Many readers are mad at me for not mentioning the cost control pilot schemes in the ACA, when I wrote the following in this post:
And in fairness to the GOP, until Obama actually presents an alternative to the Ryan plan for Medicare that is even faintly plausible as a real cost-cutter, or offers defense cuts to balance the fiscal equation, or proposes more serious tax hikes than his current position (the Clinton levels), he is empowering the GOP's fiscal vandalism.
I have often referred to the cost controls in the ACA and supported one of the most controversial – the mandatory power-of-attorney discussion for Medicare recipients. I just doubt they will match the scale of the problem 
without some more means-testing, extra taxes and a much beefed-up rationing panel.
The one thing you can say about the Ryan plan is that it does formally let the government off the hook for soaring costs. Granted, it grandfathers in all the baby boomers, and does nothing to really cut costs (and by boosting the private health insurance sector could even accelerate costs) – but it does simply put a limit on federal liability. If he actually agreed to bring taxes back to Clinton levels, you'd have a real plan for deficit control.
On the Democratic side, I just doubt that even if all the efficiency schemes, incentive programs and cost-controls work perfectly, they will never keep up with the costs of medical technology, many more seniors and far longer lives. And by the time we find that out, the debt will be crushing. Right now, we have a draconian distant cut-off from the GOP and a gradual, reformist bend-the-cost-curve strategy from the Dems. Neither, I fear, will work.
What the Dems need to do is be more upfront about cost-controls, tax increases, defense cuts and some form of rationing as the only way to keep Medicare affordable. If Americans want to keep this entitlement without drastic change to it, they need to be told up-front what it will cost to do so. Then we can have a saner, calmer, more empirical debate.
The Dish 