Can the Competition Fairy control healthcare costs?

As I've explored in the last three posts, the Medicare reform plan in Ryan's 2013 budget blurs Democratic attack lines because it looks very much like an Affordable Care Act for seniors (who, er, already have affordable care) while staking an at least ostensibly credible claim to preserve the Medicare guarantee.

The simplest counterargument was just voiced by a Florida voter to Washington Post reporter Felicia Sonmez: if it ain't broke, don't fix it. The counterargument is that Medicare is broken insofar as its cost to taxpayers has wildly outrun inflation and threatens to bankrupt the federal government.  The debate boils down to the best means to control costs while preserving the Medicare guarantee.

How Ryan duped Wyden, cont.

In my last post, I noted that

1. Senator Ron Wyden, by partnering with Paul Ryan last December in a proposal to convert Medicare to a premium-support program, seriously blurred Democrats' line of attack on Ryan/Romney Medicare reform proposals.
2. Wyden himself is having difficulty articulating the differences between that joint proposal and the Medicare reform plan included in Ryan's 2013 budget ("Ryan 2013").
3. Those differences are real, pertaining to the ways in which costs are controlled and the degree to which increased costs are passed on to seniors.

The key differences are that 1) Wyden-Ryan caps overall Medicare cost growth at GDP +1%, vs. GDP +.5% under Ryan 2013; 2) Wyden-Ryan does not abolish the ACA's Independent Payment Advisory Board, which is mandated to furnish Congress with proposals to keep costs under the cap, mainly by reducing payments to providers in various ways; and 3) Wyden-Ryan caps seniors' yearly  out-of-pocket costs while Ryan 2013 does not.

That comparison was based on a report by Kaiser Family Foundation.  I have since compared the texts of the Wyden-Ryan proposal and the Medicare reform section of Ryan's 2013 budget.  The latter comparison shows that while the differences inferred by Kaiser are real, the earlier report -- surely at Ryan's impetus -- fudges the key distinction, which is whether cost increases in excess of yearly targets can be passed on to seniors. In fact, while Wyden-Ryan emphasizes controls on payments to providers as a means to keep costs below its GDP +1% cap, it leaves the door open to increases in premiums for higher income seniors as a way to cover cost increases in excess of the cap.  Moreover, while Wyden-Ryan does not demonize the Independent Payment Advisory Board (as Ryan 2013 does at length), it does not mention IPAB at all -- and dances around IPAB's function when laying out the means of keeping costs under the cap. Wyden-Ryan also takes one Ryanesque slap at IPAB-in-absence, listing as one the authors' principles,  "Build a strengthened program around the needs of patients, not bureaucrats" (p.8 )