There are two very simple, straight forward things you can do with Medicare if you want to make a big reduction in the deficit: you can either destroy Medicare, or vastly expand it.

Rep. Paul Ryan (R-WI) has stepped forward for the Republican Party to endorse the “destroy Medicare” solution as the best way to reduce the deficit. After all, treating the medical needs of the elderly is very expensive. If we just let old people die when they can’t afford to pay the doctors anymore, we eliminate one of the government’s biggest expenses.

This is the unspoken principle behind Ryan’s plan to reduce the deficit, though it executes it in a slow and subtle way. The GOP’s “Path to Prosperity” would privatize Medicare and give older Americans vouchers to buy private insurance, but these vouchers wouldn’t increase in value at the same rate as the cost of insurance. If the voucher isn’t big enough to cover the cost of care, American seniors are out of luck or out of pocket, and the government saves the money it would have “wasted” on having Medicare pay to treat them.

Progressives have a real plan to reduce the deficit: expand Medicare

Alternately, since Medicare is dramatically more cost effective than private health insurance, government could significantly reduce the deficit by expanding this proven program. Just allowing people in the new health care reform exchanges to buy into a Medicare-run insurance plan would save over a $100 billion. In addition, given that health insurance is such a big expense for businesses, allowing the private sector to buy Medicare instead of private insurance would result in higher wages, more employees hired, and/or larger profits. All of which would generate substantial tax revenue for the government.

If the Washington took expanding Medicare one step further and turned it into a real, working, single-payer system, like that available in much of the first world, it could reduce costs so much it would effectively eliminate our entire deficit problem.

That’s a political and policy fight worth having

If it ever came to a battle between plans to kill or expand Medicare, it would be a political bloodbath. On one side, Republican saying the best way to reduce the deficit is to destroy the popular Medicare program, and, on the other side, Democrats making the unequivocal counter argument that the best way to reduce the deficit is to let more people have access to Medicare.

Sadly after watching how terribly Democrats messed up health care reform and the public option debate, I doubt America will get this dream showdown–despite Ryan offering it to Democrats on a silver platter.