House Speaker Paul Ryan (R-WI) promises that 2018 will be the year Congress attempts to reduce spending on big federal programs like Medicare. As that debate unfolds, keep this in mind: A 65-year old woman will need to have put aside $95,000 to have a just a 50/50 chance of paying her Medicare premiums and prescription drug costs over her remaining lifetime. If she wants to 90 percent chance of paying her Medicare bills, she’d need $147,000. The estimates are from the Employee Benefit Research Institute.

These estimates are for Medicare costs only. They do not include health care not covered by the program, such as dental and vision care. And they do not include the costs of long-term care. My Urban Institute colleague Melissa Favreault estimates that an average senior would have to save an additional $69,000 at age 65 to pay for high levels of long-term supports and services for the rest of her life (equal to about $138,000 in lifetime costs).  That’s combined total savings for Medicare and long-term care–which Medicare does not pay for– of more than $200,000.

For context, in 2011 the median net worth of a household aged 65-69 was $194,000, according to the US Census Bureau. That number is certainly higher now, thanks to a booming stock market and rising home values. But keep in mind that only one-quarter of those 65-69 owned stocks or mutual funds in taxable accounts in 2011 and only about one-third had retirement accounts. Thus, many seniors have not benefited at all from the long, post-recession bull market.

And, of course, people need their retirement savings for more than medical and long-term care. They’ll draw down savings to help pay for food, transportation, utilities, taxes, and the like.

At the same time, conservatives are right that Medicare is a big, costly federal program. In fiscal 2017, the federal government spent $590 billion on Medicare, about 15 percent of the entire federal budget. And as the Baby Boomers age and incur even higher medical costs as they approach their 80s, those costs will increase significantly.

And another of my Urban Institute colleagues, Gene Steuerle, estimates that the lifetime value of Medicare benefits for a woman who turned 65 in 2015 was about $220,000, net of the premiums she paid over her working life.

So when you hear Paul Ryan talk about how Medicare is breaking the back of the federal government, or when you hear progressives say the program is untouchable, try to keep two ideas in mind: First, Medicare is a costly federal program that provides big subsidies to seniors and, second, that even with those subsidies, most older adults cannot afford to pay for their medical and long-term care needs.

Both are true. And any debate over Medicare must acknowledge that reality.