Monday, February 1, 2010

Paul Ryan's Budget

Rather eye-opening:
[Ryan's] proposal would take Medicare from costing an expected 14.3 percent of GDP in 2080 to less than 4 percent. That's trillions of dollars that's not going to health care for seniors. The audacity is breathtaking.
How does he do it?
As you all know by now, the long-term budget deficit is largely driven by health-care costs. To move us to surpluses, Ryan's budget proposes reforms that are nothing short of violent. Medicare is privatized. Seniors get a voucher to buy private insurance, and the voucher's growth is far slower than the expected growth of health-care costs. Medicaid is also privatized. The employer tax exclusion is fully eliminated, replaced by a tax credit that grows more slowly than medical costs. And beyond health care, Social Security moves to a system of private accounts that CBO says will actually cost more than the present arrangement, further underscoring how ancillary the program is to our budget problem.
Klein gives Ryan credit for offering a solution that actually squares the numbers -- a vast improvement over Ryan's previous proposed budget, which forgot to do as much.

Kevin Drum is far less impressed:
The real action comes from a collection of arbitrary spending limits, but these limits don't offer any clues about how we're going to meet them. There's a freeze on nonsecurity discretionary spending from 2010-2019 — but saying you're going to freeze spending is easy. The hard part is figuring out what to cut. There's also a limit to the growth of Medicare payments — but saying you're going to limit growth is easy. The hard part is figuring out how to limit growth and deciding what you're going to cut to meet your caps. Medicaid is treated the same way: Ryan's plan simply sets a limit on growth rates without saying how those limits will be met.

In fairness, there are a few specifics. The eligibility age for Medicare would rise gradually to about age 70. Social Security payments would be reduced. All the money in the stimulus bill that hasn't been spent yet would be eliminated.

But those are nits. For the vast bulk of the savings, Ryan simply declares that they'll happen. His bill would cap growth rates, and that's that. Whatever happens, happens — and he carefully avoids actually saying what would happen. That's not serious, and it doesn't deserve praise.

I have the same problem with this year's edition of the Ryan budget that I did with last year's: he takes as givens policies that would require legislative miracles in order to become law. Privatize Medicare? That's the GOP equivalent of creating a single-payer health care system. Same thing with privatizing Social Security accounts. Ryan may as well just claim that Gremlins will devour the deficit.

The big news is that the math potentially works. If that's true, then I've been wrong about criticizing Ryan for relying on the retread GOP think tank ideas with out assembling them in a coherent order that can produce results. The big problem still remains, however, that much of Ryan's budget is still composed of retread GOP think tank ideas that are extremely controversial and don't just materialize with the wave of a wand.

MORE: Yglesias on the rhetorical divide within the GOP and Ryan's budget proposal:

The big driver of spending over the long-run is Medicare. Jackie Calmes and Jeff Zeleny report in The New York Times that Representative Paul Ryan of Wisconsin, the top Republican on the House Budget Committee, has proposed a “blueprint for a balanced budget [that] relies heavily on changes in the system of Medicare benefits for future recipients, the kind of proposal that would surely provoke an outcry among Democrats.” But forget about Democrats. The Obama administration’s health-reform proposals involved some reductions in the scope of future Medicare spending, and that prompted a GOP-led outcry about “death panels” killing America’s grandparents. Under the direction of party chair Michael Steele, the GOP has put a "Senior’s Health Care Bill of Rights” at the center of the party’s effort to retain the allegiance of old people.

1 comment:

Jack Lohman said...

Yea, as long as Ryan has a gold-plated insurance policy he's just fine. But his healthcare fix for the rest of us stinks.

Unless, that is, he proposes the same voucher for congressmen that he proposes for Medicare patients (to buy a private insurance policy, of course).

Health care is not free, but why is he so willing to see the insurance industry add 30% ($700B per year) to the cost of health care without ever laying hands on the patient?

I'd rather see those dollars spent on the doctors and nurses and hospitals needed to extend coverage to the 45 million uninsured and 50 million under-insured Americans. But then again, I'm a crazy lefty.

Granted, Ryan may be well fixed, but 50,000 Americans die each year because they lack health care... some of them Vets, some are children whose mothers could not afford pre-natal care, some are cancer patients who couldn't afford to get checked out earlier. Or is that "compassionate conservatism?"

Ryan should educate himself on the Medicare-for-all system the insurance industry has paid $46 million to keep "off the table." For the same amount of dollars we are spending today (16.5% of GDP) we could provide first-class Cheney-care to 100% of our population. Including those in BadgerCare and Medicaid, and those who are uninsured and under-insured.

We’d pay for the system through our national infrastructure... about 2% on individual taxes and 8% on companies (as opposed to the 15% they pay today). Businesses could spend the savings on keeping jobs in the US instead of outsourcing to countries already with universal healthcare. A bailout for 100% of our businesses, not just the banks and car manufacturers.

But Ryan wants anything the Dems don't want. He is a pure obstructionist. He doesn't want a fix, he wants to be ahead.