By John Brummett

We were sitting in the doctor’s waiting room Thursday afternoon and my 79-year-old mom put her Medicare card back in her purse. Then she asked, “So what’s going to happen to Medicare in this health bill?”

I sighed. I hesitated. I contemplated. I said, “Nothing — to yours.”

That was the extent of our exchange, but its brevity belied its political importance.

There are two highly significant questions: Why was she compelled to ask? And did I tell my mother the truth?

She asked because opponents of Democratic health care reform — Republicans, the health insurance industry and much of the business community — are winning the vital message war. They’ve penetrated the consciousness of the elderly shut-in who spends much of her day with CNN. They’ve put her health care in play. They’ve eroded the usual Democratic base. Democrats gave her Medicare. Now Republicans act as if they’re saving it.

Opponents are winning because they have a lot of money and they are motivated into intense focus to save their status quo.

They’re winning because the Democrats are simply not participating. They spend all their time mired in a messy congressional process that people don’t understand and are loath or ill-equipped to follow.

Democrats play only an inside game to try to get something passed. They lack an outside game with a public rallying point and an effective spokesman, which is to say a message.

They seem never to have grasped the need to communicate aggressively to drive home the point that the Medicare cuts they’re proposing are not in medical care for seniors. That failing applies even to the politically savvy Democrats, even one pretty much opposed to what his party is doing.

U.S. Rep. Mike Ross, I mean. He was telling me blithely before the August recess about the savings that could be found over time by reforming inequitable and occasionally inflated Medicare reimbursements.

I asked how he intended to reassure seniors when they heard those two thermonuclear words, Medicare cuts. He said almost casually that these were two entirely different things. We’re talking about reimbursements to providers, not treatment for seniors, he said, as if no one would ever confuse or combine the two. He said Medicare rates actually ought to go up for rural hospitals, as they yet might.

Now people have confused or combined the two.

It is beginning to appear that history may record Barack Obama as being as thoroughly failed for his purposeful detachment from the particulars of health reform as Hillary Clinton was failed for her secretive control of those particulars 16 years before.

Obama’s message seems only to be this: Pass something on health care and send it down here.

That can’t begin to compete with powerful television commercials that saturate a state with a weak Democratic swing voter in the U.S. Senate. Arkansas, I mean. Blanche Lincoln, I mean. And commercials in which good ol’ Arkansas folks warn plaintively of cuts in Medicare, I mean.

Meantime, Republicans play a cynically effective game. On this very Thursday, they were proposing an amendment to the Democratic health bill to “restore” proposed cuts in Medicare over the next 10 years. But the purpose was not remotely to make policy. It was to force a few vulnerable Democrats — again, read Lincoln — to vote against the amendment so that they could be set up for the kill of attack ads back home.

So did I tell my mom the truth? Was it indeed false that her care under Medicare would be cut?

I did.

These “cuts” actually are in the rate of growth in Medicare spending over the next decade. The most direct are in the Medicare Advantage program, which doesn’t apply to her and in which the federal government sends entirely too much money to private insurers to run so-called “boutique” plans.

Reductions in provider reimbursement rates logically would be felt mostly in the high-reimbursement areas, not rural ones where hospitals get low-end reimbursements already.

Alas, sometimes the factual answer to a question is less significant than that the question is being widely asked.

And, to tell you the truth, I don’t know that I convinced my mom. She doesn’t think I’d lie to her. But she might wonder if I’m mistaken, just this once. She’s hearing a lot the other way.

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John Brummett is a columnist for the Arkansas News Bureau in Little Rock. His e-mail address is jbrummett@arkansasnews.com; his telephone number is (501) 374-0699.