Regarding your #1, perhaps part of the solution will be a cap per beneficiary (what do you mean by "soft cap" — different levels for different people? some types of exceptions?). Probably rationing via both direct means (more denials by Medicare of authorization for requested treatments) and indirect means — (1) changing the basis of provider compensation in ways (capitation, bundling, etc.) that incentivizes them to provide/prescribe less [or less expensive] healthcare (or looked at from the other side of the coin, incentivizes them less for providing/prescribing more healthcare) and to say "no" to the patient more often, (2) reducing compensation of providers and manufacturers of drugs and medical equipment with the drawback of less quantity and quality, and (3) probably more that doesn't come to mind at the moment. There are some good papers on the subject (available online) by think tanks and coalitions of think tank members.

I think the only realistic solutions involve either

1. Capping (hard or soft) Medicare costs per beneficiary.

2. Dramatically reducing the base (via means testing)

3. Both 1 and 2.

Ryan's plan is an example of 1. Personally I favor 3 but with a good chunk of 2 in the mix because 2 is what makes a difference in the short to medium term

Re: numbers, I hope that the various non-governmental commissions (Peterson-Pew; Bipartisan Policy Center; any others), and White House-initiated commission if one is created, at least lay out some alternative solutions that are credibly scored (preferably with at least one version of scoring using a prudent application of dynamic analysis) and add up to projections of debt/GDP, deficits, and impact on growth that would be fiscally responsible and that would be as close as possible to something politically feasible someday soon.

The politically problematic part I see is probably the key to the whole thing: his capping of Medicare benefits per beneficiary by a particular dollar amount (albeit somewhat means-tested) via a voucher, thus shifting any additional costs to beneficiaries (seniors). The only thing that makes it possibly above a complete non-starter politically is that this structure wouldn't apply to anyone 55 or over, the people with these benefits most on their minds.

It's really too bad. His solution is to raise taxes by and large.

Eliminate tax deductions, raise rates maybe tinker on the margin with SS (BTW, he clearly buys the canard that SS solvency is a relevant discussion) and problem solved.

He doesn't provide any numbers so I can't judge whether it actually balances, but, if it does, it sounds like it balances with the Feds taking 23 or 24 percent of GDP. Not a solution I'd like very much.

The best part of the plan is it results in a long term balance which makes it the only plan I've seen that does so.

The worst parts about it are the "assumption" of 19% in tax receipts which looks a bit inconsistent with the policy prescriptions and the fact that it takes so long to get to balance. His solution is far enough in the future that many things could change before he gets there.

That said, for all the many critiques of the Ryan proposal, it seems at the moment to be the only one that adds to zero at any point in the future.