It depends who you are talking to what will be achieved by Privatizing Ryan's Roadmap to Ruin budget plan should it be enacted. Most people either come down on the side of "it ends Medicare" or "it ends Medicare as we know it," while the Randians like Ryan insist on pretending that it "saves Medicare (okay, something we will call Medicare) for future generations."

Those in the last group are engaging in that age-old-and-time-tested political tactic that we call "lying" when they make that claim. They may call whatever private-insurance apostasy that they want to foist on those of us under 55 "Medicare" but it will look as much like the Medicare our parents know and love as a McNugget looks like a chicken.

Medicare has been wildly popular and extremely effective at delivering healthcare to America's elderly and disabled people for nearly fifty years, and as a result of that, it has been in the crosshairs of republicans and other assorted miscreants and privatizers for it's entire existence.

It was Rahm Emanuel who said "never let a crisis go to waste" and immediately he got hammered by republicans and their mouthpieces, but they were only protesting because they wanted to deflect attention from their own pioneering work in that same field of endeavor. It was just short of brilliant the way they ran up the deficit and depleted the nation's coffers when they were in power, making it possible for them now to scream, wail, gnash their teeth and rend the cloth from their breast as they decry the deficit and insist that "we're broke!" and all the safety net programs have to be gutted, if not outright shut down, otherwise the republic is doomed.

Credit where credit is due: When they get rolling, they can be far more melodramatic than any 8th-grade girl's-school production of Romeo and Juliette, and just hope that no one fact-checks them.

For a plan that they insist is necessary because the current system is headed for bankruptcy, it sure doesn't save any money. In fact, according to the Kaiser Family Foundation, privatization would actually cost 11 percent more for the exact same services than leaving the current system in place -- and that cost disparity would widen over time, not shrink. The CBO, the non-partisan research arm of Congress, estimates that by 2022, the year the Ryan plan would start screwing retirees, it would cost a whopping 34% more than simply maintaining the current system.

The hard, cold truth is that those of us under 55 would pay more for less than our friends, siblings and spouses who are a little bit older. Our out-of-pocket expenses would skyrocket, amounting to about $6400 per year more than those born a year or two earlier.

Pity the person in their late forties who finds him- or herself struggling in this economy, underemployed, and likely to stay that way. Those poor folks get screwed seven ways from Sunday if Ryan gets his way. They will get no respite at age 65. The formerly middle class middle manager who is stocking shelves at Wal-Mart and depleting their 401K to pay the mortgage on a house that has lost a third of it's value is suddenly paying in a lot less in payroll taxes and this will affect the amount of benefit they are eligible for at retirement. Where they were on track to draw the maximum, they now stand to see their monthly benefit reduced by two or three hundred dollars, and they are depleting their savings now to save their house, so there may be nothing to supplement it. To add insult to injury, that thing they, in the spirit of George Orwell, want to call Medicare takes five hundred and change off the top of what they will get, eating up about half of their future Social Security checks, transfering that money directly to insurance companies and removing it from the economy of the areas where the seniors reside and spend their Social Security checks on living expenses.

The CBO also found that the greater cost-sensitivity could result less frequent use of newer and more expensive -- but frequently beneficial -- technologies and procedures than occur now under current law. In other words, the Ryan plan would kill that innovation that the republicans are forever insisting that free-market forces will certainly bring to bear if we just unfetter the market and let it work it's magic on our healthcare system.

There is one thing that republicans always say when healthcare is the topic that I can't believe they get away with. They always, without fail, say that they don't want a government bureaucrat between you and your doctor.

This has to register a full five cow-pies on the BS-o-Meter.

Let me provide a little anecdotal evidence and tell you about my experience with reimbursements and the filing thereof, since I did some of that in both of my two most recent jobs.

I was the second shift supervisor of a hospital phlebotomy crew...this meant that we had a waiting room full of patients up until 4:30 or so, and then we saw any stragglers that came in. I did the paperwork and filed for payment for the stragglers. When I went to another hospital and worked third shift, part of that job was processing specimens that came in to the hospital lab from doctor's offices and smaller hospitals either for in-house testing or as send-outs to Mayo, ARUP or Quest/Nichols. After I processed the specimens, I processed the "paperwork" for payment and filed the claims electronically.

I can count on one hand the times I had a Medicare claim bounce back requiring more information or a call to their offices during business hours that I had to leave in the day shift's inbox -- and it was almost always a coding error that was quickly resolved. Private insurance was just the opposite. The technologists on day shift in that facility finally revolted at the revolving insurance-resolution job that no one wanted to do, and the lab director had to go to the budget committee and add a full-time employee to her staff, an associates-level technician who did nothing but resolve insurance claims five days a week, eight hours a day.

The dirty little secret is this: There already is a bureaucrat standing between you and your doctor. But he or she doesn't work for the government. They are bean counters for an insurance company, and their bonus depends on them denying you the care your doctor deems you need.

If Ryan's plan were to see the light of day, every claim for every procedure would get that sort of unreasonable scrutiny by a Utilization Management Panel. You are familiar with these -- Sarah Palin called them "death panels" and they are the stock and trade of the private insurance / managed care / profit driven healthcare system she was desperately trying to preserve.

I realize that Ryan tends toward Randianism, and Randians are, by definition, emotionally stunted, amoral and selfish. Indeed, selfishness is not merely a virtue, it is the highest, if not only, virtue to the true Randian.

So I have to wonder, what's in it for Ryan to put in place a policy that would transfer massive amounts of formerly middle-class wealth to private insurance companies? If he is really a Randian, he has an angle he is working. And if he doesn't, he isn't a Randian, he's just a garden-variety sociopath.