THE MOST UNKINDEST CUT

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Scared by pollsters into believing that Medicare cuts cannot be sold as a budget issue, Republicans and Democrats alike are evading the truth that the budget cannot be balanced unless something is done to rein in the explosive costs of the government's health programs. Left unchanged, Medicare and Medicaid are expected to grow at a rate of 10% a year over the next decade. By 2000, they will surpass Social Security as the largest category of federal spending. As for reforming Medicare by encouraging seniors to join health-maintenance organizations, even some G.O.P. budget analysts doubt the effects of such changes will kick in soon enough to help balance the budget in seven years, with or without tax cuts. But hope springs eternal. "When the public realizes and personalizes the financial situation of Medicare, they end up backing significant reform," says Republican pollster Frank Luntz.

Republicans can still hang on to a degree of public goodwill by arguing that they are preparing credible plans that just might balance the budget in the lifetime of most Americans. Administration officials acknowledge that at some point during the budget process they will have to negotiate constructively with the Republicans to avert an ugly impasse that shuts down the government. But if last week's G.O.P. disarray and partisan firefighting are any indication, the White House's Medicare ambush is the prelude to a long summer of bloody political trench warfare. --Reported by James Carney, John F. Dickerson and Karen Tumulty/Washington