On the Third Hand: Paul Ryan

The question is: If our economy doesn't somehow get to be much more productive, and the health care system is not all that terribly much more productive, and huge advances in population health status do not occur, how exactly do we pay to put all of those medical chickens in every health care pot?

Mitt Romney's running mate, Rep. Paul Ryan, R-Wis., has dared to suggest that we ought to try to control Medicare spending by shifting to a system in which we make more use of a kind of expanded Medicare Advantage program along with government-funded medical savings accounts that the poor could use to handle the monthly premiums, deductibles and other costs associated with buying Medicare Advantage coverage.

The idea is that the medical savings accounts would grow, but they'd probably grow more slowly than the cost of the subsidies we now use to help low-income Medicare enrollees. The idea is that doctors, hospitals and health plans would have to get real and start respecting the idea that many Medicare coverage buyers' resources were limited.

Paul Krugman, a Democratic economist, and others have argued that Ryan's budget ideas are unrealistic and have suggested that making Ryan the Republican vice presidential candidate will hurt Romney's chances.

Some say it looks as if Romney is avoiding letting Ryan talk about his thoughts on Medicare.

On the one hand, I have no idea whether Ryan's proposal will work. Quite possibly not. There could well be better ways to make sure retirees have good, affordable health care without bankrupting the country.

On the other hand, I think it's a little scary that our society regards talking seriously about one of the biggest, most important risks facing the country as a suicidal act. What can we do to make talking openly about tough fiscal problems a political plus, rather than an act of political lunacy?

On the third hand, it seems as if the presidential vote in the electoral college likely will be decided by about 100,000 eccentric voters who live in a few swing states.

Maybe one of the rich super PACs that's bored with running hate commercials could instead hire a travel agency to rent a bunch of buses and airplanes, get all of those swing voters out of their caves and bombshelters and into a stadium, treat them to a nice show, and then have them decide what they want to do about Medicare. Once they hand down their decision, Obama and Romney can simply include the results in their campaign platforms and we can move on to discussing more important topics, such as the tax deductibility of Olympic gold medals.