WASHINGTON, April 24, 2011 -- The "adult conversation" around Medicare reform has taken a detour in the land of adult diapers.
President Obama warned at the start of the great debate over spending and the role of government that the one thing that can't work is if the two sides demonize each other's plans.
"We're not going to be able to do anything about any of these entitlements if what we do is characterize whatever proposals are put out there as, 'Well, you know, the other party's being irresponsible. The other party is trying to hurt our senior citizens," the president told a gathering of House Republicans in January 2010.
Fast-forward a year. Democrats are first out of the box in the time-honored tradition of "Mediscare."
They're up with a Web ad targeting GOP House members by warning of the consequences of Republicans' "voting to end Medicare" -- an ad the independent fact-check group PolitiFact.com labeled "pants on fire."
Grandpa is shown working odd jobs to make ends meet -- working a lemonade stand, mowing lawns, even working as a stripper.
"Did someone call the fire department?" an older gentleman asks. "Because it's about to get hot in here."
To be fair, rhetoric over Medicare has been overheated for decades.
Democrats during the Clinton years said Republicans wanted the program to "wither on the vine." Last year, it was Republican-aligned groups attacking Democrats for a provision in the Obama health care law that would find $500 billion in future savings in Medicare.
The result has long been political paralysis around Medicare, with neither side seeing much of an incentive in seriously engaging in a discussion that's presumed to be a political loser. It comes as Medicare's costs are expected to spike significantly, as Baby Boomers reach age 65 and health care costs continue to escalate.
Republican pollster David Winston, an adviser to House Speaker John Boehner, said attacks on politicians who are trying to fix Medicare won't work this year, since voters realize the challenges can no longer be avoided.
"They want some real substance discussed here, and they want to hear some real policy debates -- not sort of trite political advertising," Winston said on ABC's "Top Line" Friday.
But last week's ABC News/Washington Post poll seemed to confirm longstanding political instincts around Medicare. Asked about a range deficit-reducing proposals, 78 percent of respondents said they opposed cutting spending on Medicare.
Seniors -- traditionally the most reliable voters around -- also oppose changing Medicare, even though neither Democrats nor Republicans are discussing plans that would affect those currently in the program or drawing close to eligibility.
Yet buried inside those numbers is a suggestion that the public may be ready for some pain, so long as it's spread around.
Only 36 percent of those polled want only spending cuts, and just 3 percent favor higher taxes alone. But 59 percent say they want to see a mix of both, with particularly strong support (72 percent) for the president's proposal for higher taxes only on couples making more than $250,000 a year.
That sentiment hasn't been reflected in the rhetoric, however. Asked last week whether House Budget Chairman Paul Ryan's demonstrates "sufficient boldness" in attempting to address the nation's fiscal woes, the president went on the attack.
"The Republican budget that was put forward I would say is fairly radical. I wouldn't call it particularly courageous," Obama said at a town-hall meeting at Facebook headquarters in California.
For his part, Ryan, a Wisconsin Republican, continues to attack Democrats' main cost-control instrument, an independent advisory board that would have the power to recommend cost savings.
"This is the government rationing commission in Medicare," Ryan said earlier this month.
The Ryan budget and the Obama White House's counter have dimmed prospects of a major breakthrough, which had never looked all that bright in the first place.
For all the heat between House Republicans and the White House, though, the action will remain in the Senate. The bipartisan "Gang of Six" continues to hammer out solutions members hope both liberals and conservatives can embrace.
"Medicare cannot continue the way it is if we're going to survive," Sen. Tom Coburn, R-Okla., said today.
Said fellow "Gang" member Sen. Kent Conrad, D-N.D.: "We've got to decide as a nation, are we going to do some things that all of us would prefer not to have to do, or do we wait for the roof to cave in?"