The document discusses the Republican plan to reform Medicare known as the Ryan Plan and compares it to the German health care system. The Ryan Plan would replace the current Medicare system with one where seniors choose private insurance plans subsidized by the government. The German system is similar and includes choice among approved plans. While the German system costs less per capita than the US system, it includes cost control regulations that the Ryan Plan lacks. For the Ryan Plan to be sustainable, cost controls would likely be needed to prevent seniors' costs from rising rapidly over time.