I don’t disagree with a thing in either this Jon Walker post or this Jon Walker post. And I’m not about to defend the exchange scheme in the Affordable Care Act. But there are a couple key differences between that and the Ryan plan. First, health care for senior citizens is exponentially more expensive than for everyone else, and so a private system for it will be impossible to administer. You could envision an exchange plan with healthy people in the pool possibly working, but that simply won’t work with seniors. The second difference is that, at least in theory, exchange subsidies in the ACA cap the cost of health insurance at a percentage of income (not care, but insurance). That’s not the case with the Ryan plan. In fact, seniors would be expected to pay a lot more for their coverage over time.

Most future retirees would pay more for health care under a new House Republican budget proposal, according to an analysis by nonpartisan experts for Congress that could be an obstacle to GOP ambitions to tame federal deficits.

The fiscal blueprint would put people now 54 and younger in a different kind of health care program when they retire, unlike the Medicare that their parents and grandparents have known. Instead of coverage for a set of benefits prescribed from Washington, they’d get a federal payment to buy private insurance from a choice of government-regulated plans.

“A typical beneficiary would spend more for health care under the proposal,” the nonpartisan Congressional Budget Office estimated in an analysis released late Tuesday.

The whole CBO report is really damning. The bottom line is that seniors would pay more for less coverage. It’s not a reform plan, it’s a cost-shifting plan. Public debt goes down as private debt goes up. And if the senior can’t afford coverage… tough. Find a friend.

And even with privatizing Medicare, block granting Medicaid and food stamps, and radically pulling government out of the business of supporting the general welfare, the Ryan budget still doesn’t balance for two decades. That’s true for two reasons: one, Ryan doesn’t give a crap about the budget deficit and wants only to cut taxes for the rich, which he accomplishes in this program by making the Bush tax cuts permanent and then decreasing the top marginal tax rate to 25% (which he has to make up by raising taxes on the middle class); and two, he exempts Medicare recipients and near-recipients for nakedly political reasons, because people 55 and over are more Republican. Of course, as the pool shrinks over time, those seniors grandfathered into Medicare will realize they’re getting a raw deal as doctors stop taking them and costs skyrocket because the program loses its bargaining power.

The point is that we as a nation made a decision almost 50 years ago that the elderly, after spending their entire life working to the bone, deserved some dignity in retirement rather than having to live on the street because of health care costs. Ryan would leave the elderly poor – actually all the poor – on their own, and as a society we would all suffer from the indignity of our grandparents dying unnecessarily early from our collective negligence.