In North Dakota, a Glimpse at the Politics of Medicare

North Dakota voters, make up your minds: Do you want to end Medicare as we know it, or do you want to stick with a "government takeover" of health care that makes more than $500 billion in painful cuts to Medicare?

In truth, the choice is neither that stark nor that simple. But the two candidates seeking the U.S. Senate seat being vacated by Democrat Kent Conrad, who's retiring, are presenting the issue that way. And it's a rhetorical battle that's being replicated in so many congressional races that you can hear the echoes just about anywhere.

Democrat Heidi Heitkamp is slamming Republican Rick Berg for his support of a plan by Rep. Paul Ryan, his colleague in the House, to overhaul Medicare. Ryan's budget plan would provide premiums to beneficiaries, who would buy insurance on the private market. Ryan's newest version, which isn't expected to go anywhere in the Senate, would allow Medicare users to stay on the traditional pay-as-you-go plan if they so choose.

In an independent TV ad for Heitkamp, the Democratic Senatorial Campaign Committee accuses Berg of "voting to essentially end Medicare . . . while giving huge tax breaks for millionaires.'"

Berg, meanwhile, is seeking to turn the issue against the Democrats, touting his opposition to "Obamacare."

"The law does nothing to lower health care costs or increase access," Berg says. "Instead, it adds another $569.2 billion in tax increases and cuts $523 billion from Medicare."

In fact, under the Affordable Care Act, the "cuts" come in the form of reduced payments to providers - not beneficiaries - and the overall spending for Medicare is scheduled to increase every year. Heitkamp, a former state attorney general, never had to vote up or down on the law.

Come November, voters in North Dakota - and in races from coast to coast - may well be deciding which Medicare scenario is most troubling . . . and which one they believe is real. - Susan Milligan