Now that most of the drama surrounding a possible government shutdown has passed for the moment, eyes are turning back toward that other entitlement issue gaining steam as a potential political policy point among the GOP in the upcoming ’12 primaries for the presidential nomination of that party. At the center of it all is the Budget Cmte Chair Rep Paul Ryan (R-WI) and his plans to slash Medicare and Medicaid appropriations by various means. This blog has touched on committee’s reform plans for Medicaid in a recent post. With respect to Medicare, the specter of privatization raises its head once again. This time, it has nothing to do with Social Security — the failed George W. Bush public policy issue that never made it out of the starting gate five years ago. Ryan’s plan to remake Medicare in that image is becoming more controversial. Arguing that placing this entitlement in the hands of seniors to purchase coverage similar to what a basic FFS Medicare offering would be — would cut federal spending on the program by almost $6T over the next 10 years; Ryan proposes a voucherized system for seniors. The CBO — which the GOP are calling increasingly partisan — estimates that beneficiaries would spending more out of pocket, potentially increasing healthcare costs among those who cannot afford a full array of services in an open market fashion. Ryan wants to apply free market principles to Medicare. I agree this is a controversial issue at this point. But, it seems to more of an issue among GOP candidates jockeying for position as a media-anointed front runner on that side has yet to emerge. Once the presumptive primary candidates trip all over themselves on social boilerplates as a way to differentiate themselves in the early phases of campaigning, the drive to convince Republican voters of their fiscally conservative bonafides will bring this issue to the forefront of the whole entitlement discussion and how it relates to the costs of Medicare reform and healthcare reform overall. Should make for some interesting armchair healthcare politics in the coming months.