“The first step is to move the two programs [Medicare and Medicaid] away from their current unsustainable defined-benefit entitlement model to a fiscally sound defined-contribution model,” the draft platform reads. “While retaining the option of traditional Medicare in competition with private plans, we call for a transition to a premium-support model for Medicare, with an income-adjusted contribution toward a health plan of the enrollee’s choice. This model will include private health insurance plans that provide catastrophic protection, to ensure the continuation of doctor-patient relationships.”In simple terms as applied to Medicare, defined benefits means that the government-run program covers medical bills of its patients, paid directly to the provider. You get sick, your care is paid for. What the rest of us who have private health insurance have is defined contribution, what they are calling "premium support." The government would choose a fixed amount, means-tested of course, that they'd give to Medicare recipients to go buy insurance on the open market. One amount, depending on your income and assets that you apply toward a private insurance plan in the open market in which insurance companies were once again unfettered in discriminating and charging outrageous prices, because if Republicans were in charge to enact this plan, Obamacare would also be repealed.
The esoteric language gets to the heart of the change that ends the basic structure of Medicare. Since its inception in 1965, Medicare has been a government-run insurance program that directly pays medical bills for the elderly per their needs (i.e. “defined benefit”). Republicans want to turn it into a partially privatized system that pays seniors a fixed amount to buy their own health insurance (i.e. “defined contribution”).
Your health care costs more than the plan you could get with your voucher? Sorry, that's on you. Make no mistake, that's the end of the promise of Medicare.