Thomas Saving and John Goodman have written an op-ed in today’s Wall Street Journal in which they pretend that Rep. Paul Ryan’s (R-WI) Medicare cuts are almost identical to the reductions Democrats enacted through the Affordable Care Act:

In light of the heated rhetoric of recent days, it is worth noting that for everyone over the age of 55, there is no difference between the amount of money the House Republicans voted to spend on Medicare and the amount that the Democrats who support the health-reform law voted to spend. Even for younger people, the amounts are virtually identical with GDP indexing.

The law’s spending path depends on making providers pay for all the future Medicare shortfalls. But since no one can force health-care providers to show up for work, short of a health-care provider draft this reform ultimately cannot succeed. The House Republican path, on the other hand, would make a sum of money available to each senior to choose among competing private plans—much the way Medicare Advantage provides insurance today for about one out of every four Medicare beneficiaries.

Saving and Goodman surely understand that there are different ways to cut Medicare spending, and they also know that the Ryan budget actually maintains many of the ACA’s productivity cuts to providers. The distinction is worth reiterating: the ACA reduced annual increases in payments to hospitals, skilled nursing facilities, home health agencies and other institutions to spur productivity and cut overpayments to private insurers that are not delivering value for Medicare dollars. They used that money to expand coverage to 32 million Americans — many of whom were receiving uncompensated care at these institutions — to extend the life of the Medicare program and invest in new demonstration projects that aim to encourage providers to deliver quality care more efficiently.

The Ryan budget, on the other hand, tries to change the behavior of consumers (not providers) by shifting more of the costs of coverage from the federal government to the individual. Republicans believe that individuals who go out and purchase coverage on their own will use less care (spend less money on health care) and create a more dynamic and competitive health care market. The problem with this approach is that there is no credible research showing that forcing individuals to be more cost conscious will significantly lower national health care spending or that the “savings from competition would be large enough to offset the massive reduction in funding.” Most importantly, as Jared Bernstein has pointed out, the GOP’s approach fails because “there’s no market discipline that average folks with incomplete information armed with an inadequate voucher can enforce on a private health insurance market that’s…well, different.”

On Tuesday, New Yorkers in the state’s 26th Congressional District delivered House Republicans a clear message that House Budget Chairman Paul Ryan’s (R-WI) plan to end Medicare won’t fly. But a new poll shows that the American public’s distaste for Ryan’s proposal doesn’t stop at Medicare. According to a new Kaiser Family Foundation poll, 60 percent of those polled prefer the keep Medicaid — the federal heath insurance system for the poor — “as is,” as opposed to Ryan’s detrimental block grant program. Indeed, more than half want to see no reductions in Medicaid spending at all because of “a strong sense of the program’s importance.” Indeed, many said they had benefited or knew people who had benefited from the program directly:

Support for maintaining the current program may be due at least in part to the public’s personal connections to Medicaid and a strong sense of the program’s importance. About half of Americans say they or a friend or family member has received Medicaid assistance at some point, and a similar share say the program is important to their family.

Even those who initially supported Ryan’s Medicaid block grant idea said the Democratic position could sway them into maintaining Medicaid as it is. As The Huffington Post’s Emily Swanson notes, “The survey suggests the Republican Party might make some inroads in changing public opinion, but likely not enough to attain majority backing.” Overall, the Kaiser poll verified previous polls‘ findings that general cuts to vital entitlement programs like Medicaid and Medicare to reduce the deficit is an agenda deeply out of line with the American public.

The Hill’s Sam Baker reads through the latest Congressional Budget Office (CBO) letter on the consequences of defunding the Affordable Care Act and discovers that the GOP’s efforts could “lead to the end of Medicare coverage for prescription drugs”:

Although the Medicare drug benefit predates healthcare reform, the new law made changes to the program — most notably eliminating the so-called “doughnut hole,” in which seniors must pay for their drugs out of pocket.

If the new healthcare law is defunded, the changes to the prescription drug program could not be implemented and Medicare would be unable to offer the benefit, CBO said. [...]

A permanent ban on using appropriations to implement the law could prevent Medicare from signing contracts to administer the drug benefit, known as Medicare Part D. It also wouldn’t be able to set rates for Medicare Advantage, so that program might also end.

“As contracts expired on December 31, 2012, there would probably be nothing to replace them and therefore no MA and Part D plans for Medicare beneficiaries,” CBO said. “If there were no Part D drug benefit, federal spending would decline.”

The federal government also wouldn’t be able to collect its share of drug rebates from pharmaceutical manufacturers that service Medicaid beneficiaries. As a result, “the federal government would therefore not realize savings from increased rebates or from other policies that would reduce drug spending in Medicaid,” the CBO report concludes.

A permanent prohibition on the use of discretionary funding could also undermine increases in physician reimbursement rates. Doctors would not be able to qualify for bonuses and other incentives included in the new law and “the effective result would probably be that payment rates would remain at current levels.”

In March, the CBO released a report that found that defunding the ACA piece by piece “would increase spending by $3.1 billion in fiscal year 2012 and by smaller amounts in each of the fiscal years 2013 through 2021.” “Net additional costs would total $3.9 billion over the 2011- 2016 period and $5.6 billion over the 2011-2021 period.”