I just thought I'd get some information out before the sky started falling with reports about Ryan's budget:
If you read anything from this article, don't just read the title. The article explains just one of the many ways Ryan's Medicare proposal is different from the Affordable Care Act (though it's ironic in how many ways it's similar):
"Unfortunately, while Ryan has emulated a number of features from the ACA, he’s forgotten to make the adjustments the law makes to actually ensure that health care is more accessible to beneficiaries rather than more profitable to health insurance companies"
"Given that most Americans 65 and older are a walking pre-existing medical condition, it is difficult to imagine how functioning insurance pools can be constructed from a universe filled with these people. It is equally hard to see how health insurers could offer such a plan without severely restricting the benefits offered or, in the alternative, charging very large premiums – unless the government is prepared to put large enough subsidy checks in the pockets of the insurers to cover the extra costs."
This is just one of the problems with calling this proposal "Ryan-Rivlin", as Ryan is trying to do for political-cover purposes. Paul Ryan and Alice Rivlin only ever put out an agreement on a top-line policy proposal, agreeing to this voucher/premium support idea (which Rivlin delights in pointing out to Ryan is similar in many respects to the dreaded OBAMACARE!!!). But they only minimally discussed the actual particulars necessary to make this kind of policy idea a reality, which is unfortunate, because this is an importance case where the devil lies in the details. (Btw, Alice Rivlin is founding CBO Director, former OMB Director, Democrat, member of both major fiscal commissions, etc.- aka she brings a lot policy know-how and politial umph to the table).
This proposal has some THEORETICAL plausibility, especially with the kind-of protections and safeguards someone like Alice Rivlin has supported and would put in place. Unfortunately, Ryan will not be including those safeguards, which turns this theoretically-plausible concept into a disastrous reality. So to call this idea Ryan-Rivlin is a stretch- it's really a disastrous Ryan-structuring of an untested Ryan-Rivlin concept.
And this doesn't even get us started on his massive cuts to Medicaid and food stamps. Sigh.
P.S. Yes, the article's ending is over-the-top (though you have to remember that Medicaid is the nation's primary provider of long-term [including nursing home] care, so block-granting Medicaid and voucherizing Medicare will be giving the most disadvantaged elderly a one-two punch.)