"Congressional Medal of Honor"isn't that pretty much the same thing as a ribbon?"
Ribbons are a small cross-section of the ribbon that holds the medal. When wearing a "regular" dress uniform, the medals aren't worn but the ribbons that represent them are. When wearing "full" dress, the medals are worn in lieu of the ribbons.
Most people don't actually get the medals (except for the biggies, like the CMH). I "received" the Navy Expeditionary Medal and the Humanitarian Service Medal, but never actually got the medals. I had to go out and buy the ribbons.
When we had a change of command ceremony on the ship I served on, and it called for full dress, everybody was in full panic! Very few people actually had the medals that they were awarded, none of the officers actually had swords, etc. The word finally came down to wear the medals if you had them, otherwise the ribbons would suffice.
I'd still like to have the medals, though.