republican counterparts outline a two-pronged strategy: convince older voters that Romney is the better protector of the status quo for them. But they want younger voters to analyze Medicare within the GOP’s larger framing of Obama as a profligate who has left no choice but to overhaul benefits for future recipients.
Florida Sen. Marco Rubio, 41, said recently after a speech in Palm Beach County, “I believe people in my generation understand that.”
Romney demonstrates the delicate balance. He praises Ryan, 42, for forcing “serious discussion,” while emphasizing that the congressman’s budget won’t define a Romney administration. One of Ryan’s first campaign stops was at The Villages, a GOP-friendly retirement development in central Florida. He introduced his mother as a proud Medicare recipient.
Michelle Obama came to Fort Lauderdale recently and told an equally friendly audience that the Patient Protection and Affordable Care Act strengthened the program. Romney has promised a full repeal of that law, though it was patterned after an act he signed with great fanfare as Massachusetts governor. Now in general election mode, Romney has again started highlighting individual provisions of the Massachusetts law.
Florida’s senior senator, Democrat Bill Nelson, saddles his Republican challenger, Rep. Connie Mack IV, with the Ryan plan. Mack voted for one version of Ryan’s proposed budget, but skipped a second vote.
In the 18th Congressional District, which includes parts of Palm Beach County and all of Martin and St. Lucie counties to the north, Republican Rep. Allen West has in multiple statements embraced his two votes for the Ryan model. But West’s initial general election ads don’t mention that, as he pledges not to balance the budget on seniors’ backs.
Democratic challenger Patrick Murphy said Medicare “is the clear distinction” in the race. Murphy, West’s Democratic challenger, said a plan that moves from a “guarantee” to private premium subsidies “is not the same as keeping our Medicare promise.” Tim Edson, West’s campaign manager, retorted, “If you don’t have a plan, don’t criticize ours.”
That maneuvering and voters’ reactions highlight how difficult it is to understand — and how easy it is for a candidate to manipulate — the complexities of health care economics and policy.
Glenn Basile, who retired to West Palm Beach after decades as a New York City public school teacher, recalled future President Ronald Reagan lambasting Medicare as a “socialist” threat before President Lyndon Johnson signed the new law. “Has it not always been the Republican point of view to do away with Medicare?” he asked. Basile, 63, said he has voted Republican for president before.
Yet Republicans are right that Ryan has not proposed imposing vouchers on current Medicare beneficiaries, with no one 55 or over being affected by any changes. And the congressman says he would still want future seniors to have the options of government coverage.
Ted D’Alessandro, 64, said PPACA will only exacerbate the nation’s lopsided financials. Yet the self-described libertarian said the overhaul includes “good things” like barring insurers from denying coverage based on existing conditions and allowing young adults longer stays on family policies. Both provisions add cost to any coverage pool.
The law does not lower the bottom-line of future Medicare spending but reallocates some of what would have been spent under old rules. The reductions come mostly from payments to providers and private insurers who offer plans in lieu of traditional Medicare. The money will cover annual physicals, preventive care and more generous prescription drug coverage. Republicans argue that fewer physicians and hospitals will accept Medicare, meaning fewer services. Obama argues that better access to preventive care and drugs will prevent more expensive hospitalizations.
Ryan’s budget presumes some of the same savings found in PPACA. But Ryan would steer the money back to Medicare’s trust fund, a move Republicans pitch as more responsible than spending it elsewhere.
Jean Siciliano is an 85-year-old who came to Palm Beach County from Long Island, N.Y. She said her fellow seniors are less swayed any of the Medicare arguments than strategists and younger voters might assume. They formed their politics long ago, she said, proudly declaring her GOP allegiance.
“I’m set,” she said of her Medicare benefits. “They won’t come after me. I’m worried about my children. What’ll they get? How will they pay for it? … I don’t think any of the politicians know the answer.”
For more on the Medicare debate, see: