Premium Support and Medicare

I am going to start this post by admitting that my health care knowledge is lacking.  If I overlook or misinterpret information I am more than happy to make corrections to my writing.  My brother in law asked about Premium support  and it got me going on health care and this is what I have found so far.

First understanding a few key terms is helpful.
Pay-for-quality or pay-for-performance: is supposed to pay health services for the quality of care they deliver.  Better service means they get better payments.  Payment-for-quality programs take many forms, such as bonuses to physicians for satisfying certain performance measurements or incentives to physician groups for implementing health information technology, or, conversely, can include financial disincentives for not meeting quality benchmarks.  This is a key component of Obamacare and current payment policies are not effectively structured to reward improvements in the quality of care.
Exchanges: Exchanges use competitive bidding to allow insurance companies to offer the cheapest price possible for comparative coverage.  These will be advertised online and each state will have their own exchange site.  Exchanges are part of both Obamacare and Romney's health plan.

Both Obamacare and Romney's plan are based off of existing Medicare Models.  Medicare Advantage or MA is medicare brought into the private sector.  Romney's plan takes a lot of its ques from MA.

To answer Micah's question:
Premium Support: There’s a big difference between vouchers and premium support but regrettably it goes unnoticed. According to Politifact: vouchers are paid to individuals who may use the funds for a designated purpose. School vouchers are an example. They are a specific amount that don't keep up with rising costs.  So essentially vouchers lose value over time.  By contrast, premium support payments in Medicare would be made directly to qualified health insurance plans on behalf of seniors who choose them from a Medicare exchange.  In order for a policy to qualify as "Premium Support" it’s crucial to peg the beneficiaries’ payment to the actual rise in health care costs so people don't end up having to pay more because of inflation. Voucher plans that don’t do this "are virtually guaranteed to become increasingly inadequate," You could argue and some do, that Obamacare is actually a premium support plan. 

According to Reihan Salam The difference is as follows:
Vouchers cannot be "topped up" or people cannot add their own money on top of it.  With school vouchers this is supposed to prevent parents who would send their kids to private schools regardless of financial aid from taking advantage of the system.  Premium Support on the other hand allows people to top up their aid.  Wealthier seniors will be expected to add onto their medicare to get more expensive coverage.  Under Romney's plan, the wealthier you are, the more you pay on your own.

For a great overview of Obamacare vs. Premium Support plans I highly recommend visiting:
http://www.tnr.com/blog/plank/106298/guide-to-medicare-debate-romney-ryan-obama-voucher-premium-support#

At the bottom it has a quick breakdown with commonly asked questions.