I do think it's important to keep in mind a few key facts about Ryan and Medicare:
* Medicare in its current form is unsustainable.
* Obama's plans for Medicare include draconian cost controls, including the infamous IPAB board which will use the power of the purse to impose de facto rationing. As I wrote last year for PJMedia:
If the IPAB sets the reimbursement rate for services below the cost of providing it, then hospitals and doctors could no longer afford to offer such services — even if the services are medically best for their patients. Life-saving medical procedures we currently take for granted, such as PET scans to detect early cancers or minimally invasive methods to safely open up blocked vital blood vessels without risky surgery, might no longer be available.
Although those services might still theoretically be "covered" by Medicare, in practice doctors would no longer offer them, and their patients would no longer be able to receive them.* Paul Ryan will be lambasted by the Left as wanting to "end Medicare as we know it". But David Catron reviews some of the dismal facts about the future of Medicare in his 8/13/2012 American Spectator piece "Paul Ryan as the Great Destroyer" and concludes:
All of which suggests that ending Medicare "as we know it" is a pretty good idea. How then, would Paul Ryan go about cleaning it up?* If anything, Ryan's proposed systems of vouchers and premium supports don't go far enough. That's because his stated goal is to "save Medicare", rather than to eliminate it as a government program.
* There are groups like Docs4PatientCare that also support some of the same intermediate-range ideas as Paul Ryan. But they also frame their proposals in the broader context of "[u]ntil Medicare as we know it is phased out and the transition to private health insurance is accomplished". In other words, they envision completely eliminating government interference in the health care market for senior citizens. This is a praiseworthy goal which I fully support.
* Hence, Ryan's plans for Medicare do not go as far as I (or Docs4PatientCare) envision. The current Obama approach will cause Medicare to crash in a catastrophic fashion. The Ryan approach may buy it more time, but would leave in place an enormous government entitlement program. Instead of either of those approaches, we should aim to end Medicare as a government program, but through a controlled landing rather than a crash.
* Hence, Paul Ryan's ideas may move us part way in the right direction, but not as far as we should go. If the Romney/Ryan ticket wins the election, free-market advocates will still have much more work to do.