THE VILLAGES, Fla. — Who loves Medicare more? President Barack Obama and Mitt Romney's running mate vied for that distinction Saturday as Medicare became the latest flashpoint in a presidential campaign of flying elbows.

The issue is dicey for both sides: Obama is steering billions from the entitlement to help pay for the expansion of coverage under his health care law; Paul Ryan is a champion of overhauling Medicare to make the traditional program no longer the mainstay for tomorrow's seniors – just one of many old-age health insurance choices.

But that didn't stop them from going head on.

On a day Romney devoted to raising campaign cash in Massachusetts, Ryan accused Obama of raiding the Medicare "piggybank" to pay for his health care overhaul and he warned starkly that hospitals and nursing homes may close as a result. The Wisconsin congressman introduced his 78-year-old mother to an audience of seniors in Florida and passionately defended a program that has provided old-age security for two generations of his own family.

"She planned her retirement around this promise," Ryan said as Betty Ryan Douglas looked on. "That's a promise we have to keep."

Campaigning in New Hampshire, Obama said it's a promise that the Republican ticket would tear up.

"You would think they would avoid talking about Medicare, given the fact that both of them have proposed to voucherize the Medicare system," he said in Windham. "But I guess they figure the best defense is to try to go on offense.

"So, New Hampshire, here is what you need to know: Since I have been in office, I have strengthened Medicare."

He hammered the point again later in the day while campaigning in Rochester, N.H.

Said Ryan in Florida: "You want to know what Medicare is saying about this? From Medicare officials themselves: One out of 6 of our hospitals and our nursing homes will go out of business as a result of this," meaning Obama's Medicare cuts.

That was a far from exact reference to a 2010 analysis by Medicare chief actuary Richard Foster. He said then that roughly 15 percent of hospitals and nursing homes that provide Medicare services could "become unprofitable" over a decade – not necessarily go out of business – thanks to cuts in payments from the government under the health care law.

But Foster's analysis also said the law would improve key Medicare benefits, solve the "doughnut hole" gap in coverage for seniors, expand health insurance to millions more people, reduce the federal budget deficit and extend the solvency of the government's hospital insurance trust fund by up to 12 years. Hospitals remain largely on board with the health care law, without apparent fear of closing.

Ryan, a deficit hawk and the House Republicans' chief budget writer, has stood out in Washington for laying out tough spending choices that many lawmakers in both parties avoid. So it was almost inevitable that his selection as running mate would vault Medicare to the top of the campaign debate.

Democrats say it's a debate they are glad to have because voters tend to trust them more than Republicans on the big social entitlements. But Obama has vulnerabilities, too, given the Medicare cuts he pushed to expand health insurance for the nation and to keep the costs of doing so in line.

The Obama campaign recognizes that Romney and Ryan have been pre-emptive. The likely Republican ticket tried to neutralize the usual Democratic criticism on Medicare by striking first with a Medicare ad and with their criticism of Obama's health law. "They are being dishonest about my plan because they can't sell their plan," the president said Saturday.

Ryan's proposal in Congress would encourage future retirees to consider private coverage that the government would help pay for through a voucher-like system, while keeping the traditional program as an option.

According to the nonpartisan Congressional Budget Office, Medicare over time would spend thousands less per senior under the Ryan plan than under current policy. Critics say that would shift heavy costs to individual retirees. The government could always spend more than anticipated to meet changing realities, but at the cost of deeper deficits.

In New Hampshire, Obama cast the choice on Election Day as one between two fundamentally different approaches to the government's responsibility to its citizens. His approach of portraying Romney's tax and economic plans as a giveaway to the rich was familiar, but seemed to have a particularly sharp bite.

"They've been trying to sell this trickle-down snake oil before," he told his audience in Windham. "It did not work then. It will not work now. It will not reduce the deficit, it will not create jobs. It's the wrong direction for America."

