Perspective:

A number of commissions and expert groups have suggested that the United States is on an unsustainable fiscal path. Medicare is at the center of our fiscal crunch, with outlays that have grown about twice as fast as the economy over the past decade. On December 15, 2011, Senator Ron Wyden (D-OR) and Representative Paul Ryan (R-WI) released a Medicare reform proposal where Medicare would be converted from a defined-benefit to a defined-contribution program. Given the serious fiscal problems facing this country, slowing the growth of Medicare spending is no longer optional. The Wyden–Ryan proposal outlines a strategy for Medicare reform that uses market forces to control costs and appears to provide a real alternative to the top-down controls favored in the Affordable Care Act. Paul Ryan and Ron Wyden may have defined the policy parameters that could be the cornerstone for real Medicare reform in 2013.