WINDHAM, N.H. — When President Obama visits Windham and Rochester on Saturday, he will, aides say, raise the specter of a sweeping Medicare change proposed by Representative Paul D. Ryan, the presumptive Republican pick for vice president.
Ryan argues that spiraling Medicare costs can be curbed through a voucher system that would pay seniors a fixed amount for medical care. But Democrats counter that cash-strapped elders would face thousands of dollars in extra costs and lower-quality care.
It is Medicare’s moment in the national campaign, and places like the Windham Senior Center show the strong emotions raised by the conflicting appeals.
Inside, the debate can seem baffling, and therefore unsettling. Few people interviewed this week knew whom to believe about Medicare, and even fewer knew the details of Ryan’s plan. But between card games, in a room dominated by a bingo board, they did know this: They’re worried.
“Some of us need help more than others,” said Florence Wheeler, 67, who has emphysema and a tube in her nostrils. “If I need a certain amount of money a year, what if I go over the limit? What if you’re a cancer patient?”
The senior center’s director, however, thinks Ryan’s plan is needed to spare future generations out-of-control government deficits. “If we don’t do something,’’ said Barbara Coish, “it’s going to go broke.”
“[Ryan] can explain his budget,” said Coish, 74. “He’s young, he’s energetic, he’ll invigorate the whole campaign.”
Although campaign aides have said Mitt Romney would craft his own Medicare proposal if elected, on Wednesday Romney said Ryan’s plan is “the same, if not identical” to his own. And Ryan’s influence on Romney’s thinking was enough to alarm many Windham seniors. Few appeared aware that Ryan’s plan would not affect anyone now 55 or older, and that those who wish could stick with the traditional system.
“He wants the insurance companies to get rich, as far as I’m concerned,” said Donald Dalphond, 80, a retired phone company manager.
“We certainly have too much debt, and the way to reduce debt is to reduce services,” said Tom Case, 78, a retired engineer. “But you don’t cut out services to the elderly and the poor.” When asked his opinion on vouchers, Case replied, “How’s that going to work? You don’t know.”
Obama campaign officials believe the Medicare issue can sway voters in this swing state, whose four electoral votes could prove critical in November. In an average of recent New Hampshire polls, Obama led Romney, 48.3 percent to 44.8, according to RealClearPolitics, a political website.
In Obama’s two appearances Saturday, according to campaign spokesman Michael Czin, his speeches will highlight “the choice Granite State voters face between the president’s plan to strengthen Medicare and the Romney-Ryan plan to end Medicare as we know it.”
Obama aides have said that the voucher plan, coupled with the Republican goal to repeal the president’s health care act, could saddle seniors with an average of $6,400 in extra annual health costs, eliminate preventive care that they now receive for free, and reopen the Medicare “doughnut hole” for prescription-drug expenses.
“I tend to think it’s a slippery slope and not a good choice,” said Kristi St. Laurent, 44, a physical therapist from Windham who is a Democratic candidate for state representative. “I think it leaves a lot of decisions to be made that could affect people’s futures in terms of their health care and their options and their retirement.”
Now that Medicare is on the table, St. Laurent said, seniors and other New Hampshire voters are apt to pay closer attention to the campaign.
“I think people thought, phew, we dodged that bullet,” said St. Laurent, referring to Ryan-sponsored Medicare changes that passed the House of Representatives this year but were not considered by the Senate. “This seems to bring up the issue all over again and take it to a new level.”
New Hampshire has 180,000 people who are age 65 or over — 13.5 percent of the population — but that number is expected to double in the next two decades because of the state’s high proportion of baby boomers, according to Kenneth Johnson, senior demographer at the Carsey Institute at the University of New Hampshire.
New Hampshire’s share of the elderly ranks in the middle in the United States, but its median age of 41.1 is older than Florida’s median of 40.7.
Republicans argue that drastic changes are needed if Medicare is to survive in any form. Ryan’s proposal starts with the same Medicare savings as Obama’s health-care plan — $716 billion over 10 years — but would cut an additional $205 billion over that time.
The president hopes to reach his figure by cutting payments to providers; the Ryan plan envisages lowering costs through market competition created by the voucher program. The differing strategies have led to sharp attacks from each of the campaigns.
“The Obama campaign is trying to demagogue the whole thing and scare people. Governor Romney and Paul Ryan are talking about real, long-term solutions,” said Tommy Schultz, a Romney campaign spokesman in New Hampshire. “We’re going to go on offense on this issue. Our campaign will be talking about it every day and bringing clarity to it. These costs are real and will be incurred, and we need to make sure that we fix the system and make it sustainable.”
Bringing clarity to this complex, vaguely understood issue will be important but daunting as November approaches, according to party officials and campaign aides. State Representative Mary Griffin, 86, a Republican who has represented Windham for 16 years, said many of her fellow seniors are confused and fearful.
“How is it going to work? A voucher system to do what?” asked Griffin, who is assistant majority whip. “We have an election coming up. We need to explain to the people.”
A staunch Romney supporter, Griffin nevertheless said she has concerns about changes to Medicare.
Sitting in the senior center, at what she called the “politics table,” Yolan Carter, 85, pointed to a passage in a book she was reading about the Great Depression. Even then, she said, economists warned about the long-term difficulty of maintaining entitlement programs.
“These programs are unsustainable as the years go by,” said Carter, a retired sciences librarian at Harvard University. “It’s like a pyramid. Where does it end?”
The problem, she said, is the cost of government: “I don’t have a money tree in my backyard, and it’s got to come from somewhere.”
Brian MacQuarrie can be reached at firstname.lastname@example.org