The “end of Medicare” reference, of course, is one of the charges against Ryan's most aggressive plan to overhaul the program from standard fee-for-service to a “premium support,” or voucher, model. Such a change would mean seniors would be paid a fixed amount of Medicare dollars that they would then use to comparison-shop for a private insurance policy.
There can be no argument that such a plan would spell the end of Medicare as we've always known it. Even another idea floated by Ryan and Sen. Ron Wyden (D-Ore.) last year offering seniors added choices would require restructuring of the program. The real question is whether Medicare as we know it is a healthy program that we know will be there for the next generation and beyond.
Everyone agrees the current system is unsustainable. Analysis shows a “solution” such as Ryan's might make Medicare more affordable for the treasury, but at the same time equally less affordable for seniors. One of raps against the plan is that the vouchers can't possibly keep up with healthcare inflation if the proposed budget is to be honored, resulting in an out-of-pocket increase of $6,500 per beneficiary, according to the Congressional Budget Office. And that cost would continue to grow.
So, for many seniors, that could mean the end of a secure retirement as they might have known it.
Romney, set to officially accept the Republican presidential nomination next week at the GOP soiree in Tampa, Fla., was quick in his attempt to deflect the initial tsunami of criticism for his running mate's ideas, saying that he would have his own plan for Medicare, and that Ryan's plans aren't necessarily his plans. But we have yet to see the nuts and bolts of such a plan. Last week, he offered some ideas that might pass as a framework, but for detail, the only substantive proposals we have are courtesy of Congressman Ryan.
To be fair, when it comes to Medicare, we've yet to see a comprehensive plan from the Obama administration either. The White House can take some credit for extending the life expectancy of the program through provisions of the ACA, but it's no long-term fix. By contrast, Ryan's vision is there for all to take in. Based on opinion polls, the public doesn't like what they see, especially those sure-to-turn-out-at-the-polls seniors.
Romney, meanwhile, continues to vow that part of the solution to Medicare's ills is the repeal of Obamacare. Again, we say, if unplugging the reform law is part of the answer, we'd love to hear more. Where's the plan?
The nation needs to have a civil, balanced discussion about our fiscal future. The direction of Medicare, Medicaid and Social Security are core issues, along with bipartisan solutions for their solvency. The question: Can we expect to see such changes enacted anytime soon?
If so, that would mean the end of politics as we know it.
David May is the assistant managing editor for Modern Healthcare.