One thing Republican Mitt Romney's choice of Rep. Paul Ryan as his running mate will certainly do is elevate issues like Medicare and Medicaid to the top of the election agenda.
As the nation gets closer to Election Day, Ryan's addition to the GOP ticket will present the public with a dramatic choice about the role the government should play in health care.
One thing the Wisconsin congressman never does is apologize for thinking big.
"We also think we have a moral obligation to try and fix this country's big problems before they get out of our control," Ryan said in February on ABC's This Week.
Ryan is referring, among other things, to the budget plan he wrote and helped muscle through the House — twice. His plan would cut taxes, create private accounts for Social Security and, perhaps most notably, make major changes to the Medicare and Medicaid health programs.
The Medicare changes in particular are dramatic. Starting a decade from now, seniors would get a set amount of money rather than automatic coverage. They could use that to choose from a range of health plans.
"Doing it this way harnesses the power of choice and competition," Ryan said at a news conference last December. "Our goal here is to have the senior citizen, the beneficiary, be the nucleus of this program."
The amount of money the senior gets, however, wouldn't necessarily go up as fast as medical costs. Ryan and those who support his idea say that choice and competition would maintain the benefits. Others, including President Obama, aren't so sure.
"It says instead of guaranteed health care, you will get a voucher," Obama said in a speech last spring in which he blasted Ryan's budget plan. "If that voucher isn't worth enough to buy the insurance that's available in the open marketplace, well tough luck, you're on your own."
On Medicaid, Ryan's proposal would give states far more flexibility to decide how and who to cover, but also less money to do it with. In an appearance on PBS Newshour, Ryan said that what they're trying to do is couple Medicaid reforms with reforms in other programs such as food stamps, housing assistance, education and job training.
"We are trying to couple these things by sending them back to the states in block grants so the states can combine these dollars and reform the tattered social safety net," he said.
Analysts, however, say the cuts would be so large — about a one-third reduction over 10 years — states would have no choice other than to cut benefits or drop people from the rolls. Obama has said that this could put some elderly and poor people at risk.
At least one thing that's clear about Ryan's vision for health care compared to Obama's is that they're different. No one will mistake one for the other, says Aaron Carroll, a pediatrician and professor at the Indiana University School of Medicine who blogs on health economics. He says this campaign should give voters a clear choice.
"I think what Ryan puts forward is a vision of much less government involvement in things like Medicare and Medicaid, especially from the federal level," Carroll says.
What's less clear, however, Carroll says, is whether the nation really is ready to have what Ryan likes to refer to as an "adult conversation" about how to control entitlement spending.
"We probably can, but not in politics," he says. "Because in politics, of course, people want to win, and you win by scaring people into thinking [about] what the other side will do."
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