AARP’s shot over the bow on the fiscal cliff talks is most unpleasant. Perhaps you’ve seen the ad on TV. As seniors go about their day, a stern female voice says of Medicare and Social Security: “We earned them.” She goes on, “If Washington tries to cram decisions about the future of these programs into a last-minute budget deal, we’ll all pay the price.” She left out “down your throat.”

Several unpleasantries here, in addition to the blatant threat. There’s the return to the nastiness and half-truths that buried productive conversation during the debate over Obamacare. Unlike Social Security, Medicare is only a partly earned benefit. The average two-earner couple retiring at 65 can expect about $351,000 in benefits after paying $116,000 in lifetime Medicare taxes. Medicare should be subsidized by other taxpayers, but don’t pretend it’s not.

The AARP ad was a bit unexpected in that the lobbying group for older Americans supported the Affordable Care Act – Medicare savings and all. Why it’s running this ad now is unclear. Does anyone seriously believe that a cherished universal program like Medicare is going to be quickly chopped up just to get us past the fiscal cliff? Or is this about marketing?

Anyhow, one wishes that the elderly and those claiming to represent them would get over the idea – as AARP did during the Obamacare brawl – that savings in Medicare spending automatically translate into benefit cuts. The elderly lost not a splinter of benefits in the reforms. They actually gained some. A more positive tone on the ways we can curb our rising health care costs is in order.

Think of replacing a 1975 refrigerator with a modern energy-efficient model. The new one does the same thing – and perhaps new tricks, like making ice – but costs less to run. No one would see this as any kind of appliance come-down. But something about health care hinders our accepting that savings can be found that don’t impair quality of product.

Look at Canada. From 1980 through 2009, its medical spending on those 65 and older rose only 73 percent (after inflation), while American spending rose nearly 200 percent, according to a study in the Archives of Internal Medicine. Making this difference still more remarkable is that the Canadian system has not allowed deductibles and copayments since 1984.

Had America done what Canada did, it would have spent $2.16 trillion less over these three decades. And yes, medical outcomes for older Canadians were as good (or better) than those for their U.S. contemporaries.

Of course, Canada’s simple single-payer system saves a good deal on paperwork and other administration costs. Canada places hospitals under strict budgets and controls spending on new buildings and equipment. By contrast, America’s medical-industrial complex thrives on quantity of care. (Lots of studies find that overtreatment can actually hurt patients.)

Clearly, America is not going the single-payer route, nor should it. Having the government pick up all medical bills creates its own problems. But we can do some of the same things within the context of our multipayer setup.

In Canada, the government negotiates better prices for drugs. Our Medicare drug benefit forbids that. Canadians emphasize primary care, which means a family doctor – not an expensive otolaryngologist – gets first crack at a sore throat.

Another Canadian advantage is lower medical malpractice costs. American conservatives are right: We must curb litigation.

Like the $10,000 handbag that’s become a status symbol because it costs so damn much, America’s extravagant medical system has been sold on the notion that the more you pay, the more you get. In health care, that’s not necessarily so. In some cases, the opposite is true.