"Yes! It seems to be working pretty good for you, isn't it?" I tried to take the sting out of that, but failed. That was par for the course on our last visit to family near Leesburg, Florida.

She was dumbfounded. She had never thought of Medicare as socialized medicine. She had never thought of denying the uninsured and underinsured health care as immoral. She was unaware that a health care insurance policy for a family of four is $15,000 per year these days. She had no idea what rescission was. She didn't understand that private insurance companies have "death panels". She did, however, have the Kool Aid talking points down pat.

We ended up changing the subject to keep the peace.





Fast forward to today. It was my turn to be dumbfounded. I get a call.

Do you really think they will get rid of Medicare?

I have no idea why I thought rolling my eyes toward the ceiling was going to help. It's not like I've tacked any answers up there. "Well, I don't think you have to worry about yourself just yet, but yes, the Ryan plan pretty much eliminates it for your sons, daughters-in-law and grandchildren. Medicare as you know it will be exchanged for something like a Medicare Food Stamp program. The voucher will pay for as much as it does and when the money runs out we'll have to kick in our own funds to pay for our health care. Pretty much like we do now. The bright spot is that the plan will undergo a major overhaul in the Senate and it also faces a possible veto and has little chance of being enacted as is, but yes, that's what the House passed yesterday."

"But, that isn't right! You've paid into the system for 30 years! The fact that you are missing the cut off by a couple years isn't fair."

I closed my eyes....not that I've got any answers tattooed to the inside of my eyelids either; it's just that I saw this conversation coming last fall. Now that it's here, I'm conflicted about what to say. "I told you so" doesn't usually play well. "I know it isn't fair, but that's what you get when you vote Republican. You get Congress Critters who are hellbent on destroying Social Security and Medicare" would have a similar incendiary result. I don't remember my exact words, but they went along the lines of "Well, elections have consequences and the current Republican majority thinks this is what their supporters want." I don't think she heard what I said, because she vectored off to:

"But, they're saying that Medicare and Social Security is paying out more than they are taking in this year."

Stifling a sigh, "That is true. What I'd like to know is what about the $2.6 trillion surplus they've collected since the 1940's? Are the Republicans saying they are going to default on that loan? Are they saying the United States isn't good for the money they borrow?" My worried mother-in-law didn't like what she was hearing...

"Will the Social Security and Medicare really go broke?"

It's not like we haven't talked about this reality over the last 20 years or so. I took a breath. "You know, if you listen to the Republicans like Paul Ryan, they make it sound like we have to deal with this right now, after all; this is the year that Social security was predicted to have to dip into the trust fund and that fund is predicted to last for 10 years. The thing is, many people have been talking about this problem for years, but most of them forget that there's a $2.6 trillion promissory note attached to the problem and that the recession led to massive unemployment that depressed tax collections over the last 2 years.

It comes down to philosophical differences. The Republicans have always hated both Medicare and Medicaid and want those programs gone. The bottom line is that we don't have to solve the problem now in 2011. We don't have to kick you or anyone else down a flight of stairs in your scooter. The solution can be as simple as removing the cap from contributions. Right now the annual max is around $109k. We could simply remove the cap, but that idea isn't in the building; let alone on the table. We could also ramp up the RAC audits and put some teeth into efficacy treatment guidelines that will prevent wasteful care. We could require HHS to negotiate for better pricing from pharma. We could do a lot of things that would increase the value of our health care and reduce our outlays for it without destroying Medicare as we know it today."

But, Medicare's costs are going up faster than anything? Could they eventually start cutting my benefits?

Ah, now we're getting to it. "Sure, but not right now. Not this round."

We chatted a little longer about Medicare and I reassured her that she will be fine for the time being, but that's the crux of it, isn't it? Once we allow a change in Medicare for those getting on the program in the future, how long will it be before we start tinkering with those already on it? The problem is in finding a solution that we can live with. Ryan's solution is one we'll die with.

Paul Ryan's solution lacks balls. He's still pandering to the very special interests that have led to a health care system that costs twice as much and performs half as well as other industrialized countries. Ryan wants the government off the hook for the costs, but his plan doesn't "do" anything to control costs. His plan raises the debt ceiling and doesn't save much of anything for years. He goes back to the same ole solution of forcing people into self-rationing, self-denial. It's a killer solution. Elegant in it's simplicity and expedience. Brutal and ineffective in reality.

We don't need a simple solution that panders to the special interests that have led to this mess. We don't need a bold solution that sets the clock back to 1964 like the Ryan plan does. We need a bold solution that curtails the excesses of greedy corporate health care. That means we take a bold step forward and double down on ACA's MLR requirements. The bold plan I'm looking for mandates HHS to negotiate for better pricing for everyone and move forward with efficacy based standards of care. Why not boldly opening up the exchanges ahead of schedule? How about something really bold and open up Tricare to anyone who wants in? We saw what comes of half measures in health care reform. We already know what happens when seniors and people with low incomes try to get health insurance on the private market - they die. That's how Medicare and Medicaid came into being in the first place. I guess Paul Ryan thinks no one remembers how poorly his plan (the "free" market) worked for seniors pre-1965. At the very least he's hoping enough people don't care if people can't afford their health care and are willing to go along with his foolish plan.

America deserves better.