By Geoff Colvin

Fortune

Nov. 2, 2012

Long term, Medicare is the largest element of our largest problem, the exploding federal debt. Can we talk about that? Apparently not. The 112th Congress couldn't get anywhere near it. When President Obama proposed reducing future Medicare spending by $700 billion, Republicans suggested he was personally tormenting oldsters. When Paul Ryan co-sponsored a plan to control Medicare finances, Democrats ran TV ads in Florida saying he wanted to end Medicare as we know it.

Let's get something straight: Medicare as we know it is going to end, with or without Obama or Ryan or anyone else. The question is what it will become. The wrongly labeled Ryan plan, previously known as premium support, is the most promising bipartisan proposal. Its latest version is actually the Wyden-Ryan plan, since it's co-sponsored by Sen. Ron Wyden, a liberal Democrat from Oregon. It would let seniors stay with Medicare or buy medical insurance in the open market with federally funded vouchers. Premium support was first outlined by two Democratic economists at the Brookings Institution. It was supported in 2010 by the Bipartisan Policy Center's Debt Reduction Task Force, chaired by former Republican Sen. Pete Domenici and former Clinton OMB chief Alice Rivlin. It's as solidly centrist a proposal as you'll hear.

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Economic Policy Project