In an effort to reverse their lagging popularity with the public after taking serious hits for their plan to privatize Medicare, Republicans have dusted off their 2010 playbook and returned to attacking Democrats on Medicare from the left, with the accusation that they voted to "end Medicare as we know it." Here's Paul Ryan leading the charge on the floor of House:
Let’s for a moment talk about Medicare. Medicare as we know is already gone. Our friends on the other side of the aisle – when they passed the Affordable Care Act – stopped the Medicare status quo. The President’s new health care law already ended Medicare as know it. It does two things: It raids Medicare; and it rations Medicare.
This is just false. As currently constituted, Medicare is a single-payer insurance program that guarantees health care coverage for the elderly. The Affordable Care Act does nothing to change the basic structure of Medicare; rather, it streamlines the program by ending subsidies for private insurers and reinvesting those funds into coverage for uninsured Americans. It also includes measures designed to improve the quality of care while lowering the growth rate for Medicare costs. Pace Ryan, this doesn't include "rationing"; the newly formed Independent Payment Advisory Board is specifically prohibited from rationing. From the bill itself: "The proposals [made by IPAB] shall not include any recommendation to ration health care, raise revenues or Medicare beneficiary premiums, increase Medicare beneficiary cost sharing (including deductibles, coinsurance, or co-payments), or otherwise restrict benefits or modify eligibility criteria."
For now, the only plan that "ends Medicare as we know it" is Ryan's own proposal, which scraps the current program and replaces it with means-tested vouchers and regulated private insurance. By design, those vouchers would fail to cover the full cost of insurance for most seniors, and would leave millions to either pay the difference out of pocket or forgo care altogether.
Put another way, Ryan plans to save the village by destroying it. Unfortunately for him, and the Republican Party, voters aren't too keen on that approach.