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An election which was supposed to be a shoo-in for Republicans in a solid GOP upstate New York district is suddenly very close. Why? Because the citizens of 26th congressional district realize that there is an issue that even the regular, hard-core Republican base voters over 45 are concerned with: Paul Ryan’s Medicare plan.

Readers of this column know I have been all over the fact that I pay an inconceivable amount of money for individual insurance. I am 59 and – even if I am in pretty good health – my age precludes paying a reasonable amount for high-deductible coverage.

Now, Paul Ryan, the youngish budget genius of the Republican Party, has a plan for Medicare.

There are many aspects to his plan, but it includes a voucher system and block grants to the states. Ryan and his protégés have extolled the virtues of competitive systems among states. During last Thursday’s Fox/GOP South Carolina debate, potential candidates were discussing how to save the economy and were pointing to the virtues of this state-by-state competition.

Having spent almost 20 years in the health-care field before moving into media, I have seen “competition” up close. If you want to see real waste in health care then get health-care agencies competing. Charitable hospitals will compete to see who can have the latest and greatest MRI machine or maternity ward. Only states that put in a “certificate of need” for new equipment have tried to stem the process and even that has only been known to work moderately well.

Now, the Ryan proposal wants to issue vouchers and give block grants to the states. Vouchers sound like a great idea. Let people go to whatever health-care insurer they want. The problem is that there is no assurance in the Ryan plan to force the companies to provide insurance at a reasonable rate to everyone. How on earth would Chairman Ryan ensure that us old bats get access to insurance without having to mortgage the house and the family assets?

To add more to this privatization insanity is the idea of block grants. What works in health care is not having 50 systems. What works is streamlining and careful planning, not 50 startups. Block grants to states are often fraught with politics and the changing winds of who is in power. Unlike the federal government, which has had years and years of jobs that are not subject to who is in office, states being smaller are subject to faster changes. Block grants, administered by state legislators could change every few years. Federal systems put in place and refined since the mid-1960s would now be relegated to the states. Is there waste in Medicare? Of course! So, fix the waste and abuse problems on a system-wide basis.

The Republicans, in reacting to “Obamacare” have been the champions of allowing people to purchase health policies across state lines. Why then would they want to have 50 separate systems for Medicare? What if Grandma, who lives in Texas, decides to visit her family in Ohio in the summer and suddenly has a stroke? Which system is going to pay for Grandma? How is Grandma going to be transported back to Texas where they are obligated to pay for her health care?

What if Texas pays for a preventive colonoscopy but Oklahoma doesn’t? What if Sally’s sister offers her address for her Oklahoma relative? Is that fair to Texas? Fifty standards of care?

Why not save Medicare in the way we know we can. Put the money and energy and research into prevention. Make Bill Gates, “The Donald” and others pay more. Let people over 55 buy into Medicare at a reasonable costs so that people hanging on to jobs can leave them and pursue other interests and small-business ideas without fear of becoming sick with no insurance.

Eliminate the drug company’s influence on doctors and in areas such as in mental health, where breathing and herbs can do as well as drugs in treatment of anxiety and PTSD.

Develop more residency training slots and nurse practitioner programs so that there are more health-care professionals to provide care, thereby lowering the costs.

The Ryan plan sounds great at first blush. Like anything else, the devils are in the details. If Mr. Ryan has them, then by all means he should release them.

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