On the other hand, Ryan's plan could empower consumers to choose options best suited to their needs and their pocket books.
Gail Wilensky, who ran the Medicare and Medicaid program under President George H.W. Bush, offers Medicare's prescription drug plan as an example of how this system could work. It allows consumers to choose among different coverage plans, depending on their needs.
According to the House Budget Committee, chaired by Paul Ryan, costs per beneficiary in 2010 were 22% lower than the Medicare trustees originally projected.
Moon and Wilensky both say that today's Medicare must change.
Is it true that $716 billion will be cut from Medicare under the Affordable Care Act (ACA)?
That all depends on the meaning of the word "cut." The law does slow the rate of Medicare growth by that amount, primarily by trimming reimbursement rates to medical providers like doctors, hospitals, and managed care plans. At the same time, the law encourages innovations that make care more efficient. A newly created institute will make high-level recommendations about which treatments work best for the money. So proponents argue some of the reduced funding will be offset by incentives to create a more efficient system.
Will the health reform law result in less coverage for seniors?
In the short run the ACA provides extra benefits, like shrinking the insurance coverage gap in the Medicare prescription drug plan and covering preventive services like an annual wellness exam and mammograms. What happens over time depends on how successfully the ACA's new cost control mechanisms rein in Medicare's current growth trajectory. Decreasing reimbursements may discourage some doctors from taking Medicare patients.
Will health care costs for seniors go up under the health reform law?
Even with the cost control measures built into the new law and the increased emphasis on prevention, Medicare's history suggests program costs and patient premiums will continue to go up over time. Although the health reform law puts much of the financial burden on providers, beneficiaries will share some part of the expense.