There are two aspects of the Ryan plan for Medicare: its transformation of the benefit from a fixed entitlement to a premium support plan; and the level of the support. Yuval Levin looks at the first part here, and sees promise. The deepest problem for Ryan was that his plan would not give seniors anything like what they now get; but doing so via premium support, without structural reforms to cut costs, would break the bank pretty quickly as well.
I wish I believed market forces would help bring down costs significantly in this way. So far, the results are not encouraging that savings would be very substantial. I'm forced to concede that healthcare, especially among the elderly, is not really a market, and can only function as a shadow of such. I suspect that once you have conceded the right to healthcare – as Americans essentially have – then rationing must follow given medicine's advances in capacity and cost, and our own adamance on preserving life and health. What premium support plans do is help sustain rationing by price in a highly inefficient private-based system. If we could both enforce the ACA cost controls and replace Medicare with premium support, you'd be getting somewhere.
The Dish 