WASHINGTON (The New York Times News Service) -- The ad opens with a gray-haired woman grocery shopping, an older man working in an auto repair shop and two little girls running to hug their grandmother. While these people go about their everyday lives, politicians in Washington are once again deciding the fate of Medicare, a program more important to seniors than almost any other.

"We can do better than a last-minute deal that would hurt all of us," the announcer says in the AARP ad running across the country.

Advocates for seniors are cranking up their lobbying efforts again to try to prevent Congress and the White House from slashing Medicare.

Because leaders could not agree on a plan last year to cut the deficit, they are now confronting what's known as the fiscal cliff. Come Jan. 1, about $500 billion in tax increases and $200 billion in spending cuts will drop like a load onto the backs of American taxpayers and businesses. Elected officials can avoid it only by coming with a similar number of cuts or additional revenue.

Medicare is the nation's third most expensive program, behind Social Security and defense spending. And its costs keep growing. That's why many analysts have concluded that cost-saving changes to the program are essential to any long-term plan to cut the nation's deficit.

In 1970, Medicare accounted for 4 percent of government spending. In 2011, Medicare cost $560 billion, or 16 percent of federal government spending.

Lobbyists for seniors, however, say ensuring the sustainability of Medicare is such an enormous challenge that no deal reached in the waning hours of a budget deadline can bring a lasting or well-considered solution.

"Whatever changes Washington makes at this state in the game, they're not going to be focused on making the program better; they're going to be focused just on making the numbers add up," said Jeff Johnson, AARP's Florida director.

AARP says it spent seven figures -- though it won't say exactly how much -- on its ad campaign to stop what it considers mindless cuts to the program.

On Friday, the National Committee to Preserve Social Security and Medicare also went into protection mode. It send out an email alerting advocates that Washington deal makers are taking Social Security off the table. That program is in better financial shape than Medicare.

In a news conference Thursday, White House spokesman Jay Carney confirmed that Medicare is in play. He did not describe President Barack Obama's proposed Medicare plan in any detail but said that Obama "has put forward additional savings from those health care entitlement programs -- again, savings that are reasonable." On Friday, another spokesman, Josh Earnest, indicated the president's proposal includes asking wealthy seniors to pay more for their health care.

Seniors and the groups that represent them are in a unique position. While Wall Street, business owners and many average Americans will consider elected Washington a failure if it does not avert the fiscal crisis, Medicare beneficiaries are largely shielded from the big cuts associated with going over the so-called fiscal cliff.

When congressional leaders and the president designed the poison pill that was supposed to force a better deal, it agreed to limit the damage to Medicare and Social Security. Payments to Medicare providers would be cut by about 2 percent. But that's much less than the across-the-board cuts of around 8 percent that other programs face if there's no deal by 2013.

In some ways, Medicare beneficiaries could come out better if leaders fail to avert the financial meltdown.

"When you look at other proposals that are under serious consideration, the common theme in all of these proposals is that they basically save the federal government money by shifting costs onto consumers. That's problematic for two reasons," said Joe Baker President of the Medicare Rights Center. "Most people with Medicare are ill-equipped to afford these added costs."

Half of current beneficiaries have incomes of less than $22,000 a year, he said.

Another reason the current proposals won't work, Baker said, is that "they don't really get to the underlying problem. We can do this eligibility age change. We can rejigger the benefits so that people can pay more, but if we're not getting at the underlying costs we're going to be back here in two or three years, putting more costs on consumers."

Laura Green writes for The Palm Beach Post. Email: laura(underscore)green@pbpost.com.  

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