Revisiting Paul Ryan

Ross Douthat and Tyler Cowen offer more commentary on Paul Ryan’s plan to balance the budget by eliminating Medicare, cutting Social Security, and even more drastically cutting every program that isn’t Social Security. Ezra Klein also has an interview with Rep Ryan.

I think it’s important to note that taken as a whole this “plan” isn’t actually much of a plan. It’s handling of non-defense, non-entitlement spending, in particular, is just hand-waving. The part that looks like a plan is the part where for people under 55 there’s no Medicare, and instead you get health care voucher whose sum doesn’t keep up with the cost of medicine. Douthat says liberals are talking about this because we “think that his small government plan makes big government look good.”

I wouldn’t put it that way. The point I would make is that Ryan’s plan comes close to clarifying what it is that’s so expensive about the policy status quo — not waste, not inefficiency, not bureaucrats, not illegal immigrants, but the government’s commitment to providing health care to senior citizens. The core element of Ryan’s plan for Medicare isn’t that it involves means-testing or other cuts around the edges, it’s that it just abandons that commitment. Right now if you’re old, and you get sick, and there’s some treatment that will uncontroversially cure you, then doctors come and cure your illness no matter your income. The Ryanverse won’t look like that. Ryan’s vouchers will buy some kind of health insurance for all seniors, but over time that insurance will start looking pretty skimpy relative to prevailing standards of care. Lots of seniors will die preventable deaths due to lack of funds.

In essence, there’s a choice facing the country. We can maintain something like the tax rates that have prevailed for the past 40 years, which is what Ryan does, or else we can maintain something like the policy status quo that’s prevailed for the past 40 years, which is what Ryan doesn’t do. I think it’s pretty much inevitable that the future will involve some “give” on both points — higher taxes and changes to Medicare, in other words. What you mostly hear from the right, though, is the idea that we can make taxes lower and basically leave the country in the same place if we just cut down on earmarks. Ryan’s proposal inches toward conceding that that’s not the case, that the only way to keep taxes low is to radically revise not just the nature of Medicare as a program but the underlying principle that there’s a responsibility to ensure that seniors’ medical needs are taken care of in a comprehensive way.