The CBO estimates that money coming in to support Medicare, the Medicare payroll tax, will not be able to support the benefits being paid out in future years, especially as the baby boom ages and more and more reach eligibility at age 65.

What’s becoming more clear is that Medicare, as currently structured, is a very risky insurance business. That’s because it insures the people who are at most risk for getting sick and needing medical care (those 65 an over) and has an income or “premium” stream that seems limited by the same demographic trends — fewer people paying taxes.

It’s still basically a fee-for-service medical system that rewards the number of doctor visits or medical procedures.

Rep. Paul Ryan, R-Wis., is described by many as having controversial plans for a whole series of radical changes called Ryan’s Roadmap. Among other things, he proposes the government get out of the Medicare business and give those needing health insurance vouchers to buy private insurance.

It may be a radical idea, politically unfeasible, and scary, but it also is an idea that sheds light on the overall problem and what drastic solutions might be needed.

Ryan’s plan would keep Medicare as is until 2021, though higher earning people would probably pay more in premiums — a rare higher tax idea coming from a Republican, but one that may be, again, very realistic.

The voucher idea would give people their own money to buy insurance in the private marketplace, thereby creating an easier way to cap the government’s costs. Costs would be tied to how much members of Congress want to pay out in vouchers to taxpayers versus the current system that has Medicare paying higher and higher medical costs without much control.

Ryan is already floating the idea that people under 55 now would probably not even qualify for the voucher until they were 69.5 years old.

Ryan contends his plan would encourage consumer choice, savings and efficiencies in health care. That may be, but the CBO did estimate people would pay more for the same benefits they’re getting today.

Ryan’s ideas may not be readily supported by Democrats or Republicans just yet, but the issues he raises should be faced much sooner than later.

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