STEVE INSKEEP, host:

Important, though, it is, the battle over unions is small compared to the fight over Medicare. Republicans have proposed to change the popular health care program for the elderly. Politicians from both parties have moved entire elections by positioning themselves as Medicare defenders, and that raises a question for NPR's Julie Rovner. She's asking if politicians can ever give up this political weapon.

JULIE ROVNER: Last year's sweeping health overhaul envisioned truly massive changes to the nation's health care system. But in the fall elections, Republicans zeroed in on one particular change. The law cuts a half a trillion dollars from Medicare.

It's not hard to figure out why Republicans chose that issue, says Harvard political scientist and pollster, Bob Blendon.

Mr. BOB BLENDON (Political Scientist/Pollster, Harvard University): Older Americans tend to vote at much higher rates than most other voters. Secondly, they are the group that most care about health care as a voting issue.

ROVNER: And so most of last fall's ads focused on Medicare. Here's one the conservative senior group 60 plus targeted at Florida Democrats Alan Grayson and Suzanne Kosmas, both of whom voted for the health bill.

(Soundbite of commercial)

Unidentified Woman: ...Grayson and Kosmas; they betrayed the trust of Florida's seniors.

Unidentified Man: And this November...

Unidentified Man and Woman together: ...we'll remember.

ROVNER: Ads like that helped Republicans sweep Grayson, Kosmas, and dozens of their Democratic colleagues out of office and the GOP into the House majority. But now Democrats sense a chance to turn the tables, also using Medicare as their weapon. They're taking aim at the budget plan every House Republican voted for in April. That plan's major Medicare changes wouldn't affect current seniors, but you wouldn't know that to listen to Democrats and their advocates.

(Soundbite of commercial)

Unidentified Woman #2: ...seniors will have to pay $6,000 more while they give tax breaks to millionaires. You're looking for cuts? Why are you looking at us?

ROVNER: That's from a group called Protect Your Care, whose mission is to back the health overhaul law. It's the latest in a long string targeting the plan written by House Budget Committee Chairman Paul Ryan. Despite the backlash, however, Ryan, in an interview at NPR last month, says he's not sorry for putting the Medicare plan forward.

Representative PAUL RYAN (Republican, Wisconsin; House Budget Committee Chairman): I would do it just like this if I had to do it all over again.

ROVNER: And Ryan says he's convinced that his plan to essentially privatize Medicare won't pay off for Democrats come Election Day 2012.

Representative RYAN: I really believe people are ready for these kinds of solutions; and they are sick of the political demagoguery. And I think people are becoming more desensitized to all these attack things.

ROVNER: Of course that's not how House Democratic leader Nancy Pelosi sees it. She also sat down at NPR for an interview recently.

Representative NANCY PELOSI (Democrat, California): Medicare for us is the pillar of health and economic security for our seniors. It's an ethic. It's a value, and we intend to fight for it.

ROVNER: Now Pelosi is quick to point out that she understands there is a problem with Medicare, that problem being that it's not financially sound enough to sustain the retirement of 78 million baby boomers who are beginning to join the program this year. And that Medicare costs are a major drag on the nation's debt and deficit problem. And she says using Medicare as a weapon is not her first choice.

Representative PELOSI: Would you rather have success with the issue or would you rather have it as a fight in the election? Of course you'd rather have success. That's what you came here to do, that's what's important to the well being of the American people.

ROVNER: Still, there's another reason Medicare is such a potent political weapon, particularly for seniors, says Chris Jennings, who advised President Bill Clinton on health policy. When it comes to elections, fear beats hope.

Mr. CHRIS JENNINGS (Advisor to President Bill Clinton): So fear of losing something is far more salient an issue than hope of something to be improved upon.

ROVNER: But Jennings says there may light at the end of the tunnel. A Democratic President and a Republican Congress did manage to rein in Medicare spending and balance the federal budget in the 1990s - but only after huge fights in the years immediately leading up to that.

Mr. JENNINGS: In the end of the day, though, the pendulum swung back and forth till it got to the middle in 1997, where both sides concluded it was in both interests to step back and to negotiate an agreement.

ROVNER: Which, if history repeats itself, would happen again in the year 2013.

Julie Rovner, NPR News, Washington.

(Soundbite of music)

INSKEEP: It's MORNING EDITION from NPR News.

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