As conservative media scramble to defend Congressman Paul Ryan (R-WI) from charges that his proposed overhaul of Medicare would negatively affect seniors, one point is noticeably absent from their discussion: Ryan's plan imposes a Medicare “mandate” remarkably akin to the requirement to purchase insurance under the Affordable Care Act. Fox News and other conservative media are apparently ignoring this similarity, despite their two-year campaign against the highly similar provision in the Obama-supported health care reform law.

Fox News' Dana Perino asked on the August 13 edition of Fox & Friends, "who wouldn't want" Ryan's plan for Medicare? Left unsaid is that the health care reform law's constitutional choice of obtaining a private health insurance plan or paying a health insurance tax and Ryan's choice of obtaining a private Medicare plan or paying a Medicare tax are essentially the same.

Health care law expert Simon Lazarus wrote in Slate that:

Republicans' proposal to replace Medicare with partially subsidized private insurance also operates to “compel” people to pay for private health insurance policies. Moreover, this mandate is not even a pay-or-play option; Medicare taxes are mandatory, whether workers want to buy eligibility for old-age vouchers or not.

Ezra Klein reiterated the Medicare “mandate” parallel in a Washington Post blog on Ryan's plan:

His plan for Medicare is even closer to an individual mandate. There, everyone has to pay into the system through payroll taxes. When you're 65 years old, you get a voucher that will pay part of the cost of health-care insurance. If you decide not to use the voucher, or the voucher is insufficient, all the taxes you paid into the system are forfeit. Either you buy insurance as a senior, or you face a tremendous lifetime tax penalty.