The way in which Americans access health care is uniquely different from any other major country. As an immigrant to this country, I was immediately struck by the peculiarities of America’s health care “system.” The simple fact is that for most working-age Americans, health insurance is directly connected to their place of work.

Members of Congress, under pressure from industry lobbyists, are poised to make taxpayers and seniors pay more than they need to pay for durable medical equipment and supplies in the Medicare program.

For years, political deadlock has stymied pressing reforms from health care to taxes to entitlements. Congressman Paul Ryan (R-WI), ranking member of the House Budget Committee, has attempted to break the deadlock, challenging members of both parties to take these serious issues seriously. Leading by example, Ryan has released a collection of bold, comprehensive, and sweeping reforms covering a broad spectrum of issues.

Medicare Advantage is a success and can serve as the first stage of reform, but Congress will have to change the existing payment system and provide a system of premium support, properly adjusted, for each beneficiary. What is needed next is more robust competition for the entire program and parity in the payment to health care options that seniors choose.

Medicare Advantage is a success and can serve as the first stage of reform, but Congress will have to change the existing payment system and provide a system of premium support, properly adjusted, for each beneficiary. What is needed next is more robust competition for the entire program and parity in the payment to health care options that seniors choose.

Medicare is based on the cost of seniors’ health care being borne primarily by younger workers. The demographic reality is there are diminishing numbers of workers per senior. Promises to today’s and future beneficiaries must be kept, but not at the expense of future generations. Building incentives for high quality, efficient care directly into the Medicare payment structure and using the power of personal choice and competition are key reform elements.