Since conservatives continue to swoon unashamedly over Paul Ryan and his near-unique ability to ability to discuss health care at some higher level than Fox News talking points -- more examples of the Ryan love-fest can be found here and here -- I should interject to point out that Ryan has proven fairly unable to defend himself.
If you're not following this gripping story, Ryan appeared at the Blair House summit and charged that President Obama's health care plan would increase rather than decrease deficits. Obama, who had already interjected to refute numerous Republican claims, let the attack pass and allowed a Democratic member of Congress to speak. Conservative ecstasy followed -- a Republican who out-debated Obama! Using actual numbers!
Based on what I've seen him Ryan, I like him. I appreciate his interest in ideas and his willingness to debate his position at a high level. The country would be better off if we had more members of Congress like him. But his overall point is wrong, and his grasp of the facts, while far higher than many Democrats and probably all the Republicans in Congress, remains tenuous.
Ryan's overall argument here come down to three categories. The first is that counting the savings in Obama's health care plan toward extending the solvency of the Medicare trust fund is a sort of double-counting. This is something of an angels-of-a-pin question about trust fund accounting, not an actual charge that Obama's plan won't pay for itself. In any case, Ezra Klein questioned Ryan, and pointed out that, on this issue, Ryan is only taking issue with some rhetorical claims made by supports of the bill, not with the validity of the CBO score:
Klein: what I want to make sure is clarified here is that the numbers people are using from CBO are not afflicted by that rhetorical overreach. When CBO says the bill will save this much money, it really will, at least according to the best estimates.
Ryan: I'm not disagreeing with that.
Second, Ryan has expressed skepticism that Medicare cuts will actually be implemented. Now, historically, Congress has allowed Medicare cuts -- including those much larger than the ones Obama proposes -- to take effect. Klein didn't mention that. He did, however, suggest that if you take the view that Congress can't be trusted to cut Medicare, you're saying that out only alternative is insolvency:
Klein: On the question of whether we can trust Congress to implement modest cuts. If you don't think government can abide by even the modest spending cuts in this bill, then where are we left? We're going to need to do much more than this bill. Your bill does much more than this bill. But if Congress can't do what it says it's going to do, what's the point in talking about any of this at all? If none of the policies can be implemented, then we're going bankrupt.
Ryan: I can't disagree with what you just said.
So, on two of the three main points, Ryan has conceded to Klein. The final point concerns the "sustainable growth rate" in physician payments. I've discussed in numerous times. Basically, in 1997 Congress attempted to legislate a slight trim to physician reimbursements under Medicare, but due to poor policy design, the law ended up demanded enormous cuts. Congress routinely cancels those cuts, but they remain on the books, which means that the official deficit projections are a little too rosy.
Now, Democrats in the House at first thought they'd set aside money to fill in those cuts, which is both highly responsible and would endear them to the powerful physicians' lobby. As the money started to get tight, they decided to leave that fix out of the bill. This has become one of Ryan's pieces of evidence that the financing is phony. Here's his exchange with Klein:
Klein: if it exists completely independently of health-care reform -- and if it was developed in 1997, that has to be true -- how can it be properly understood as part of the cost of health-care reform?
Ryan: Here's my challenge to that. These bills had the doc fix to begin with. And if you're going to say that Medicare savings can be counted as health-care reform, then the Medicare spending issues should go in there as well. You can't say I'm going to take out $467 billion in savings from Medicare and apply it to this entitlement and then I'm going to exclude the doc fix.
Ryan did not concede on this point. But he's clearly wrong. The budgetary hole from the badly designed 1997 law is going to exist regardless of whether health care reform passes. It would be nice if Congress filled that hole in this bill, but failing to do so hardly shows that the financing is phony. The question isn't whether Obama's plan is maximally responsible. The question is whether or not it pays for the new benefits that it creates. And the doctor reimbursement issue has nothing to do with that question. Ryan's answer is that the House briefly considered taking care of that problem in this bill, but finally decided not to. This is a pure red herring.
So, again, on the three main pillars of his argument, Ryan outright conceded on two, and resorted to a non sequitur on the third. In his interview with Klein he said something very honest:
There's a broader point I was trying to make here, which is that size of government matters. It would matter if we had $50 trillion in spending increases even if we had $51 trillion in tax increases.
That's a valid point of view: it doesn't matter if you have more taxes than spending, because I'm for smaller government. But that isn't what he said at the summit. What he said is that Obamacare will add to the deficit. It isn't true.