In a surprise move, Paul Ryan found a Democratic partner to propose a new Medicare plan that does not fully privatize it, but instead keeps fee-for-service Medicare as an option alongside a premium support plan. This is the same proposal that the front-running Republican Presidential candidates have made.

We now have additional proof that raising the Medicare eligibility age would be a ridiculous program on all levels. It would not only cause needless anxiety and suffering to 65 and 66 year-olds, it would not achieve its alleged goal of saving money. In fact, it would increase costs almost everywhere in the health care system.

The somewhat good news here is that the seamless coverage regulations proposed by the Department of Health and Human Services have been widely praised. They are designed to do all those calculations backstage, so that the consumer need only to visit one portal to figure out which program they slot into. And it sets up a process for annual eligibility review, so individuals are not responsible for flagging their increase in income. Individuals who end up making too much for Medicaid will get to keep their coverage until they get a new plan on the exchange.

The somewhat bad news is that because of the new rules, the tax credits just got less affordable.

Some Democrats took a look at the automatic cuts and thought they were tough, but probably better than a bad agreement that would slash the safety net and in all likelihood do little on revenues. After all, Medicaid, Social Security and programs for the poor were protected in the agreement, and Medicare would only see a provider haircut. And half of the automatic cuts would hit the Pentagon. What’s the forcing mechanism for the left?

Turns out, that would be the exchange subsidies from the Affordable Care Act:

The real concern should be to make sure Americans don’t need to worry about whether or not they can afford to get sick; in that department, even its supporters admit the Affordable Care Act is lacking. We are going to make people buy insurance they can’t afford to use.

The whole CBO report is really damning. The bottom line is that seniors would pay more for less coverage. It’s not a reform plan, it’s a cost-shifting plan. Public debt goes down as private debt goes up. And if the senior can’t afford coverage. . . tough.

The Senate has passed this bill a half-dozen times, sometimes attached to other bills, and more recently as a standalone. The pay-for that the Senate uses differs from the House’s. But instead of a House-Senate conference, the Senate, unbelievably, will vote on the House bill today.

Republicans are about to unveil a budget that privatizes Medicare. It ends enrollment to the single-payer program entirely within 10 years, and everybody else who reaches the age of 65 gets a voucher they can use to purchase health insurance on the private market. The voucher’s value does not increase over time even as health insurance rates rise, so it will cover less and less of the cost of insurance. These Medicare-certified private plans, ironically, would live on an exchange, much like the private market in the Affordable Care Act. But two things here: one, the Medicare certification would have no standards like essential benefits, annual limits and minimum guarantees, unlike the vision for insurance exchanges in the ACA; and two, this would cost more money overall, since Medicare is much cheaper than private insurance, similar to all single-payer health care systems. The burden of that additional cost would fall on the individual, as the voucher would stretch less over time.

If you think Democrats are incapable of coordination, let me forward you my email inbox for today. In it, you will find no less than 18 Democratic members of Congress sending the exact same message – in list-building petitions and recaps of multiple press conferences and advisories of additional press conferences and guidance for reporters and press aides – about attacks on women’s health by the House GOP.

Democrats may be trying to outflank Republicans on health care, but how will the Republicans counteract this? It’s clear they will attempt to take apart the law piece by piece if a full repeal fails as expected. But the six ideas in this Kaiser Health News piece do not include the biggest threat to the coverage expansions in the law, the largely state-based effort to circumvent Medicaid rules.