Rep. Paul Ryan will be running against Democratic Vice President Joe Biden on the November ballot, but in an ideological sense he will be opposing former President Lyndon B Johnson, who proposed and signed the landmark Medicare Act in 1965.

Older readers will recall that before Medicare, most people over 65  had no health insurance at all.  When they got sick, some were able to pay their medical bills from their own savings and income,  some went to County Hospital  (or  charity hospitals), but most  were dependent upon their adult children to pay their bills.  For middle-aged  people with elderly parents, these bills could wipe-out their life savings, including  what they had saved toward their own retirement.  

Although Medicare was a Democratic program, first proposed by President Harry Truman,  the bill  had significant Republican support.  At that time Republican senators included  moderate liberals,  like  Jacob Javits  (NY) and Clifford Case  (NJ), who would be personae non gratae in today's  GOP.  Thanks to Medicare, elderly people  have received far better health care  than they (or their families) could otherwise afford, and that is one reason that people live  longer now than  before 1965.

However, Medicare is more expensive than was expected, partially because the  increase in longevity  has meant that more old and sick people are on the program.  Another reason is that medical costs have risen faster than inflation,  in part because  the high-tech tools available today cost more, and  in part because  hospital employees are paid more now.  

One way to meet the increased cost of Medicare would be to increase the tax that pays for it; another would be to gradually increase the age of eligibility from 65 to around 70.  However, Paul Ryan's  proposal is far more drastic: replace Medicare  (for those now under 55) with a voucher system.  Under Ryan's plan,  seniors would receive  federal vouchers they could use to buy health insurance in the marketplace.   

This plan would definitely reduce the cost of the program, but at the expense of  the elderly who depend upon Medicare.  There is no guarantee that private insurance companies would provide the  Medicare  level of care   for the premium paid for by the voucher,  and there would be no public option.  I would expect that most Medicare beneficiaries  would not buy additional coverage, and  the coverage paid for the vouchers would be insufficient for those who became seriously ill.  Thus the   financial risk of serious illness  would be transferred from the US Government  (through Medicare) to the ill patient.   The cost of  advertising, marketing and  executive options and bonuses (as well as stupendous salaries) would be passed on the  buyers of   these policies.

The Ryan plan fits the current Republican  goals  of smaller government and privatization.   However, I do not believe that the majority of Americans would not choose the Ryan plan over Medicare, so they are  less likely to vote for the Romney ticket with Paul Ryan on it.  Trust the AARP and Democrats to make sure that everyone  knows about that before November.

Gerald S Glazer