Ryan's Radical Plan

Here's former Bush administration budget wonk Jim Capretta's description of Rep. Paul Ryan's proposal to reform Medicare:  

To hear opponents tell it, it's a "radical" proposal. But is it?

Beginning in 2022, new program entrants (those under age 55 today) would get their entitlement in the form of "premium support credits." Today's Medicare enrollees and those who enter the program over the next decade would be entirely exempt from this reform—an important piece of information that seems to have gotten lost in all of the shouting. Those receiving the credits would get to apply them to one of several competing private insurance plans. The federal government would oversee the plan choices, ensuring they meet standards for quality and accessibility of care. Low-income Medicare participants would get extra financial support to cover additional out-of-pocket expenses. In the years after 2022, the federally-financed "premium support credits" would rise commensurate with the consumer price index.

Premium credits for program participants. Competing private insurance options. Government oversight of plan choices. Additional help for the low-income.

And the twist:

If this all sounds vaguely familiar, it should. It's the description used by advocates to sell the president's own health reform program to the American people.

See what he did there? It's always been absurd to call Ryan's budget proposals "radical." Last year's Roadmap proposed to continue funding health care for seniors and the poor to the tune of hundreds of billions every year, and didn't get around balancing the budget until 2063. In a post-ObamaCare world, Democrats calling Ryan's plan radical is even goofier: Structurally, Ryan's plan and ObamaCare are fairly (though not exactly) similar.

ObamaCare's backers have tried to argue that this ought to cause fans of the Ryan budget, most of whom opposed last year's health care overhaul, to think twice about refusing to back ObamaCare. Yet I would argue that the reverse is true: The key goal in health reform ought to be fixing the broken system we already have: Democrats warn that Ryan's budget would "end Medicare as we know it."

Oh, the horror! Guess what? "Medicare as we know it" will implode on its own without any help from Ryan or anyone else. It's run up a $30 trillion unfunded liability, and the Congressional Budget Office says it will go bankrupt in 2021. Long term, the program (along with Medicaid), is the biggest driver of the federal debt. So the first question for American health policy and budgeting ought to be: How do we control the growth of Medicare spending, and ensure that we don't end up doing something roughly akin to sinking the nation's finances down the thousand-year-long digestive tract of a Sarlacc pit monster? 

ObamaCare answered this question with a mixture of shoulder-shrugging apathy and dubious, politically unstable gimmicks that aren't likely to achieve the sort of savings we need. Ryan's budget plan, for all its flaws, at least understands what the important question is, and attempts to address it directly. It's imperfect. It may not work as well as Ryan hopes. But it's far from radical.