So, people are always asking what I would do about health care costs. One answer is that I would do all the things that are in the Affordable Care Act, and more.

But if you want a really radical proposal — but one that, unlike privatization, actually has strong evidence on its side — why not add a true public option to Medicare?

What do I mean by that? I mean creating a network of hospitals and clinics actually run by the government — a civilian VA, as Phillip Longman puts it — and giving Medicare recipients the option of using that system.

The public option would be required to spend significantly less per risk-adjusted recipient than traditional Medicare. And if it couldn’t provide care that seniors wanted given that restricted budget, it would have no takers and would close.

But the actual experience of the VA suggests, of course, that such a system would have major cost advantages — and that it could be used to achieve major cost savings.

Look, I know this isn’t politically feasible, at least not now. But neither is Ryan’s system of inadequate vouchers. And this one has the virtue of being something that experience suggests would actually work if we could overcome the political hurdles.

I’m sure the trolls will be screaming as soon as this is posted. But notice that neither I nor Longman are suggesting that anyone be forced into such a system. It would have to win patients in a fair competition with both traditional Medicare and Medicare Advantage.

And what would terrify the right, of course, is the likelihood that genuine socialized medicine would actually win that competition.