Republicans muscled a budget through the House of Representatives in April that they said would take an important step toward reducing the federal deficit. Introduced by U.S. Rep. Paul Ryan of Wisconsin, the plan kept Medicare intact for people 55 or older, but dramatically changed the program for everyone else by privatizing it and providing government subsidies.



Democrats pounced. Just four days after the party-line vote, the Democratic Congressional Campaign Committee released a Web ad that said seniors will have to pay $12,500 more for health care "because Republicans voted to end Medicare."



Rep. Steve Israel of New York, head of the DCCC, appeared on cable news shows and declared that Republicans voted to "terminate Medicare." A Web video from the Agenda Project, a liberal group, said the plan would leave the country "without Medicare" and showed a Ryan look-alike pushing an old woman in a wheelchair off a cliff. And just last month, House Minority Leader Nancy Pelosi sent a fundraising appeal that said: "House Republicans’ vote to end Medicare is a shameful act of betrayal."



After two years of being pounded by Republicans with often false charges about the 2010 health care law, the Democrats were turning the tables.



PolitiFact debunked the Medicare charge in nine separate fact-checks rated False or Pants on Fire, most often in attacks leveled against Republican House members.



Now, PolitiFact has chosen the Democrats’ claim as the 2011 Lie of the Year.



It’s the third year in a row that a health care claim has won the dubious honor. In 2009, the winner was the Republicans’ charge that the Democrats’ health care plan included "death panels." In 2010, it was that the plan was a "government takeover of health care."



A complicated and wonky subject with life-or-death consequences, health care is fertile ground for falsehoods. The Democratic attack about "ending Medicare" was a pervasive line in 2011 that preyed on seniors' worries about whether they could afford health care.



Even when explained accurately, the Republicans’ Medicare plan was not particularly popular with the public, nor with some independent health policy analysts. But the plan was distorted and attacked again and again.



"In terms of creating a national conversation about fiscal reform, the last thing we need is demagoguing attacks against people who have put forward serious policy proposals," said Jason Peuquet, a policy analyst with the bipartisan Committee for a Responsible Federal Budget. "It’s very worrying."



A persistent falsehood



With a few small tweaks to their attack lines, Democrats could have been factually correct, said Norman Ornstein, a resident scholar at the American Enterprise Institute, a conservative think tank. "I actually think there is no need to cut out the qualifiers and exaggerate," he said.



At times, Democrats and liberal groups were careful to characterize the Republican plan more accurately. Another claim in the ad from the Agenda Project said the plan would "privatize" Medicare, which received a Mostly True rating from PolitiFact. President Barack Obama was also more precise with his words, saying the Medicare proposal "would voucherize the program and you potentially have senior citizens paying $6,000 more."



But more often, Democrats and liberals overreached:



• They ignored the fact that the Ryan plan would not affect people currently in Medicare -- or even the people 55 to 65 who would join the program in the next 10 years.



• They used harsh terms such as "end" and "kill" when the program would still exist, although in a privatized system.



• They used pictures and video of elderly people who clearly were too old to be affected by the Ryan plan. The DCCC video that aired four days after the vote featured an elderly man who had to take a job as a stripper to pay his medical bills.



"Both parties use entitlements as political weapons," Ryan said in an interview with PolitiFact. "Republicans do it to Democrats; Democrats do it to Republicans. So I knew that this would be a political weapon that the other side would use against us."



Liberal bloggers and columnists contend it's accurate to say Republicans voted to end Medicare. Left-leaning websites such as Talking Points Memo, Daily Kos, and The New Republic said PolitiFact's analysis was wrong, as did New York Times columnist Paul Krugman.



"According to (PolitiFact's) logic, if the FBI were replaced with a voucher program wherein citizens would receive subsidies for hiring private investigators to look into criminal activity, but the agency running the voucher program were still called the FBI, it would be unfair to say that the FBI had been ended," wrote Jed Lewison for Daily Kos. "I guess it's their right to make that argument, but it's transparently absurd."



In a blog post, the DCCC stood by its claim, saying the ad accurately stated Ryan's plan would "abolish" Medicare.



But PolitiFact was not alone. Other independent fact-checkers also said the claim was false.



"Medicare would remain an entitlement program, but it would also be more costly to future beneficiaries. It would not end," noted FactCheck.org, a project of the Annenberg Public Policy Center at the University of Pennsylvania. The Washington Post’s Fact Checker concluded that while there’s "a worthwhile debate" about whether Ryan’s proposal should be adopted, "it is not true to claim Republicans are trying to ‘kill’ Medicare."



