Most of the attention surrounding Paul Ryan's budget plan has centered on the change of Medicare to a voucher. Basically, a cash payment that can be used to purchase health insurance.
Critics argue that the value of the vouchers will not be enough to pay for the level of medical services that current beneficiaries enjoy and that this is shifting the risk of escalating costs away from the government and on to seniors. I think it is hard to argue with that description, so the question is:
Do you think senior citizens should be shielded from 100% of the risk of high health care inflation?
I don't know the history of Medicare well enough to say for sure, but I would be surprised if that was the program's original intent. Regardless, if you think the answer to this is yes, you need to start advocating for higher taxes now, and not just on millionaires. Projections have Medicare, Medicaid, Social Security, Defense and debt payments eating up the entire federal budget in the not too distant future.
The marginal tax rates required to keep up with Medicare costs are likely to be politically impossible. That means not only widening the group affected by higher rates, but probably reducing or ending some very popular tax expenditures, like the mortgage interest deduction. Wisconsin's progressive hero Russ Feingold couldn't even withstand contemplating such an idea during his 2010 campaign. This despite the fact that the evidence clearly shows the MID disproportionately helps the wealthy (how's that for progressive?). If Feingold couldn't campaign on a high tax/high services platform, what Democrat can?
For the record, I think using competitive pricing to determine the value of the vouchers has the potential to address the concern about shifting risk to seniors and harness the power of the market.