Trudy Lieberman at Columbia Journalism Review explains how Republicans are dressing up the voucher idea this time.
Proposals floating around Congress these days call for privatizing Medicare via vouchers, but they don’t use the term. In general, the proposals would encourage insurance companies to bid against each other, to produce the lowest-cost policies in the private market. Customers would receive a sum of money—aka a voucher— to help defray the cost. Tennessee Sen. Bob Corker introduced his “Dollar for Dollar Act,” and a good chunk of it deals with what he calls structurally transforming Medicare by “keeping fee-for-service Medicare in place, competing side-by-side with private options that seniors can choose instead. Utah Sen. Orin Hatch used the term “competitive bidding” and said allowing health plans “to compete with traditional fee-for-service Medicare” would reduce costs and preserve the quality of care. The plans would allow people to choose between these voucherized plans and traditional Medicare, preserving the notion of choice.Foes of our social insurance programs have gotten savvy enough to realize that they can't privatize Medicare in one fell swoop, as Ryan's original budget (back before "vouchers" were a dirty word) envisioned. So in the next iteration, they employed the idea of "choice," of competition with traditional Medicare. That allows them to chip away at it, pulling away younger, healthier patients who might be able to get good private insurance deals and leaving the older, sicker, more expensive patients in traditional Medicare to sap the program more quickly and make killing it off entirely that much easier.
No matter what they call it, it's still the same idea: put more and more of the burden of paying for health care on seniors, and put that money in the pockets of private insurers.