Here's the real argument young and middle-aged people need to hear, and the real reason why the "more skin in the game" argument can never work for seniors or other vulnerable populations, including them when they reach that age. Seniors and the poor account for over half of health care spending. Within those groups, 5 percent of the population accounts for 50 percent of health care costs; and 20 percent of the population accounts for about 80 percent. These costs come for the most part at times when economic incentives have no influence at all on medical decision-making: in medical crises; in treating chronic conditions; and, for most Medicare patients, in the last six months of life. That's why a voucher program for Medicare, which will shift an increasing share of those inevitable costs onto the elderly themselves, can fairly be categorized as a 100 percent estate tax or death tax. People under 55 need to know that if the plan crafted by Rep. Paul Ryan were passed, most of them will never have a cent to leave to their children. It will all go to the health care industry to support the American way of dying.

In an excellent column about the House Republicans' plan to kill Medicare, James Fallows quotes Merrill Goozner, who gets down to the crux of the issue

Which is why the Republican plan creates the real death panel, along with being a "100 percent estate tax or death tax." But it goes beyond that. Not only could parents use up every cent of their estate, leaving nothing for their children, this plan could very well create even more medical bankruptcies when children are forced to try to pay for the critical care for their parents or watch them go without.

That doesn't necessarily apply just to the end-of-life medical care, when you consider whether private insurers would take on seniors.

Unlike the Affordable Care Act, which mandated that millions of young and healthy Americans purchase insurance with government subsidies, the Paul Ryan plan would instead bring the oldest, sickest, and least profitable demographic to the table. And with the CBO projecting that the average senior would be on the hook for over two-thirds of their health care costs within just 10 years of the plan's adoption -- a proportion that is projected to worsen in the long run --- the government subsidies backing them up may not bring in enough profitable customers to make things worthwhile. "If reimbursement rates are too low to provide basic benefits, they'll tell the government, 'You do it,'" one insurance lobbyist told TPM. "I don't think they can require they lose money, they'd just pull out." .... Insurers have successfully demanded funding hikes to other programs even as their clients faced far less dire circumstances than projected under Ryan's plan, raising the question of whether Ryan's savings would ever come to pass. Take Medicare+Choice, a private exchange for seniors created in 1997 by the GOP Congress. Under the program, the government paid the equivalent it would use to fund Medicare coverage to reimburse private HMOs instead under the theory that the free market would operate more efficiently and produce better results. Instead, insurers found they were unable to sustain a profit and began pulling out en masse. In 2000, more than 900,000 patients were dropped as HMOs deserted the program, citing inadequate federal backing and a lack of a prescription drug benefit.

This isn't a "serious" plan, it's a cruel joke. It also won't reduce the nation's price tag for medical care at all, it'll just shift it to the people who can least afford it.