M.S. writes (for the Economist blog),

Mr Ryan’s plan ends the guarantee that all American seniors will have health insurance. The Medicare system we’ve had in place for the past 45 years promises that once you reach 65, you will be covered by a government-financed health-insurance plan.

The key word here is promises. There is essentially zero chance that the government will keep its current promises. The author concludes,

I agree with Mr Ryan that the government needs to limit taxpayers’ exposure to Medicare cost inflation. I think this plan is a fundamentally immoral way to do it.

Baloney sandwich. The term “cost inflation” means a pure increase in prices charged for the same services. Some of that takes place. But most of the rise in health care spending reflects increased use of expensive inputs, in particular fancy equipment and medical specialists.

There are always three ways to deal with the increased usage of premium medicine.

a) have government experts ration medical services
b) give consumers fixed amounts of money based on income and medical condition, and having them make their own decisions
c) tell people that neither (a) nor (b) is necessary

Remember that what everybody wants for themselves is unlimited access to medical services without having to pay for them. So the politics of health care push in the direction of (c). I am always ready to have the debate between (a) and (b). But instead, politicians and pundits attack (b) with (c). That is fundamentally immoral.

Pointer from Mark Thoma.