Mitt Romney may be losing the fight to win the hearts and minds of voters, at least if the polls are accurate. But he may be winning the battle to obscure his real agenda for Medicare. 

The proposals Romney has made so far would, with virtual certainty, require cuts to Medicare. These cuts would likely be larger, and possibly much larger, than the cuts in the Affordable Care Act—yes, the very same cuts that Romney keeps attacking Obama for enacting. 

As far as I can tell, pundits and reporters are not holding the Romney campaign accountable for this. Nor are they demanding Romney explain how he’d possibly drain Medicare of so much money without causing harm to seniors. I’m not trying to beat up on the press here. Romney has been cagey about this part of his agenda, describing his Medicare plan only in broad brushstrokes and vowing, at every turn, to “save” Medicare for seniors. And the selection of Paul Ryan as a running mate has actually muddled things more, since Ryan’s latest budget proposal happens to have less severe cuts to Medicare.

But Romney’s designs for Medicare become crystal-clear if you look at his agenda as a whole. Yes, you also have to keep some numbers in your head. But I think I can keep it to just two. Let’s give it a shot, shall we?

The key fact is that Romney has proposed to cap federal spending at a fixed level, while setting aside some of that money for defense spending. I’m going to spare you the precise figure; you can look it up here. All you need to know is that it would represent a really, really severe cut in federal spending.

How severe? The Center on Budget and Policy Priorities ran the numbers. If Romney leaves Social Security untouched, then spreads the rest of the cuts equally across domestic programs, he’d have to reduce Medicare funding by $2 trillion over the next ten years. (First number!) That’s in the next years, so it’d affect current retirees. And that’s nearly three times the $700 billion cut in the Affordable Care Act that Romney keeps attacking.* (Second number!)

Do we know for sure Romney would spread the cuts equally? Nope. Remember, he won’t give specifics. He could decide to undo the cuts already in the law, thanks to the Affordable Care Act. (His advisors have said he would do something along those lines.) He could cut more deeply into other programs. He could finance his entire tax cut by closing loopholes, something the Center on Budget did not presume. All of these would, on paper, allow Romney to cut less than $2 trillion from Medicare. 

But Medicare is such a big program, and the spending cap has so little room, that realistically he’d still have to find cuts in the program. They might not total up to $2 trillion, but they’d almost certainly be bigger than $700 billion—and probably a lot bigger. That’s particularly true if Romney abided by the constraints of a balanced budget amendment, as he’s said he would.

Here’s how the authors of the Center on Budget Paper, Richard Kogan and Paul van de Water, explained it:

Medicare would be cut by $185 billion in 2016 and $2.0 trillion from 2014 through 2022. Achieving cuts of this size solely by reducing payments to hospitals, physicians, and other health care providers would threaten beneficiaries’ access to care. Thus, beneficiaries would almost certainly face large increases in premiums and cost-sharing charges.

Keep in mind that if Romney decided to cut less than $2 trillion from Medicare, the money he’d find elsewhere would inevitably come out of the pockets of the middle class and poor, either in the form of higher taxes or (more likely) less funding for Medicaid, a program he’s already proposing to cut. More cuts to Medicaid would impact seniors as well. Among other things, millions of seniors (and their families) rely on Medicaid to pay nursing home bills.

By the way, there’s a somewhat separate question about what Romney’s agenda would mean for Medicare after the first ten years, and how that approach differs from what both Ryan and Obama have proposed. I’ve seen some of Romney's supporters, like campaign advisor and Forbes writer Avik Roy, suggest Romney would actually cut the program by less. That doesn’t appear to be true, either. But that’s s topic for another post.

Update: An alternative interpretation of the above facts is to assume that Romney really has no intention of cutting Medicare. That means his entire budget is a fantasy. Ezra Klein games out that scenario.

Correction: The post originally stated that Romney's cuts would be more than four times, instead of nearly three times, the $700 billion cut in the Affordable Care Act. We regret the error.

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