Private health insurance exchanges, like those created by the Affordable Care Act or in Medicare Advantage, have historically failed to control costs. Part of the reason is the basic economic issue of individuals lacking real market power and actually choosing the “best” insurance option, which is extremely complicated. Another problem is lobbying related. Whenever you needlessly create private middlemen you also create another layer of lobbyists.

While we may not know whether David Brooks’ try out as a Romney speechwriter was successful, he clearly is doing his best for the campaign. Today he pushes the idea that a voucher system is the only way to contain Medicare costs. This requires ignoring an awful lot of evidence, but that is an exercise at which David Brooks excels.

The substance of the Medicare debate in the 2012 election is completely at odds with the realities. The Romney campaign hammers away at the $716 billion in “Medicare cuts” imposed by the Affordable Care Act, designed to blunt a traditional Democratic advantage on the topic, as it did in 2010. So far this has worked; the last two national polls show the Romney-Ryan ticket aheadof Obama-Biden on the subject of Medicare.

Robert Samuelson devotes his column today to misrepresenting a new article in the Journal of the American Medical Association, claiming that it shows the Ryan-Romney Medicare plan would save money. In fact, the article compares costs of Medicare Advantage plans with the current traditional Medicare plan. It notes that in many cases the former are lower, however it does not attribute the savings to the more efficient delivery of care. It notes that lower costs may be due to cherry picking healthier patients, which has been the finding of other research

Mitt Romney and Paul Ryan kept getting tripped up in their attacks on Barack Obama’s “$716 billion in Medicare cuts” by the inconvenient fact that Ryan included the same cuts in his budget. So after a fruitless week, Romney and Ryan came up with a new plan: to explicitly disavow those Medicare cuts.

Sen. Ron Wyden doesn’t appear on Sunday shows much and he comes from a Western state, so he’s typically an un-politician among the Beltway elite. But he drafted a white paper with Ryan about a potential premium support program for Medicare, and so he has been name-checked by the GOP Presidential ticket at every opportunity over the past week to explain the differences.

Paul Ryan spent his first day as a Vice Presidential candidate watching his counterpart on the ticket disavow a plan he spent years generating.

Mitt Romney turned 65 today, and he celebrated by putting out a misleading memo about Medicare that claims President Obama’s policies, rather than the GOP’s, would end Medicare as we know it, because it will be bankrupt. Actually, the trend of Medicare costs is falling, relative to private insurance, and the cost control board adopted in the ACA hasn’t even started yet, because the GOP won’t approve any board nominees.

Now that Klein isn’t trying to defend Democrats and President Obama’s poorly designed and corrupt health care law he has dramatically changed his tune.

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.