Representative Paul Ryan, the Republican representative from Wisconsin just released his anti-budget for the U.S. today, which Ezra Klein from the Washington Post deconstructs. Ezra is well worth reading. However, the upshot is that Ryan would balance the budget by cutting Medicare. Not only that, but he would cut Medicaid.
He would actually privatize those two programs, plus privatize Social Security. However, that is actually besides the point. Ryan's proposal would issue Medicare and Medicaid beneficiaries a health insurance voucher. However, that voucher's value would grow by the average of the Consumer Price Index and the medical component of the CPI. The CPI is the U.S.' primary measure of inflation. The CPI-medical measures medical and health insurance costs; in general, healthcare costs have been growing about 2% faster than GDP, which has itself been growing a bit faster than inflation. Thus, in the long run, Ryan would balance the budget by cutting Medicare. And Medicaid.
In the absence of other measures in the health reform bills, the private insurance companies would most likely respond by increasing co-pays and deductibles. If Medicare and Medicaid were to remain government programs, this is also the most likely thing they would do. In contrast, the Democratic health reform proposals would have set up the infrastructure for these programs to ration services by their comparative effectiveness and would not have cut the benefits promised to beneficiaries in the statutes. Ryan condemned comparative effectiveness research, and in fact I believe his anti-budget would not implement such research. Thus, the foremost avenue to contain costs will be to increase cost-sharing - which will put many effective treatments out of the reach of low- and moderate-income people.