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Obama vs. Paul Ryan: five ways their debt plans differ


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Howard Gage, a Medicare recipient who lives in Rep. Paul Ryan's congressional district, talks about Ryan's 'Path to Prosperity' budget on April 6.
Andy Manis/AP
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5. Medicare

The Republican plan pushed by Ryan emphasizes reducing the growth of Medicare spending for the future, while keeping current benefit levels for people in or near retirement. Longer-term, the program would evolve into a "premium-support" system in which the government would pay for a chunk of insurance premiums.

The GOP blueprint says this is not a voucher program, but it would cap federal liabilities in a similar way. Currently, the Ryan plan says, "the open-ended, blank-check nature of the Medicare subsidy drives health-care inflation at an astonishing pace."

Critics say the Ryan plan shifts costs away from the federal government, but wouldn't reduce health-care costs overall.

The nonpartisan Congressional Budget Office, while not voicing an opinion on the Ryan plan, estimates that "beneficiaries participating in the new premium support program would bear a much larger share of their health-care costs than they would under the traditional program."

Obama said in his speech that the Republican plan would push up a senior's healthcare costs by $6,000 or more a year. "Put simply, it ends Medicare as we know it," he claimed.

The Republican blueprint estimates its savings on Medicare at $389 billion over the decade ending in 2022.

Obama says his new plan would save $200 billion over 10 years by squeezing more costs out of Medicare, through better bargaining for prescription drugs, and tapping an advisory board of physicians and health-care consumers to revise the payment systems for doctors and hospitals. The White House fact sheet calls for "holding Medicare cost growth per beneficiary to GDP per capita plus 0.5 percent beginning in 2018, through strengthening the Independent Payment Advisory Board" that was set up in Obama's health-care reform act.


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