As budget talks ramp up, Americans should not allow the highly successful Medicare health insurance program for retirees to get caught in the buzz saw of Beltway politics.

Today, 48.5 million retirees get health coverage through Medicare; by 2035, with the retirement of the Baby Boom generation, that rises to 85.3 million. The president and Congress have to figure out how to deal with the enrollment bulge and the cost it brings.

House Republicans, led by Rep. Paul Ryan, R-Wis., would "end Medicare as we know it" by creating a voucher system for retirees born after 1956 (or perhaps 1954) to buy private insurance. This would reduce costs by capping the amount of care paid for by vouchers, thus shifting costs to future seniors. While some seniors are wealthy, half of the nation's retiree households have annual incomes of less than $25,000. At the same time, the Ryan plan fails to rein in costs for the existing Medicare program.

Some Democrats take a "been there, done that" attitude, standing pat with Medicare savings from the Affordable Care Act of 2010. Those savings just are not enough to address the scale of the problem.

Americans who want to see Medicare preserved should reject the Ryan/House Republicans voucher plan and push President Barack Obama and congressional Democrats to take further steps to rein in Medicare costs.

Congress and Obama should start by getting rid of the 2003 law that forbids Medicare from negotiating prices with drug companies. Some experts estimate that alone would save $230 billion over 10 years.

Weaning providers from out-of-control fee-for-service reimbursements and encouraging them to adopt alternative pay models promises the biggest savings. The National Commission on Physician Payment Reform has called for eliminating the fee-for-service model within seven years.

Former Senate Majority Leader Bill Frist, R-Tenn., who chairs the commission, said, "We can't control runaway medical spending without changing how doctors get paid. This is a bipartisan issue."

We don't need to replace Medicare or put significant new burdens on retirees. But we do need to fix how we pay for health care.