Why Medicare Is the Toughest Vote for Democrats

Obama wants to deal on Medicare, but the issue is a tough one for congressional Democrats.

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This evening, House and Senate leaders from both parties will meet at the White House for what are expected to be substantial negotiations over how to raise the nation's debt ceiling. The chances of both sides finalizing a deal during the meeting are slim. But, according to congressional staffers, it's expected to produce some specifics on the proposals which, for now, have been mentioned in press leaks or whispers during the standoff.

For anxious Democrats, the meeting might finally answer some nagging questions: How much will the party give up in the face of Republican demands? How much will the party's traditional constituencies be hurt by possible cuts to social programs? And, perhaps most important to their political careers, what will happen with Medicare? While any vote to cut social spending is hard for a Democrat, there are some reasons why a vote to cut or overhaul Medicare is a particularly tough vote right now for left-leaning lawmakers.

In a way, cuts to Medicare could be more substantial than cuts to Social Security, the famed third rail of American politics—touch it and you'll die, the saying goes. But at least Social Security is a relatively simple program. Workers pay in, retirees get the benefits, and actuaries can make realistic guesses about what changes the program might need to continue in the future. But Medicare, which experts say is the single biggest contributor to the nation's long-term debt, is tied into the rising costs of the nation's healthcare. Beyond long-held Democratic policy positions on how to cut Medicare spending, including allowing the program to negotiate on prescription drugs and cutting Medicare fraud, the options for restraining the program's future growth get trickier. Solutions the Democrats would prefer—cutting the overall cost of healthcare rather than cutting benefits—get into the overall debate on healthcare reform. It's a debate that Democrats, still scarred from the 2009 and 2010 battles over the Affordable Care Act, would rather put behind them.

But there's another big factor: the 2012 election. Republicans have insisted that Medicare overhauls be part of any debt ceiling deal. From their perspective, they had no choice but to double down on the path staked out by Wisconsin Rep. Paul Ryan and the GOP's budget resolution, which the party overwhelmingly backed. Rather than try to backtrack, Republican leaders hoped that Democrats would eventually sign on to a deal with President Obama on Medicare to soften the blow, and make it harder for Democrats to draw a distinction between the positions of the two parties. Democrats know this—which is why they're reluctant to help Republicans out.