I applaud Paul Ryan for having the guts to propose a drastic solution to our long term fiscal problem. That being said, I think his plan misses the mark. People have looked at the case of Medicare Advantage as a proxy for the effect of health care costs when using a voucher system. They've found that costs are not controlled in such circumstances. So there is no reason to think that privatizing medicare would actually slow growth in spending.
Remember: it is not medicare that is the problem, it's the fact that health spending is growing faster than the economy as a whole. If you could bring those two into line, medicare would be fine. The other problem with the Ryan plan is that the idea of privatizing medicare will be very politically toxic which will make it almost a non-starter. Any real solution to our fiscal mess needs to be politically viable.
As I've said before, Obama's ACA addresses the problem of access to health care, but does not reform the way we deliver health care. I'd love to see the Republicans and Obama agree to sit down and work on the ACA to include more cost-control measures. Obama would go along with it, no doubt, because with a bipartisan stamp of approval his bill would be implemented, Americans would get universal coverage, and the system would be sustainable. Republicans should go along with it because that is the only real shot we have to "bend the medicare cost-curve".
Yea, I'm still naive.