The committee began debating the compromise measure last week, with arguments erupting over Democratic proposals to reduce subsidies for some Medicare coverage while eliminating fraud and waste in the government health care plan for senior citizens.

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They have said an agreement must include major reforms of entitlement programs such as the Medicare and Medicaid government-run health-care programs for senior citizens, the disabled and the poor.

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Ryan also revived his proposal to reform Medicare, the health care program for senior citizens that is considered the biggest driver of rising federal deficits as costs increase and more Americans become eligible.

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Given a choice of providing nursing home care for poor senior citizens, keeping criminals off the street, or subsidizing the college education of relatively affluent middle class students, politicians are not about to favor the universities.

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Then there is the issue of how we are going to care for our senior citizens going forward in a way that we can afford and that fulfills our implicit obligations to our elders who often cannot fend well for themselves.

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It was a Bush administration priority that nearly failed despite heavy lobbying by the White House, GOP House leaders, lobbyists for the health care industry and senior citizens.

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Simply put, if the residents of nursing homes did not have Medicaid and Medicare to help pay for their medical costs and nursing homes, many senior citizens would be priced out of nursing home care altogether.

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She listed essential elements for passing a health care bill, including making coverage more affordable for middle-class Americans, sustaining the solvency of the Medicare program for senior citizens while eliminating a gap in their prescription drug coverage, no deficit increase and holding insurance companies accountable.

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