It seems to me that the most important feature of the Ryan proposal is that it introduces an incentive for health care consumers at both the personal and state level to consider the costs of their health care choices.
It is clear that some health care management systems work not only better but also more cheaply. I have seen several lists of 10 around the country. If the input from the government were limited, and choices were made more free, I would argue that the rate of cost increase would decline, as consumers (and states) made more careful choices.
Right now, it feels too much like the payments come out of someone else's pocket.
There is one vehicle that has proven singularly effective at decreasing cost while improving quality over the years. It is markets.
In fact the only industries where cost is rising are government controlled; education, health care are good examples.
A proposal to 'fix' health care is effective if it is a politically acceptable first step that can easily evolve into putting the consumer back in charge of spending and the market back in charge of health delivery while allowing at least some of the benefits of markets to work on the cost issue.
After 2022, why not have all retired government employees, including members of Congress, covered by the Ryan proposals?
If people were allowed to keep their private insurance as their primary when they reach Medicare eligibility age rather than being forced to use it as their primary, more people would steer clear of Medicare and the system would save an great deal of money. I for one would not mind keeping and paying for my own private insurance rather than having to 'depend' on a so-called 'entitlement' that I do not want. If we 'like our health insurance plan, we should be able to keep it'.
Incresing copayments and deductibles should be on an income based rating rather than one rate for all. Above a certain level these expenses could be tax dedcutible. In general, deductibles and copayments decrease utilization. There is too much hysteria and too little real understanding of what is going on by all. I thought that Obama had a real grip in the details and rationale of the Health Care reform when he met with the leaders. I am confident that he will do that again.