Is the U.S. ready dive into hard core entitlement reform? Wisconsin Republican Paul Ryan thinks it might be, so he’s floating his proposal to revamp Medicare in his new powerful position as chairman of the House Budget Committee.

Ryan’s idea is to give Medicare recipients a voucher so they can buy an insurance plan of their choice. The amount of the voucher would increase with the inflation rate, but if health care costs rise faster than the overall rate, well then, best of luck in finding affordable coverage.

His plan would exempt current Medicare recipients and those Boomers age 55 and older. People under the age of 54 would be turned loose in the market place, and you can bet that as you go down the age ladder fewer and fewer would receive vouchers that come anywhere close to covering premium costs.

Republicans see openings, though. Historically, the GOP game plan for achieving its goals – and it makes a lot of sense – is to take an issue that polls close and then promote the bejesus out of their position. If they can ultimately poll a bare majority for the plan, they’ve laid the groundwork for success.

And the door of public opinion on Medicare reform is far from being completely closed. Fifty-one percent oppose the voucher system, according to an Associated Press poll, with 35 percent in support.

But look a little deeper at the data, and you find that people born after 1980 support the concept by 47 percent to 41 percent. So, it looks like there is in fact a window of opportunity for major changes to Medicare.

Once the proposal is on the table, and that could happen by summer, the rest comes down to politics. How successful will each side be in reshaping and fine-tuning public opinion? The Democrats have been able to score points by defending both Medicare and Social Security in the past, but these aren’t ordinary times.

Rock-solid public support is not a given. This time, there really IS a debt crisis brewing and something has to be done to control health care costs.

Here’s a place to start, without resorting to the extreme structural changes proposed by Paul Ryan. In a word, the answer is telemedicine. Yeah, I know. Sounds simplistic. But in my view, the potential efficiencies and cost savings that could be achieved through virtual health care are staggering.

There is no reason, for example, why basic patient checkups can’t be conducted over the Internet. We’ve certainly reached the point where blood pressure, glucose monitoring and other tests can be done at home and uploaded to a primary care provider who can then consult with the patient via teleconference.

The technology is there – it just hasn’t been pieced together. Not only will telemedicine save vast amounts of money, it will make health care more satisfying to patients. I can guarantee you no senior likes running out to two or three doctor appointments every week just to have this or that checked.

Right now, most insurance companies won’t cover telemedicine. So if House and Senate members want to address Medicare expenses in a meaningful way, passing legislation requiring insurers to pay for telemedicine is a great place to start. There’s plenty of room for expansion of the idea as time goes on, particularly in Medicare.

It would be great to see Washington discussing innovation rather than the hackneyed “cut” and “don’t cut” arguments you usually see on the House and Senate floor and Cable news channels. But I won’t be holding my breath.

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