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Supporters of U.S. Republican presidential candidate Mitt Romney cheer during a campaign event at El Palacio De Los Jugos in Miami, Florida August 13, 2012.SHANNON STAPLETON/Reuters

To understand the latest gambit to win the White House, sit down for dinner at The Veranda Club in Boca Raton.

The meal is an early affair – most people who live here are over 80 – and on a recent Tuesday, the theme was Britain, with fish and chips on the menu and flags on the table.

The talk was of doctors, acupuncturists, the cheapest place to fill prescriptions. By the main course, the conversation had moved to Medicare, the government program that covers health care for senior citizens.

All agreed it was essential. "I feel it has kept us alive," said Dorothy Isman, an 86-year-old Brooklyn native who relocated to Florida 30 years ago. "I'm not kidding."

But not everyone felt the program had to stay the same. "I don't care if they change it," said Glenda Jackson, 56, who works as a part-time aide to the elderly. "I just want something to be there when it's time for me to get mine."

Over the past week, the U.S. presidential campaign has shifted course and veered directly into the conversation taking place at this dinner table.

Mitt Romney, the presumptive Republican nominee, is wagering that Americans are ready to reduce the size of their government, and in particular, to reshape signature programs like Social Security, Medicare and Medicaid, which provides health benefits to the poor. Paul Ryan, Mr. Romney's new running mate, was the driving force behind proposing such changes in a budget plan passed by the Republican-dominated House of Representatives.

Now, by choosing Mr. Ryan to join the ticket, Mr. Romney has driven the campaign into uncharted territory. Nowhere are the risks of this strategy more evident than in Florida. For Mr. Romney to become president, analysts believe he must win the state, which once again is up for grabs. Swaying Florida's older population – more than half the registered voters are over the age of 50 – is critical.

The battle to control the national narrative about the stark differences in domestic policy between the two campaigns begins now. Already both sides have rolled out television ads and so-called "robo-calls" staking their positions and lines of attack on Medicare. It's part of a wave of campaign spending that will wash over the country in the 79 days remaining before the election.

In a nod to Florida's importance, the Republican National Convention is taking place in Tampa at the end of the month. There Mr. Romney will have the opportunity to make his case for far-reaching change in government programs to a national audience, while ensuring wall-to-wall coverage of the event within the state.

Issues like Medicare are so potent – in Florida but also across the nation – that Mr. Ryan is expected to address it on Saturday. His destination: The Villages, a sprawling community northeast of Tampa that is home to about 60,000 retirees, most of them Republicans. Joining him on the campaign trail will be his mother, who herself receives Medicare benefits.

Republicans say their changes are necessary to save the Medicare system for future generations. They are attacking President Barack Obama for reducing Medicare spending by $700-billion (U.S.) as part of his health-care overhaul (though such savings are achieved through reducing payments to providers, not by changing benefits).

Democrats, meanwhile, say the medicine favoured by their opponents is too strong and would spell the end of the program as voters understand it. Mr. Ryan's approach gives seniors a fixed amount to purchase health insurance starting in 2023 and could leave the elderly shouldering more out-of-pocket costs than under the current system, according to the Congressional Budget Office.

Which message will resonate with Florida's voters? The answer will prove a litmus test for other battleground states, including Ohio, Pennsylvania, Nevada and Virginia. So far in Florida, the polls show an extremely tight race. Purple Strategies, a political consulting firm focusing on swing states, conducted a survey this week that showed Mr. Romney leading Mr. Obama in Florida by 48 per cent to 47 per cent, within the margin of error, and a slight improvement for the President.

Florida is no stranger to playing the role of linchpin in presidential contests, most memorably in 2000. In the scenarios envisaged by political analysts, Florida emerges again and again as a state Mr. Romney must win in order to reach the threshold of 270 electoral college votes required for victory. "It's do or die," said Doug Usher of Purple Strategies. "There are many, many more ways for Obama to win without Florida than for Romney."

In the most recent presidential election, Republican John McCain garnered the majority of votes from Florida's seniors. Yet Mr. Obama carried the state with strong support from young, African-American and Hispanic voters. Mr. Obama's strategy is to retain those votes and peel off some who might be inclined to vote for Mr. Romney, using issues like Medicare.

One of the votes that Mr. Obama will not retain belongs to Janet Kline, 92. Ms. Kline voted for Mr. Obama in 2008, only the second time in her life she had voted for a Democrat (the other was Franklin D. Roosevelt). She gave Mr. Obama her vote out of distaste for Mr. McCain's running mate, Sarah Palin, but faults the President for not delivering on his promises and for swelling the country's debt load.

Medicare coverage and Social Security payments are critical to her well-being, she said. In recent years, her health problems have included a broken arm, a fractured hip, an infected gallbladder and a heart attack.

"When I need these benefits, I don't want to worry about what's going to be and what's going to change," she said. Mr. Romney and Mr. Ryan, she noted, aren't proposing changes for people currently on Medicare.

Still, the talk of overhauling Medicare is unsettling those approaching retirement age. Such voters have contributed to government programs throughout their working lives and witnessed their savings accounts and home prices ravaged by the recession. "We feel like we have paid through the nose to get to this point," said Lynda Goldman, the sales director at The Veranda Club, who is under 65.

Both of the local candidates for the House of Representatives have visited the facility to press their case with its elderly residents. Adam Hasner, the Republican candidate, said in an interview that Medicare is going bankrupt and the status quo "is not only unsustainable, it's unacceptable." His opponent, Democrat Lois Frankel, countered with an analogy. The solution to a leaking roof "is not to burn down the house," she told The Globe. "That's what the Ryan plan is like."

By turning the debate toward questions of Medicare and the national deficit, Mr. Romney is sidelining the question of the broader economy. After past recessions, Florida has tended to recover quickly.

"This time, we're lagging and it's not sitting well with Floridians," said Susan McManus, a professor of political science at the University of South Florida.

Some of those Floridians could be found on a steamy August afternoon at El Palacio de Los Jugos, an open-air Cuban restaurant and juice bar in Miami. Earlier in the week, Mr. Romney had held a campaign rally under its yellow-and-red pavilion.

Oscar Gonzalez, 49, used to run commercial construction jobs but is now unemployed. Mr. Obama may have inherited a mess – "He got a hot potato, I know he did" – but didn't do anything to improve the economy, Mr. Gonzalez asserted. "He ain't the man for the job."

A few tables away, Eddy Fandino saw signs of improvement. He pointed to the headquarters of F.P.G. Wholesale Inc., across the street. The door retailer was hiring again after laying off half its staff. Mr. Fandino, 49, a former forklift operator, is a diabetic who lives on disability payments. Although he has voted for Republican presidential candidates in the past – including George W. Bush – he won't support Mr. Romney.

"I'm not going to vote for someone who's going to hurt me," he said, referring to Mr. Romney's plans to cut spending on social programs. "Obama's not going to touch none of that, and Romney is."

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