The changing of Medicare into a voucher program was something that Romney and Ryan want to do. The problem is that, if the value of the vouchers fails to keep up with rising costs, the elderly will be forced to pay more of the cost of their own care. Worse, the Medicare service has been controlling costs. If this “business” was passed over to private insurers, it would add to inflationary pressures and all costs would rise. This is a nonsense.

The only real option for a sustainable future is to positively control costs. This means forcing hospitals and doctors to switch to preventive medicine and, if people do fall ill, using the most cost-effective treatments where there’s evidence of good outcomes. At present, hospitals do not need to limit the range of tests they perform nor are they limited in the treatments they can use. This means bills are inflated as hospitals maximize their profits without actually delivering the best value for money to the patients.

Sadly, this is also a major defect in the President’s confirmation that he will continue with the Affordable Care Act as it is. With costs rising fast, health insurance quotes will rise no matter whether purchased directly or through one of the new exchanges. Only when costs are controlled will insurance be affordable. It may never be possible to get back to cheap health insurance unless government provides subsidies. That would be redistribution and so unacceptable to many voters.