Ezra Klein wonders how Paul Ryan obtains $1.2 trillion in savings from repealing the Affordable Care Act if the Congressional Budget Office has previously scored the action as actually increasing the deficit by $210 billion. The answer, as Ryan himself explained at yesterday’s AEI speech, is that he repeals all of the coverage provisions, while maintaining the cuts to Medicare providers:

RYAN: We retain the Medicare savings and instead of double counting the Medicare savings…we end the raid of the Medicare program and we reapply those savings to Medicare to advance its solvency. Doing that, combined with eliminating all the Obama health care spending gets you the numbers I’m talking about. But we do repeal the IPAB.”

As Klein points out, this opens Ryan up to grave charges of hypocrisy because the GOP spent a lot of their time arguing that the Medicare cuts would 1) increase costs to the beneficiaries 2) were unsustainable and would drive providers out of the program. In fact, here is Ryan himself making this very point with CMS actuary Rick Foster earlier this year:

RYAN: Are you basically saying with a 10-year period, you believe that about 15% of Part A providers will stop taking Medicare or go bankrupt?

FOSTER: If nothing else happens other than they have these lower payment rates under the Affordable Care Act. [...]

RYAN: So basically what you’re saying is that not unlike what happened in the last decade, Congress went too far from the perspective of providers and took a lot of the savings back. And you’re basically suggesting that that’s probably the kind of pressure we’re going to face again?

FOSTER: Um, yes, the possibility is definitely there.

Providers, who went along with the cuts because they would have received 32 million new customers are already raising hell. “The coverage expansions are rescinded, but the cuts remain,” American Hospital Association President and CEO Rich Umbendstock told The Hill. “The two were coupled in healthcare reform… It’s unacceptable if just the cuts stand.”

“The combined effect of dropping the new coverage and maintaining the cuts threatens the care that communities depend on,” FAH President and CEO Chip Kahn said in a statement, “and will place harsh limits on the very health care providers who are frequently the most significant job creators in their local communities.”

The Congressional Budget Office (CBO) estimate of Rep. Paul Ryan’s (R-WI) recently unveiled “Path to Prosperity” demonstrates the difficulty of placing programs like Medicare and Medicaid on the right “path” without taking significant steps to slow the growth of health care spending by going after the and inefficiencies in the system. Ryan’s only discernible method of cost control is the free market, which, in effect, shifts spending from the federal government to the beneficiary. From the CBO’s analysis of Ryan’s proposal:

Under the proposal, most elderly people would pay more for their health care than they would pay under the current Medicare system. For a typical 65-year-old with average health spending enrolled in a plan with benefits similar to those currently provided by Medicare, CBO estimated the beneficiary’s spending on premiums and out-of-pocket expenditures as a share of a benchmark: what total health care spending would be if a private insurer covered the beneficiary. By 2030, the beneficiary’s spending would be 68 percent of that benchmark under the proposal, 25 percent under the extended-baseline scenario, and 30 percent under the alternative fiscal scenario. … CBO estimates that average spending in traditional Medicare will be 89 percent of (that is, 11 percent less than) the spending that would occur if that same package of benefits was purchased from a private insurer.

Look:

As the CBO explains, Ryan dumps seniors into a Medicare exchange with private plans that have higher costs than traditional Medicare — both because of higher “administrative costs (including profits) and payment rates to providers” — and provides those insurers with a voucher (excuse me, “premium support”) from the federal government that does not not keep up with health care spending:

In 2030, the government’s contribution under the proposal would be smaller than that under either of CBO’s long-term scenarios because the premium support pay- ment would grow at a slower rate than is projected for Medicare spending under either scenario. In that year, under the proposal, the government’s contribution would cover 32 percent of a typical 65-year-old’s total health care spending…When expressed as a percentage of the benchmark [total private health care spending to cover a beneficiary], the beneficiary’s share in 2030 would be 68 percent under the proposal, 25 percent under the extended-baseline scenario, and 30 percent under the alternative fiscal scenario.

At the same time, Ryan is doing nothing to make health care itself more efficient. In fact, he’s repealing some of the Affordable Care Act’s delivery reform demonstration projects (that could yield potential savings) and cost control mechanisms like the Independent Payment Advisory Board. Health care costs, in turn, go nowhere but up.