Last week’s Health Wonk Review included several articles about Rep. Paul Ryan’s “Roadmap for America’s Future“, which includes significant changes in Medicare and Medicaid, and a repeal of the Affordable Care Act. This article from Avik Roy is particularly interesting, and raises some valid points in support of some aspects of the proposed budget reforms. But there are definitely problems with some of the radical changes being proposed. Wright On Health looks at some of the moral issues involved, and makes some very good points. I also think The Incidental Economist is correct in noting that turning Medicaid into a block grant program will ultimately result in fewer people being covered by this safety net health insurance program. Certainly, states would still be free to contribute more money to their own Medicaid programs, but it’s unlikely that all states would do so, and the result would be less overall funding for Medicaid (which translates to coverage for fewer people). Joe Paduda points out that while the major health care reform aspects of Ryan’s proposal will appeal to a lot of people at first glance, they don’t really do anything to address the rising cost of health care. This is a problem with the PPACA too – what began as health care reform seemed to devolve along the way into health insurance reform. But health insurance premiums (and the rapid pace at which those premiums increase) reflect the cost of health care, and much more needs to be done to address the issues surrounding the cost of care.