Eight questions for Paul Ryan about his new compromise Medicare plan

1. Solvency. The CMS Actuary says that Medicare is going to be insolvent in 2016. CBO says Medicare is insolvent in 2020. Your plan doesn’t truly kick in until 2022. How exactly does this help?.

2. The biggest difference with your original plan is that seniors would have a choice between staying in traditional Medicare, or opting into new private plan alternatives purchased through a federally regulated exchange. You say this will “Ensure a sustainable future for Medicare.” Why do you have confidence that the conservative base will accept what is essentially doubling down on the methods of Medicare Part D? And given that this idea was also in Rivlin-Domenici, can you explain how this new plan is any better, or any more conservative, than that bipartisan approach?…

4. You anticipate that consumers will make choices to drive insurers and Medicare to be more efficient and more price conscious, driving down Medicare spending. If this doesn’t happen at below nominal GDP growth plus 1 percent, you bring Congress into the picture to “offset an increase in the cost”. Combine that with the fact that this plan retains the Independent Payment Advisory Board, and together you’re putting a lot of stock in the political courage of future elected officials. But doesn’t that create a similar problem to the “doc fix”, keeping your fingers crossed that future Congresses will act responsibly? Won’t this set up a rationing conflict where Congresses continually respond to the demands of Medicare constituents, resulting in no meaningful decrease in spending?