In Massachusetts, Romney told reporters on Martha's Vineyard that he wishes he could spend more time campaigning in competitive states but must raise money at a furious pace because Obama broke all barriers four years ago.

"That's the challenge with a president who blew through the federal spending limits," he said. "Campaigns now have to spend a disproportionate amount of time fundraising. You appreciate all the help you get, but you wish you could spend more time on the campaign trail."

Asked if campaigns ads are not already saturating the airwaves in swing states, Romney replied, "80-some-odd days to go."

His staff estimated Romney will raise nearly $7 million from fundraising events held Friday and Saturday in Boston, Long Island and the Massachusetts resort areas of Martha's Vineyard, Cape Cod and Nantucket.

Romney took a 10-minute break from fundraising Saturday to shake hands and pose for pictures at Millie's Restaurant in Nantucket, Mass.

Romney bought ice cream for several staff members, shook hands with adults and stroked a baby's head.

Alec Gavenda, 13, of Summit, N.J., marched up to Romney and introduced himself and his family to the candidate, who asked several questions about the vacationing group.

Greg Gavenda, 12, told Romney, "my brother has Down Syndrome," to which Romney smiled and said softly, "I figured that."

The boys' father, T.J. Gavenda, told the former governor, "We just ordered our Romney-Ryan yard sign."

But as the campaign entourage left the restaurant, a less-friendly man shouted demands that Romney release five years of personal tax returns.

Although Romney was governor of Massachusetts, he's conceded that Obama's almost certain to win the state in November.

Ryan, too, took a break – to raise money. At an evening reception on Florida's Treasure Island, Ryan drew a crowd of 200 people and raised another $1 million.

Speaking to donors who paid as much as $50,000 to have dinner with him, Ryan compared the United States with Europe, where a financial crisis has led to cuts in benefits for retirees. He said lawmakers there delayed action even though they saw impending problems, and seniors paid the price.

"They ran out of road to kick the can down, and now they have a debt crisis," Ryan said.

Ryan warned the same could happen here if the country doesn't get its hands around its own affairs.

Ryan's stop Saturday at the gated retirement cluster known as The Villages was familiar ground for presidential candidates. Florida has the highest concentration of voters over 65 in the country, with some 17 percent of Floridians fall into that group. Betty Ryan Douglas spends part of her year in Broward County's Lauderdale-by-the-Sea community and has been registered to vote in Florida since 1997.

___

Kuhnhenn reported from Rochester, N.H. Associated Press writer Charles Babington in West Tisbury, Mass., and Calvin Woodward in Washington contributed to this report.

Also on HuffPost:

Loading Slideshow...
  • Marco Rubio

    "Throughout his life, Mitt Romney has made great decisions, and choosing Paul Ryan as his running mate is a truly inspired choice. I got to know Paul during my Senate campaign when he endorsed me early on when I was still considered a long shot. Paul Ryan is a courageous reformer who understands our nation's challenges, has proposed bold policy solutions to solve them, and has shown the courage to stand up to President Obama and other Washington politicians trying to tear him down. "The Romney-Ryan ticket is going to win in November because it offers the American people visionary leadership to recapture the free enterprise spirit that has empowered countless Americans to build businesses from scratch and live the American dream. I'm excited about the visionary change a Romney-Ryan team will bring to Washington, and I look forward to campaigning

  • Rob Portman

    <blockquote> "Mitt Romney has made a great choice in Paul Ryan. He is an accomplished public servant and a leading voice on the most pressing issues facing our country. Paul is one of my best friends in Congress and someone I have worked closely with as a former colleague on the House Ways & Means Committee. "Jane and I wish Paul and Janna and their kids the very best. As the Chairman of the Romney campaign in Ohio, I look forward to working with Paul to ensure that the Romney-Ryan ticket carries Ohio and is victorious in November. Most importantly, as a member of the Senate, I look forward to working closely with a Romney-Ryan Administration to restore fiscal sanity and enact pro-growth policies to create jobs."</blockquote>

