Smart Democrats like my colleague Matt Miller are already pleading with Democrats to get off Mediscare tactics. He patiently explains that harping on this “allows the presumption that Ryan, and thus Romney, are the true apostles of fiscal responsibility in this race, a value important to the voters who will decide November’s outcome.” (Miller thinks Paul Ryan is a “fraud” and many other bad things, but his political advice is nevertheless sound.)

Here’s the catch: It’s not up to Democrats to get off the topic. Medicare is now the GOP’s issue. And it is working very well, at least so far. (By the way if putting Ryan on the ticket made Medicare a GOP strength instead of a liability, then all those naysayers better rethink their objections.) By now even the mainstream media acknowledge that President Obama did cut Medicare to pay for Obamacare.

The Post’s Sarah Kliff does the math, concluding: “The Medicare Advantage cut gets the most attention, but it only accounts for about a third of the Affordable Care Act’s spending reduction. Another big chunk comes from the hospitals. The health law changed how Medicare calculates what they get reimbursed for various services, slightly lowering their rates over time. Hospitals agreed to these cuts because they knew, at the same time, they would likely see an influx of paying patients with the Affordable Care Act’s insurance expansion. The rest of the Affordable Care Act’s Medicare cuts are a lot smaller.”

In short, there is no doubt Obama cut Medicare, thereby impacting current beneficiaries. Democrats will say that “benefits” didn’t get cut, but that’s a weak retort. By slamming doctors and crippling Medicare Advantage, Obama is limiting seniors’ options, forcing more providers to refuse Medicare patients and thereby diminishing the quality of their care. It is incorporating one of the worst aspects of Medicaid into the Medicare system. (“Medicaid beneficiaries have very limited access to physicians, a great deal of difficulty seeing specialists, and clog hospital emergency rooms which can’t turn them away.”)

The Democrats holler: But Ryan would have kept those Medicare cuts! The obvious rejoinder to that is two-fold: 1) Who cares? The GOP ticket is running on Romney’s plan, which explicitly would undo the cuts and 2) Ryan’s entire budget is a long-term plan for saving Medicare (and abolishing Obamacare), so if Democrats now praise Ryan for his fiscal prudence they should know “Ryan’s plan” includes a shift to Medicare Premium Support.

All of the liberal pundits and Republican nervous Nellies who feared what Ryan would bring to the ticket look a tad foolish now. Democrats are on the run on what was supposed to be their killer issue.

Obama has another problem: He doesn’t have any plan other than rationing care through the Independent Payment Advisory Board to preserve Medicare solvency going forward. The best person to explain that, by the way, is — you guessed it — Paul Ryan. As he has said many times, he explained at the Hoover Institute in 2011 the impact of the IPAB:

The law empowers a board of 15 unelected officials – the Independent Payment Advisory Board, or IPAB – to hold the growth of Medicare spending to GDP plus 1 percent by reducing reimbursements to health-care providers. Unless overturned by a supermajority in Congress, the recommended cuts dictated by this board become law.

The President’s latest proposal simply called for letting IPAB cut deeper. This board of bureaucrats will now be tasked with holding Medicare’s growth rate to GDP plus half a percent. To put that in context, Medicare is currently growing at 6.3 percent per year.

Medicare’s non-partisan chief actuary, Richard Foster, has been clear on this point: Going from 6 percent growth down to the President’s targets, using only the blunt tools that his law gives to IPAB, would simply drive Medicare providers out of business, resulting in harsh disruptions and denied care for seniors.

In fact, the deterioration in seniors’ care that is projected to occur under IPAB would be so untenable, the board is unlikely to yield any savings at all. Future Congresses would be under tremendous pressure to undo the cuts, just as past Congresses have time and again reversed scheduled cuts to physicians’ pay.

Pain cannot be sustained. You cannot control costs by using price controls, which impose painful cuts within a fundamentally broken framework. Instead, you have to revisit the structure of federal health policy and change the incentives – something that many leading Democrats, with their unwavering commitment to early 20th Century social insurance models, remain totally unwilling to do.

Look for Romney-Ryan ads promising to reverse Obama’s IPAB rationing board.

Only liberal arrogance and the thick walls of the liberal echo chamber could lead Democrats to believe they had no vulnerability on this issue. Romney and Ryan have no such illusions, understanding that Obama’s stealing from Medicare, in essence robbing Peter to pay Paul (sorry, I couldn’t resist) and his Medicare rationing plan are losers for the Democrats.