The Democratic attacks struck a chord. Polls showed voters were skeptical of the Ryan plan and want Medicare to remain largely the way it is now. That may be why the plan has virtually no prospects of passing the Senate, which voted to shelve the plan. President Obama has indicated he would veto any changes to Medicare that would privatize the program and substantially shift costs to beneficiaries.



How the Ryan plan would work



Under the current Medicare system, the government pays the health care bills for Americans over age 65. Under the Ryan plan, future beneficiaries would be given a credit and invited to shop for an approved plan on a Medicare health insurance exchange. It received overwhelming support from Republicans in a House vote on a budget blueprint.



Starting in 2022, beneficiaries would receive "premium support payments" from the government to help pay for the private insurance. People who need more health care would get a little more money, and high earners would get a little less.



The plan has some guarantees for coverage, although seniors would have to pay more to get the benefits they receive today, according to an analysis completed earlier this year by the nonpartisan Congressional Budget Office (CBO).



The guarantees: Ryan's plan requires private insurers to accept all applicants and to charge the same rate for people who are the same age. The plans would comply with standards set by the U.S. Office of Personnel Management, which administers the health plans of federal employees. The Medicare eligibility age would rise from 65 to 67, an idea that has received some bipartisan support in the past.



The CBO found that it would save the government money. But it does so by asking future Medicare beneficiaries to pay more for the same benefits.



Ryan says the plan would offer more choice for Medicare participants and increase competition among private insurers to drive down cost.



"I’m a big believer in patient-centered choice, where the beneficiary is the prime decision-maker, which drives competition and innovation, and that’s missing from the status quo, to a large degree," he said.



It’s not the first time it’s been suggested that Medicare be changed from its current fee-for-service, where the government pays all the bills, to one that uses private insurers. In the past, some Democrats have even favored such proposals, especially if -- unlike the Ryan plan -- the support was linked to medical inflation, or there were an option for traditional Medicare, or there were more explicit protections for consumers.



Just last week, Ryan agreed to a new framework with Sen. Ron Wyden, D-Ore. Their proposal uses Ryan’s idea for private insurers and exchanges, but it leaves traditional Medicare as an option.



Private insurers already offer Medicare plans under the program Medicare Advantage, though those plans have proven more expensive than traditional Medicare, not less.



The partisan split on health care reveals the contradictions of congressional debate. Republicans were staunchly against the insurance exchanges in the federal health care law. But they endorsed them in the Ryan proposal, even as Democrats switched to oppose the plan.



"Ryan basically proposed the Affordable Care Act for future seniors," said Jonathan Gruber, an economist at the Massachusetts Institute of Technology, who advised both President Obama and Republican Mitt Romney on health care. "I don't understand how you can like it for future seniors but not like it for today's needy uninsured. That doesn't make any sense."



'Scaring 85-year-olds'



Kathleen Hall Jamieson, an expert on campaign advertising who directs the Annenberg center at the University of Pennsylvania, says Democrats have been using falsehoods and exaggerations about Medicare and Social Security since at least 1952. She calls it the longest-running "Democratic deception."



It fits with a core theme from Democrats that they will use government to protect seniors and needy people, while Republicans supposedly want to cut those programs, she says. It is a scare tactic that works.



"If you're reliant on Medicare, a suggestion your benefits are going to be cut in any way is a direct, visceral threat," said Jamieson.



Republicans actually used a version of the attack in 2010, claiming Democrats cut $500 billion from Medicare to pay for Obama's health care law; the law actually sought to reduce the growth of future spending with a series of efficiency measures. But historically, attacks about Medicare have come from Democrats.



In the 1950s and 1960s, Democrats used images of Social Security cards being torn in half to suggest that Republicans wanted to cut the program. In 1995, Democrats said House Speaker Newt Gingrich's plan to restructure Medicare would force seniors to pay more and would "wreck" Medicare.



President Bill Clinton vetoed the Republicans' Medicare bill, and used the issue to pummel GOP nominee Bob Dole in the 1996 campaign.



Gingrich complained at the time that "Medicare is the one issue the left believes they can lie about and demagogue." He described the Democrats as "totally morally bankrupt" and said, "They are reduced to scaring 85-year-olds."



The scare tactics are effective because seniors worry about being able to pay their medical bills and Medicare is a vital program for them. Also, seniors represent a large, up-for-grabs voting bloc.



Jonathan Oberlander, a health policy professor at the University of North Carolina-Chapel Hill, said, "If you can scare seniors that something is going to happen to those programs, there is potentially a huge payoff in votes."