It's that time of year again: Washington is talking about cuts to Medicare. President Obama's health-care reforms depend on them - up to $400 billion worth over 10 years.

As a psychiatrist, I'll break the bad news gently: Medicare cuts are like Santa Claus and his flying reindeers - often talked about, never actually seen.

The federal government has long fought to control Medicare spending. Today's Medicare program costs taxpayers twice what it did 10 years ago. But whenever lawmakers from either party agree to savings, Congress reverses course, fearing cuts will anger voters on Election Day.

Congress reversed planned cuts in 1999. And 2005. And 2004. And 2006. In fact, since 1997, when members of both parties agreed to automatic cuts if spending rose faster than...