Last week, after months of arguing that health care reform would ration care and pull the plug on grandma, Republicans initiated a focused and organized campaign against seniors. Since “older people vote in bigger numbers than younger people” and are “more likely to call their representatives or attend a town hall meeting,” their support is key. The elderly are weary of health care reform and afraid of losing their existing government-sponsored health care plans; convincing them of the Republican narrative on health care reform, could doom Democratic reform efforts and virtually guarantee large Republican gains in the midterm elections and beyond.

For Republicans, the strategy requires some juggling and plain old intellectual dishonesty: the GOP has to support Medicare, but argue against a Medicare-like public option. Last Monday, GOP Chairman Michael Steele penned a rather awkward op-ed defending and defaming the Medicare program. He rebranded the proposed $500 billion cuts to Medicare and Medicaid waste — which he himself has supported in the past — as a “raid” on Medicare and accused the President of cutting Medicare benefits.

The AMA and AARP endorsed House health care bill rationed care to seniors, Republicans claimed. The President must scrap the House plan, and propose his own legislation. This afternoon, during an appearance on Fox News, Rep. Mike Pence (R-IN) made that very argument, criticizing Democrats in Congress for writing health care legislation and calling on Congress to “scrap the bill that has been moving through the House of Representatives” and “demand the President of the United States to bring forward his own bill.” The House legislation, Pence claimed, increased “the cost of prescription drugs for seniors under Medicare Part D”:

It really is, particularly, when you start to realize that where they are going to find these supposed savings are in cuts to Medicare. They are actually talking, as House Republicans published today, they are talking about increasing the cost of prescription drugs for seniors under Medicare Part D of upwards to 20% in the coming years, to close that so-called ‘donut hole.‘

Watch it:

False hits only work if they build on kernels of truth. In this case, Pence is perverting a recently released Congressional Budget Office letter — which found that premiums would increase but net spending on drugs would decrease — to substantiate the Republican narrative. The reality is quite different. The House bill would improve Medicare payments to physicians, create incentives for doctors to work in underserved rural areas, eliminate co-payments and deductibles for preventive services in Medicare, and fill in the coverage gap – the “donut hole” – in the Medicare prescription drug benefit.

According to the Congressional Budget Office, closing the donut hole alone would cause “spending on prescription drugs apart from those premiums” to “fall, on average, as would their overall prescription drug spending (including both premiums and cost sharing).” The federal government would save “about $30 billion over the 2010–2019 period.”

Beneficiaries’ premiums would increase as a consequence of the donut hole contraction and the behavior of prescription drug companies. Under the legislation, “prescription drug plans would be responsible for covering some costs in the doughnut hole and above the catastrophic level that they are not required to cover under current law.” “Because enrollees pay for about 25 percent of the cost of coverage through their premiums, premiums would also be higher.” Pharmaceutical manufacturers would also add to premiums by “charging higher prices for new drugs,” and lowering “the rebates they pay to prescription drug plans.” Yet on the whole, “in return for those higher premiums, enrollees would receive greater protection against incurring high drug costs” and incur lower out-of-pocket expenses. As a result, “beneficiaries’ total prescription drug spending would fall on average,” the CBO found.

The counter-narrative is more complicated but no less essential; without it, the President will likely lose the debate. Until now, Obama has treated the health care debate as an economic symposium; he has played the professor in the GOP’s far more moving drama about long waiting lines and rationed health care services. To win the health care debate and blunt the GOP’s far more compelling story, the President will have to reassure seniors that health reform will strengthen the Medicare. His story could sound something like this: health care reform “ensures that Medicare beneficiaries will continue to choose their doctors, hospitals and other providers, receive an improved range of benefits, and enjoy the financial and health security Medicare has provided for more than 40 years.” After all, this narrative has the benefit of being true.

This morning, during an interview with WNYC’s Brian Lehrer, health care provocateur Betsy McCaughey suggested that policy makers could slow Medicare spending without cutting $500 billion from Medicare and Medicaid over 10 years and “denying care to the elderly.”

Instead, the author of the “death panels” charge, suggested that policy makers should cut Americans aged 65 to 69 from the program:

The fact is that if Medicare inched up the eligibility age one month a year, until 2043 when it reached age 70, Medicare would be solvent. And that is what the Congress should do and that is what the Congressional Budget Office has urged Congress to do every year. That would solve the problem without telling elderly people that they have to suffer with crippling arthritis rather than get a knee replacement.

Listen:

Despite McCaughey’s claim, the Congressional Budget Office does not “urge” Congress to raise Medicare’s eligibility age “every year.” The CBO merely includes the policy as one of “115 options for reducing (or, in some cases, increasing) federal spending on health care, altering federal health care programs, and making substantive changes to the nation’s health insurance system.”

To put the debate in terms McCaughey can understand, page 51 (37 in print version) of “CBO’s Budget Options Volume 1” says that death paneling Americans 65 to 69 years old from the Medicare system would have little effect on the trajectory of Medicare’s long-term spending. First, the option would require Medicare to “inch up” the eligibility age by two month every year, not one. And, since “younger beneficiaries are healthier and thus less costly than the program’s average beneficiary,” “outlays for Medicare would [still] rise to 7.7 percent of GDP by 2050.”

What’s more, “increasing the age of eligibility for Medicare would shift costs that are now paid by that program to individuals and to employers that offered health insurance to their retirees. Those higher costs might lead more employers to reduce or eliminate such coverage.” Uninsured 65 to 69 year olds would enter the Medicare program in worse health, only increasing Medicare’s costs.