In the world of federal budget politics, February may end up being the month of Medicare. And not a moment too soon.

President Bush will submit his annual budget request next week, and early news reports say he's going to propose cuts to control the growth of Medicare and Medicaid [1]. In addition, the president is legally obligated to submit legislation to put Medicare on a sounder financial footing [1]. And Congress will be under pressure to reverse a 10 percent cut in Medicare doctors' fees set to take effect in July.

This may sound like miserable news to you. It certainly will sound miserable to plenty of people in Washington. For most people in Congress, even talking about changes to Medicare in an election year is like handing your opponent a stick to beat you with.

But here's why we have to start talking about this problem: Medicare is by far the biggest, meanest and most dangerous part of the long-term federal budget challenge. People lump Medicare and Social Security together like they're the same thing, but that always puts me in mind of this poster from a very bad movie [2]. The long-term projections for Medicare dwarf Social Security [2]. That's because Medicare brings two troubling trends together in one place: the growing number of baby boomers who will be eligible for benefits [3] and the overall skyrocketing costs of the nation's health care system [4].

But based on Public Agenda's research for Facing Up, relatively few people understand the problems facing Medicare [5]. They know something about the problems of Social Security, and they're certainly concerned about health care. But they don't "connect the dots" when it comes to the nation's financial situation, and their overall attitudes about health care costs are a bundle of contradictions [6]. People haven't really considered the options and tradeoffs [6] that will probably be needed to solve this.

Bush's proposals may or may not be the right approach -- there are a lot of other options out there, ranging from minor revisions to complete overhauls of the health care system. But at least this may start a conversation. Perhaps its unrealistic to think that anything can be done about Medicare in an election year. But it's not at all unrealistic to think that we can get people to start talking about Medicare seriously. And that's fundamental if we're going to have a real, sustainable solution to our fiscal problems.