Strip away the rhetoric and accusations about Medicare reform and the historic importance of the issue becomes clear: The debate over $270 billion in spending represents a pivotal decision over the role of government in the lives of free citizens.

The coming showdown presents both Congress and the American public with a clear choice: Either continue with a program based on government central planning and control, or give smart consumers operating in a competitive marketplace the chance to reform the system from the bottom up.

The Soviet Union and Eastern Europe have made their decisions about which way to go; now it's time for the United States to follow suit.

Liberals already are waging their battles to protect this dinosaur of a program that even the Clinton administration admits is unsustainable as currently constructed. Medicare is going bankrupt. It must be changed. There is no argument about that. The question is how: Do we want to raise taxes -- again! -- to pay for the program, or cut services and restrict choices -- again! -- to seniors? Or do we want to make changes that put trust in the somewhat messy and unpredictable genius of consumers operating in a competitive marketplace?

In this choice lies the whole battle. Raising taxes is how the Washington establishment has for decades "solved" problems. But this would leave in place a program that would continue to expand over time and suck in more and more tax dollars.

Restructuring the program so it operates more like business -- providing better services at lower cost -- is the solution that puts ordinary Americans back in charge.

Fortunately, the public has grown wary of big government. The public rejected the Clinton administration's health-care plan, which would have put virtually the entire health-care system under the government's thumb through employer mandates, health-service alliances, draconian regulations, fines, penalties, and jail terms. Even though citizens knew -- and still know -- there are fundamental problems in the health-care system that need to be addressed, government control was and is not the answer. It wasn't the answer for the private sector, and it isn't the answer for Medicare.

After the voters overwhelmingly rejected the Clinton bill, they threw out many of the liberals in Congress who supported the plan. Now, liberals warn that the tables could turn on conservatives who dare to touch the sacred Medicare program.

Conservatives should not back down. Senior citizens are no different than other Americans who do not want government to run their lives; they want responsible government, and they want a government that recognizes their right to choose for thenselves.

Republicans won the battle against the Clinton health plan, and now they need to begin challenging the programs, like Medicare, that were built upon the same foundation. Major change cannot and should not come overnight. But conservatives should start now by making decisions that will lead to a more sustainable, more responsible, more efficient Medicare program in the next century.

Liberals know they can't win an open debate challenging Republicans' goals of cutting taxes and balancing the federal budget. They have to use a back door like Medicare to preserve paternalistic government programs. But conservatives can reform Medicare, balance the budget, and cut taxes, just as voters demanded.

The free market can easily give seniors better health care more efficiently than the government can. The big secret is: If we reform Medicare -- one of the few weapons left in the liberal arsenal -- the bigger battle will practically be won. A new course will be charted, and we will sail into a new era where government serves its citizens -- not the other way around.