That calculation is at the center of Rep. Paul Ryan’s proposal to replace Medicare with a voucher system, but only for those reaching retirement age in a decade.

Ryan and the Republicans have sought to dilute the political toxicity of their radical plan by grandfathering in people who are currently within the Medicare system and those who are now 55 or older.

Senior citizens vote in higher percentages than other demographic groups and thus could overturn the GOP’s House majority if they felt threatened by the transformation of Medicare.

So, Ryan and other advocates of his plan have stressed to seniors at town hall meetings that they will continue to get the system’s guaranteed benefits, an explanation that has drawn applause from some of the over-55 set but has prompted questions from others.

For instance, in Elkhorn, Wisconsin, 64-year-old Clarence Cammers hesitantly asked Ryan a question that got to the heart of the matter. After describing himself as a disabled veteran living on Social Security, Cammers said he could stand some cutbacks for himself; that wasn’t his concern.

“I will be fine,” Cammers said. “I guess what I’m saying is, what are all these changes going to mean for my son?”

Cammers was noting the hard truth that it would be Americans under 55 who would face Ryan’s scheme of replacing Medicare with government vouchers (or “premium support” as Ryan insists on calling it). That prospect is certain to be a grim one.

Though Ryan has inserted some pleasant language promising that the sick will get adequate care, the reality is sure to be much different, essentially requiring the elderly – many with preexisting conditions – to negotiate with insurance companies that don’t want them and their illnesses.

As the Brookings Institute’s Henry Aaron explained to the Washington Post’s Ezra Klein, “We’ve all heard about the great proportion of health services used by people in the last year of life. That means if you’re an insurer, you want desperately to not enroll those people.

“That means you need to try every marketing device you can not to get stuck with the sickies.”

Since Ryan’s plan also repeals last year’s Affordable Care Act, known as “Obamacare,” with its prohibitions against insurance companies excluding your preexisting conditions, there can be little doubt that industry sharpies would do all they can to limit their liability for medical treatments.

Finding the ‘Savings’

Indeed, the dramatic savings that Ryan projects once his “premium support” system takes effect would be derived from the shortfalls between the vouchers and the cost of medical care for seniors, in other words, the money would be taken out of the pockets of the elderly or be saved by them skipping treatments that they otherwise would receive.

Even for current and near-term Medicare beneficiaries, the Republican plan would have that effect for people needing lots of prescription drugs. The Ryan plan would repeal the subsidy for seniors facing the “doughnut hole” gap in drug benefits.

But the hardest impact of the Ryan plan would hit those turning 65 in 2022 and later. Though Ryan’s sketchy proposal lacks many of the specifics needed to fully evaluate its effects, a New York Times editorial noted, “there is little doubt that the Republican proposal would sharply reduce federal spending on Medicare by capping what the government would pay at very low levels. …

“The Congressional Budget Office estimates that by 2022 new enrollees would have to pay at least $6,400 more out of pocket to buy coverage comparable to traditional Medicare. Huge numbers of Medicare beneficiaries live on modest incomes and are already struggling to pay medical bills that Medicare does not fully cover.

“We should not force them into private health plans that would charge them a lot more or provide much skimpier benefits.”

In the years beyond 2022, the gap between Ryan’s voucher and the actual cost of medical care would widen even more because he attaches it to a slower measure of inflation than the rise in medical costs.

“We’re looking at linking to an index that grows less rapidly than health-care costs by three to four percentage points a year,” said Aaron of the Brookings Institute. “Piled up over 10 years, and that’s a huge erosion of coverage.”

So, the obvious result of Ryan’s plan would be that many Americans who are now under 55 would die prematurely because they would have to skip treatments or because they would be forced deeper into poverty trying to meet the premium demands of the insurance industry.

Which gets us back to Clarence Cammers’s question: “what are all these changes going to mean for my son?”

The Republican assumption about the “greedy geezers” is that they don’t share this concern; that all they care about is their own welfare; that they want to live as long and as healthy a life as possible but don’t feel the same about their children and grandchildren.

More startling, the Republicans are betting that these over-55 Americans would prefer lowering  the top tax rates even further for millionaires and billionaires (to 25 percent from today’s historically low 35 percent) than seeing their progeny enjoy a full and fulfilling life.

Because of those new tax cuts (and maintaining Persident George W. Bush’s other tax breaks), Ryan’s plan doesn’t even foresee a balanced budget for nearly three decades -- and only then because Medicare costs would have been shifted onto the next generations.

In making these various assumptions, the GOP’s political calculus remains something of a mystery – and certainly a risk.

In 2010, the Republicans did very well in the congressional races partly by rallying senior citizens to vote against the Democrats and the impression that “Obamacare” would trim some spending from Medicare. That is apparently why this age group was excluded from the dramatic changes in Ryan’s plan, to lock them in as Republican voters in 2012.

But that GOP calculation suggests the Republicans really do believe that today’s senior citizens and those reaching 65 in the next decade represent the most selfish generations in American history, caring only for their own wellbeing and not for their children.

Another possibility is that the Republicans have concluded that their advantage in ideological media and in corporate campaign cash insulates them from any backlash by Americans who otherwise might begin to recognize that the next phase of Reaganism is a program to kill them off early.

Many Americans do feel a sense of helplessness – even fatalism – with their lives dominated by powerful forces beyond any control.

The Right has had success, too, in diverting this fear and anger – via Fox News and talk radio – into a fury over the African-American in the White House, whose legitimacy is challenged under the cover of racially tinged questions about the location of his birth.

But other Americans aren't racists; they simply despair over their powerlessness -- and they have good reason.

For instance, though polls show overwhelming numbers favoring raising taxes on the rich, that is the one option that Official Washington considers unthinkable. Far more admiring news coverage has been devoted to Ryan’s “bold,” “courageous” and “serious” plan to destroy Medicare than to progressive proposals to hike taxes on the well-to-do.

The Republicans seem to be counting on a mix of these factors to ensure them electoral success in 2012 and beyond: shifting blame onto Barack Obama, encouraging defeatism among the masses, and trusting the selfishness of today’s elderly, the GOP's "greedy geezers."

It is a strategy of breathtaking cynicism.

[For more on these topics, see Robert Parry’s Secrecy & Privilege and Neck Deep, now available in a two-book set for the discount price of only $19. For details, click here.]

Robert Parry broke many of the Iran-Contra stories in the 1980s for the Associated Press and Newsweek. His latest book, Neck Deep: The Disastrous Presidency of George W. Bush, was written with two of his sons, Sam and Nat, and can be ordered at neckdeepbook.com. His two previous books, Secrecy & Privilege: The Rise of the Bush Dynasty from Watergate to Iraq and Lost History: Contras, Cocaine, the Press & 'Project Truth' are also available there.

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