With Medicare looming large in the austerity push, with everyone from President Obama down through the Democratic ranks on the reform bandwagon, it's worth taking a step back and looking dispassionately at whether focusing on Medicare right now, in this political climate, makes any sense.

From a policy perspective, maybe not so much. Here's a reminder, from the Center on Budget and Policy Priorities' Paul N. Van De Water earlier this summer. Medicare isn't bankrupt.

The 2011 report of Medicare’s trustees finds that Medicare’s Hospital Insurance (HI) trust fund will remain solvent — that is, able to pay 100 percent of the costs of the hospital insurance coverage that Medicare provides — through 2024; at that point, the payroll taxes and other revenue deposited in the trust fund will still be sufficient to pay 90 percent of Medicare hospital insurance costs. (The Medicare hospital insurance program is considered insolvent when revenues and trust fund balances will not cover 100 percent of projected costs.) Over the next 75 years, revenue will cover an average of 83 percent of Medicare’s hospital insurance costs. This shortfall will need to be closed through the provision of additional revenues, program changes that slow the growth in costs, or most likely both. But the Medicare hospital insurance will not run out of all financial resources and cease to operate after 2024, as the "bankruptcy" term may suggest. [emphasis in original]

That's not to say that Medicare doesn't facefinancing challenges. It does, but it isn't in need of emergency surgery with a bunch of nihilistic Republicans assisting—particularly considering that the Affordable Care Act has started to improve Medicare's long-term financial outlook. Largely because of the ACA and providers' efforts to prepare for it, Medicare spending has significantly slowed . Medicare's growth rate has slowed from an average of about 9.7 percent a year to just 2.5 percent in the last year. That's while the growth rate of health care costs covered by private insurers increased by 7.5 percent—3 times the rate for Medicare.

The kinds of policies that actually make sense for Medicare reform make sense for the larger system as a whole. For example: lowering the Medicare eligibility age (which, no, won't happen in this political environment); letting the modernization provisions of the ACA that tackle the system inefficiencies and redundancies that cost so much; building on the prescription drug reforms in the ACA that are saving seniors money now, and apply them to the system—actually forcing the industry to negotiate prescription drug prices. And of course, adding revenues.

So here's an alternative for President Obama and Democrats: Use the facts to make the case that the ACA is working for Medicare reform and, for now, leave it at that. In this, they should follow the old medical adage: First, do no harm.