Medicare heated up the October 12 vice presidential debate as Vice President Joe Biden and Congressman Paul Ryan sparred over the best way control Medicare costs, extend the program's life, and protect the benefits of future beneficiaries.

Ryan repeated the often-heard claim that the Obama administration cut Medicare by $716 billion through the Affordable Care Act (ACA). Biden defended the law—the Obama administration’s signature domestic achievement--saying it extends the life of Medicare by guaranteeing solvency through 2024 while giving seniors enhanced benefits such as wellness visits, certain cancer screenings and shrinking out-of-pocket costs for prescription drugs.

Ryan said the best way to protect Medicare is by reforming the program for future beneficiaries.

"You see, if you reform these programs for my generation, people 54 and below, you can guarantee they don’t change for people in or near retirement, which is precisely what Mitt Romney and I are proposing," Ryan said.

Biden said their plan would add $6,400 a year more to beneficiaries’ out-of-pocket costs.

Biden told viewers: "Who (should) you believe, the AMA, me, a guy who’s fought his whole life for this, or somebody who would actually put in motion a plan that knowingly cut — added $6,400 a year more to the cost of Medicare?" He added, "Now they got a new plan: 'Trust me, it’s not going to cost you any more.' Folks, follow your instincts on this one."

But Ryan touted the benefits of “choice and competition” that would come with converting Medicare to a premium-support program. In the Romney-Ryan plan, beneficiaries would have the choice to remain in traditional Medicare or receive an income-adjusted defined contribution from the government to subsidize the purchase of insurance in the private market.

Ryan took aim at the controversial Independent Payment Advisory Board (IPAB) created by the ACA and charged with controlling Medicare costs, saying he and Romney “would rather have 50 million future seniors determine how their Medicare is delivered to them instead of 15 bureaucrats deciding what, if, when, where they get it.”

His comments seemed meant to trigger the strong emotions tied to the “death panel” concept introduced during the 2008 campaign by then-GOP vice presidential candidate Sarah Palin.

Biden laughed away the comparison.

"You know, I heard that death panel argument from Sarah Palin,” Biden said. "It seems every vice presidential debate I hear this kind of stuff about panels. "

During the debate on saving costs in Medicare, Biden also touted the Obama position of letting Medicare bargain the price of drugs like other federal health programs. Obama has proposed using the government’s bargaining power to drive greater efficiency by negotiating lower prices for prescription drugs purchased through Medicare. This has been met with fierce opposition from the pharmaceutical industry, which has labeled such bargaining tools as government price setting and job killing, as higher drug prices significantly add to pharmaceutical companies’ profits. 

In the context of Ryan’s theory that the private market could do better at controlling Medicare costs through competition, Biden didn’t hesitate to add that the ACA saves a large chunk of money by halting overpayments to insurers who administer Medicare Advantage plans and other providers.

"We saved $716 billion and put it back, applied it to Medicare. We cut the cost of Medicare. We stopped overpaying insurance companies, doctors and hospitals, " Biden said. "The AMA supported what we did. AARP endorsed what we did. And it extends the life of Medicare to 2024. They want to wipe this all out. "

But Ryan said, "Here’s the problem. They got caught with their hands in the cookie jar, turning Medicare into a piggybank for Obamacare. Their own actuary from the administration came to Congress and said one out of six hospitals and nursing homes are going to go out of business as a result of this."

Ryan said the law will force 7.4 million seniors to lose access to their Medicare Advantage plans, a $3,200 benefit cut. Biden countered that more people have signed up for Medicare Advantage since the law was enacted than they did before.

In regards to Medicare’s future, both men agreed the problem needed to be addressed soon.

"We’re not going to run away. Medicare and Social Security did so much for my own family,” Ryan said. "We are not going to jeopardize this program, but we have to save it.’

But Biden said the manner in which the GOP team pledged to address the program does indeed jeopardize it.

"You’re changing the program from a guaranteed benefit to premium support, " he said. "Whatever you call it, the bottom line is people are going to have to pay more money out of their pocket and the families I know and the families I come from, they don’t have the money to pay more out."

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