In the current Medicare program, you have several choices – you can choose traditional Medicare which leaves about 20 percent of your costs uncovered; buy a supplemental or “gap” plan to fill in those uncovered costs; or sign up for a Medicare Advantage managed care plan. Ryan is not clear about what would happen to the choices of current beneficiaries in ten years when his reforms are implemented.

He proposes to cut 20 percent from the Medicare program, so where would those “savings” come from? Would traditional Medicare survive if sicker members flock to it out of confusion with the new marketplace or mistreatment by private insurers?

And what about the increasing share of cost that would be borne by beneficiaries under the Ryan plan?