The next time you hear someone say that Mitt Romney wants to “end Medicare as we know it,” consider what New Hampshire has done with Medicaid.

Last week, the federal government gave New Hampshire the final OK to switch to what is being called Medicaid managed care. The state has hired three companies to manage the coverage provided to the state's Medicaid recipients. (Medicare is the subsidized government insurance program for seniors; Medicaid is for low-income and disabled individuals.)

With Washington's approval last week, New Hampshire officially has ended Medicaid as we know it. The new managed care plan will end the state Medicaid program's old fee-for-service model (in which patients go to the doctor and Medicaid pays for services individually) with a managed care plan in which the three contracted companies work with patients to more effectively spend health care dollars and provide better care.

This is not the Ryan or Romney plan for Medicare. But it does substantially change the way this public insurance program is structured, and it does so in a way that will affect what kinds of care people will get. Costs will be more closely monitored. Yet few people are complaining that this “ends Medicaid as we know it.” (Nor did Democrats complain that Obamacare “ended health insurance as we know it.”)

The fact is, our big entitlement programs must be fundamentally changed. They cannot survive “as we know them” without significantly damaging, if not crippling, our economy. President Obama himself has acknowledged this. But every time a Republican proposes an alteration that would keep an entitlement program solvent, the President and his party have, ironically, attacked the “change” and insisted on maintaining a status quo they know cannot be maintained.

When it comes to entitlements, don't fear change. It is coming in one form or another, either through a planned transformation or a sudden, shocking jolt as politicians make emergency changes when the money runs out. Wouldn't it be better to adopt the former so we can prevent the latter?