by Dr. Marvin Malek

The mudslinging that passes for a health policy debate between the presidential candidates must be almost incomprehensible to those who don’t follow the health issue closely, and can only be viewed as bizarre by those who do.

Each is accusing the other of proposing policies that will destroy the Medicare program. Over a 10-year period, President Obama proposes to cut spending in Medicare. These cuts don’t affect the benefit package, but reduce reimbursements to hospitals and to private insurance companies with which the Medicare program has subcontracted. The latter set of cuts is actually a benefit to the program, since under every Republican administration since Reagan, the Medicare program has been needlessly overpaying private insurers to provide the same coverage as traditional Medicare, but at higher cost to the taxpayers.

This represents unadulterated corporate welfare, and needs to end. And perhaps the hospitals will respond to these cuts by eliminating the endless advertising for elective orthopedic procedures.

In contrast, Paul Ryan’s proposal dramatically transforms Medicare. Under the Ryan plan — later adopted by Romney — senior citizens would be given a voucher for a fixed amount of money and an internet link or the written equivalent — of a list of eligible private insurance companies with which senior citizens can use the voucher. Ryan is proposing the voucher model to promote cost control by making “consumers” (the elderly) more cost-sensitive.

The voucher will not cover the full cost of a policy, and to allow it to be an effective cost-control measure, Ryan has indicated that the value of the voucher will not rise with health cost inflation. Less affluent senior citizens will likely be forced to select policies with large deductibles and less comprehensive benefits.

The Republican privatization proposal is a profound transformation of the Medicare program. For the first time since the passage of the Medicare legislation in 1965, it eliminates the guaranteed benefit, and forces seniors to contend with the private health insurance companies. For Romney and Ryan to insinuate that it’s actually Obama’s proposal that is destroying Medicare while they are “saving it” is a cynical deception of breathtaking proportion, and can justifiably be characterized as a “Big Lie.”

Quite appropriately, the Democratic candidates have expressed outrage at this proposed undermining of the Medicare program. How horrible to eliminate Medicare as we know it, and replace with a voucher and an Internet link.

But wait! What is the single most costly component of Obamacare? Nearly the entire middle class under age 65 will be given — you guessed it — a voucher and an Internet link. They’ve been renamed, of course. The voucher of Ryan et al gets labeled “subsidy,” and the Internet link becomes an “exchange” in the Democrat’s lexicon.

You would think the Republicans would be criticizing the Democrats’ inconsistency. But they’re not. What have we been hearing from the Republicans instead? They’re calling Obamacare socialism. But wait! What Ryan is proposing — and what Romney enacted in Massachusetts — is the very same concept. Socialism? Really?

What’s really odd is that both parties’ policy proposal is not something Americans want. If Americans get wise to the Romney/Ryan bogus claim that they are “saving” Medicare, Romney will definitely lose the coming election.

And for Obama’s part, when he touts the benefits of “Obamacare,” it’s never the costly insurance subsidy program that he talks about. What he talks about is the new regulations he is imposing on the private insurers: He is requiring insurers to extend coverage to 23– to 26-year-olds, and he is eliminating the hated pre-existing condition clause.

Had Obama simply given a Medicare card to every American, his presidency would have been elevated to a caliber with Lincoln and FDR. He would have been swept into a second term — in spite of the weak economy. Americans pay into Medicare throughout their entire lives. There is no reason why we all wait until age 65 to be eligible for Medicare coverage.

For those who worry that this would be unaffordable, tremendous savings from administrative simplification and empowering the greatly expanded Medicare program to seriously negotiate for reasonable prescription drug prices by themselves would save billions.

Americans’ love of Medicare — our nation’s only single-payer program — is identical to the experience in all the other countries with single-payer systems. They are immensely popular. How long will we have to wait until we finally have leaders who do what Americans want: Give every American a Medicare card. It will save us money, save tens of thousands of lives, and relieve millions of American families of one of their greatest sources of anxiety — being overwhelmed by health care costs if they get sick.

Let’s do it for ourselves, our neighbors, our children. It’s common sense. And it’s basic decency. When will these values we all share matter more to our politicians than corporate largesse?

Marvin Malek is an internist at Central Vermont Medical Center in Berlin.