Pretend Medicare is a patient. He decides to go see a doctor because he is stressed. He is worried about his future.

“Well, just like any other person who is 47-years-old, you are always concerned about what’s going to happen,” says Jon Oberlander, a professor of health policy at the University of North Carolina-Chapel Hill. There are other stressors — everyone is talking about Medicare, there is a lot of weight on his shoulders.

According to Oberlander, more than 50 million people rely on Medicare, and that number is expected to grow to 80 million over the next two decades. “Its costs are going up, and that’s both because more beneficiaries are joining the program as the baby boomers age into Medicare, and also due to the rising costs of medical care,” he says.

Diagnosis in hand, Medicare decides to see a specialist: Dr. Obama. “The way for us to deal with Medicare in particular is to lower health care costs,” Dr. Obama says.

Vivian Ho, the James A. Baker III Institute Chair in Health Economics at Rice University, puts it another way. “We’ve got an obese patient here, which needs to be put on a strict diet and exercise program,” she says, adding that, for years, no one told Medicare to get in shape. “It is almost as though we have given incentives for Medicare as a patient to perhaps eat more but not necessarily exercise and watch what they’re eating.”

Dr. Obama outlined his course of treatment in the Affordable Care Act. Medicare decides to get a second opinion; so, he visits Dr. Romney. Dr. Romney says Medicare is at a breaking point and cannot handle 30 million more people relying on him. So, he prescribes a choice, “to allow them either to choose the current Medicare program or a private plan.” 

“The private sector, typically, is able to provide a better product at a lower cost,” says Dr. Romney. 

Medicare has his options. His future health depends on which treatment voters choose.