  • Obama for American Campaign Manager Jim Messina

    <blockquote>"In naming Congressman Paul Ryan, Mitt Romney has chosen a leader of the House Republicans who shares his commitment to the flawed theory that new budget-busting tax cuts for the wealthy, while placing greater burdens on the middle class and seniors, will somehow deliver a stronger economy. The architect of the radical Republican House budget, Ryan, like Romney, proposed an additional $250,000 tax cut for millionaires, and deep cuts in education from Head Start to college aid. His plan also would end Medicare as we know it by turning it into a voucher system, shifting thousands of dollars in health care costs to seniors. As a member of Congress, Ryan rubber-stamped the reckless Bush economic policies that exploded our deficit and crashed our economy. Now the Romney-Ryan ticket would take us back by repeating the same, catastrophic mistakes."</blockquote>

  • Michelle Malkin

  • Michael Moore

  • Brad Woodhouse

  • Rachel Maddow MSNBC

  • mike murphy

  • Michael Steele

  • Larry Sabato

  • davidfrum

  • Charles M. Blow

  • Robert Reich

  • Nilay Patel

  • Mark Harris

  • Progressive Change Campaign Committee

    The Progressive Change Campaign Committee issued the following statement: <blockquote>"Paul Ryan is a right-wing extremist who wants to end Medicare. This is a major unforced error by Mitt Romney. It gives President Obama and Democrats a chance to draw a clear contrast in 2012 by promising not to cut one penny from Medicare or Social Security benefits. If Democrats win in a landslide, this was the game changer." -- Adam Green, co-founder, Progressive Change Campaign Committee, a 1 million member grassroots organization</blockquote>

  • Laura Ingraham

  • John Kasich

  • Ari Fleischer

  • Susan B. Anthony List

    The national pro-life organization released the following statement: <blockquote>"By selecting Congressman Ryan as his vice presidential running mate, Governor Romney demonstrates his commitment to protecting American women and unborn children," said Marjorie Dannenfelser, president of SBA List. "A longtime pro-life advocate and a strong fiscal conservative, Congressman Ryan has insisted that there can be no 'truce' when it comes to advancing the rights of the unborn and achieving fiscal responsibility. He has a pristine pro-life voting record and will be an asset to Governor Romney's campaign. "Pro-life voters are a key demographic and help secure victory in critical elections," continued Dannenfelser. "The addition of a second strong pro-life leader to the ticket energizes the pro-life base - we are thrilled with this pick."</blockquote>

  • GOProud

    <blockquote>"The selection of Paul Ryan is a bold and inspired pick," said Jimmy LaSalvia, Executive Director of GOProud. "Paul Ryan has been the architect of policies that would benefit all Americans, especially gay Americans." "Paul Ryan is one of the few political leaders anywhere in the country willing to tell the American people the truth about the unprecedented budget crisis we are facing, and - more importantly - willing to put forward bold plans to put this country back on the road to fiscal solvency," continued LaSalvia.</blockquote>

  • Log Cabin Republicans

    <blockquote>"Congressman Paul Ryan is a strong choice for vice president, and his addition to the GOP ticket will help Republican candidates up and down the ballot," said R. Clarke Cooper, Log Cabin Republicans Executive Director. "As chairman of the House Budget Committee and author of the Republican "path to prosperity" that provided the blueprint for serious spending cuts in this Congress, nobody is more qualified to articulate a conservative economic vision to restore the American economy and stimulate job creation. </blockquote>

  • Sen. John Cornyn (R-Texas)

