The presidential deficit commission is debating whether to shift Medicare from a government-paid plan to one in which seniors are issued vouchers to pay for private health insurance. The proposed change would not affect beneficiaries currently covered by Medicare or those who will become eligible before 2021.

Congressman Paul Ryan, a Republican, and economist Alice Rivlin, a Democrat, who proposed the plan, will likely face resistance from their mostly Democratic fellow commission members. According to the plan, seniors would face higher premiums or reduced benefits, and the eligibility age would gradually increase from 65 to 67.

Ryan, the future head of the House Budget Committee, says, “Medicare’s open-ended, fee-for-service model distorts the health care market, inflates costs and invites fraud and abuse. With tens of trillions of dollars in unfunded promises, Medicare is on an unsustainable trajectory, and yet ‘do-nothing’ politicians irresponsibly insist the program remain on autopilot.”