The battle between the parties over Medicare reform is a battle about how best to control costs. Ryan and Romney rely exclusively on the Competition Fairy, -- the notion that if private insurers are induced to compete for Medicare policyholders, they will find ways to hold down costs. If that fails, Ryan/Romney would most likely shift costs to seniors, with some ostensible protections for low-income beneficiaries. The Obama administration, via the Affordable Care Act, seeks to use the government's market clout to change the rules of the payment game for providers, creating new incentives to reduce unnecessary care and new rewards and penalties focused on patient outcomes.