  • Jason Chaffetz

  • Center For American Progress President Neera Tanden

    <blockquote>"Just like Sen. John McCain's choice of Sarah Palin and George H.W. Bush's selection of Dan Quayle, Mitt Romney has been cowed by the right wing into choosing an extreme vice presidential nominee who will alienate moderate voters. It's now clearer than ever that as president, Mitt Romney would end Medicare as we know it, and will raise taxes on middle class families by more than $2,000in order to slash taxes on the wealthiest Americans. While there is a lot that can be said about Paul Ryan's extreme views, more important is what this choice says about Mitt Romney: that he is unwilling or unable to stand up to the far-right of his party and select a vice-presidential candidate that is both able to be president on day one and capable of governing by reaching across the aisle."</blockquote>

  • SEIU President Mary Kay Henry

    <blockquote>"If there were ever any doubt that Mitt Romney is not on the side of working people, today's choice of Rep. Paul Ryan as a running mate makes it crystal clear. With this choice, Romney has shown the American people that he believes Rep. Ryan's extremist, irresponsible and anti-worker agenda is what's right for our country. "Rep. Ryan has made a name for himself by fighting in the halls of Congress for tax giveaways for the wealthy and big corporations while proposing to gut vital services like Medicare and education, and eliminating any sense of retirement security for working families. His no-holds barred record of attacking seniors, children, and working men and women is frightening for the 99 percent of Americans who are not rich -- but for Mitt Romney it was a calling card to choose him as a running mate."

  • NARAL Pro-Choice America President Nancy Keenan

    <blockquote>"Mitt Romney's choice of Rep. Ryan as his running mate reminds us of why elections matter when it comes to our ability to make personal and private medical decisions," Keenan continued. "The outcome of the 2012 presidential election very well could determine whether abortion remains legal and accessible for the next generation of American women. Romney has pledged that taking away women's rights will be a priority for him and his choice of Ryan amplifies that promise to the extreme anti-choice backers of this ticket. My organization's priority is to make sure President Obama remains in the White House."</blockquote>

  • Kelly Ayotte

  • Herman Cain

  • Rick Perry

  • Tommy Thompson

  • Pete Hoekstra

  • Steve King

  • Eric Cantor

  • Dana Rohrabacher

  • Kenny Marchant

  • Gregg Harper

  • Rick Santorum

  • Rep. Kathy Hochul

    <blockquote>"Americans deserve new ideas for how we can reduce the debt and protect our seniors and the middle class. Just one year ago, Western New York voters rejected the Ryan-Collins policies that would end Medicare as we know it and hurt middle class families while giving more tax cuts to the rich. Our country needs to move forward, not re-hash failed ideas. Given Chris Collins' ongoing support for tax cuts for the rich that add nearly $1 trillion to the deficit and his willingness to send his business to China to line his pockets, it is clear my opponent is going to continue to pursue policies and priorities that have already been rejected."</blockquote>

  • Sen. Lisa Murkowski

  • Claire McCaskill

  • Jim DeMint

  • Chris Van Hollen

  • Rep. Mary Bono Mack

  • Sam Brownback

  • John Shimkus

  • Rep. Trent Franks

  • Frank Pallone

  • Michele Bachmann

  • Rob Zerban

    <blockquote>"Now that Paul Ryan's personal ambition has clearly trumped his interest in the First District, I have no doubt he'll find himself out of a job come November. Once Wisconsinites and voters across our country learn the truth about Ryan's radical plot to end Medicare as we know it, de-fund women's health care, and preserve tax breaks for millionaires, they'll vote against him not just once, but twice. In the coming weeks, our campaign will work with President Barack Obama and Vice President Joe Biden to continue getting the word out on Ryan's indefensible record, and building momentum to ensure victory on Election Day."</blockquote>

  • Scott Walker

    <blockquote>"Governor Mitt Romney made a bold and reform-minded selection in Congressman Paul Ryan of Wisconsin. This election has to be about who is going to look out for the next generation. America needs a comeback team to turn around the economy and to turn around the fiscal status of our country. Romney and Ryan have the ideas and the experience needed to take on these core issues. This is a great day for Wisconsin and an even greater day for America."</blockquote>