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The Counterintuitive Liberal Case For Ryan Is Too Counterintuitive

Slate's Dave Weigel deftly skewers Paul Ryan's political persona:

Two products made their debuts in Congress on Tuesday. The first was "The Path to Prosperity," House Republicans' budget resolution for the next fiscal year. The second was the budget's author: Honest Paul.
Honest Paul is the heroic persona of Rep. Paul Ryan, the chairman of the House budget committee. He's like the regular Paul Ryan, except he must pause regularly to accept plaudits for his candor, heroism, and courage. This persona had been in beta-testing for several years, at least since the Weekly Standard profiled him as one of the GOP's rising stars in October 2007 (headline: "The Thinker"). Honest Paul got a good, long trial run in 2010, when Ryan introduced—after plenty of Democratic goading—the budget-cutting"Roadmap for America's Future." The trial run was a success, because for all of the bashing Democrats and liberal-leaning think-tankers did, it didn't stop the Republicans from taking the House.
And so Tuesday belonged to Honest Paul. David Brooks wrote a column praising Ryan for "the most comprehensive and most courageous budget reform proposal any of us have seen in our lifetimes." When Ryan appeared on MSNBC's "Morning Joe," he was interrupted several times to accept more praise. "Let us stop right now and commend him," said host Joe Scarborough, who served with Ryan in the House from 1999 to 2001.

Another good example Weigel could have quoted, but understandably chose not to, is his colleague (and former TNR staffer) Jacob Weisberg, who writes, "more than anyone else in politics, Rep. Ryan has made a serious attempt to grapple with the long-term fiscal issue the country faces." In my forthcoming TRB column I take issue with the plaudits for Ryan's fiscal seriousness. But let me focus on a specific argument Weisberg makes about Medicare:

before they reject everything in Ryan's plan, liberals might want to consider whether some of what he proposes doesn't in fact serve their own ultimate goals. Ryan's proposal to turn Medicare into a voucher provides an easy political target. But it's hard to make a principled liberal case for the program in its current form. To do so, you have to argue that government-paid health care should be a right only for people over the age of 65, and for no one else.

This is a really strange argument. It seems like it was written in the 1990s and placed in a time capsule. We do have government-paid health insurance for everyone. It's called the Affordable Care Act. It was signed last year, there were a lot of protests, it was kind of a big deal.

Moreover, even if it that had never happened, making a principled liberal case for keeping Medicare in its current form does not require you to believe in government-paid health care as a right only for the elderly. You can believe it should be a right for everybody, and that eliminating that right for senior citizens moves you farther away from that ideal rather than closer.

Weisberg makes a general argument for restraining the cost of Medicare, and he's right about that. But his endorsement of Ryan's proposal to do so is misguided. Privatizing Medicare is expensive. You add a layer of cost with no corresponding savings. You also introduce all the adverse selection problems that make insuring the elderly so difficult, and which required the establishment of Medicare in the first place. So the liberal case for keeping down Medicare costs ought to rest on beefing up the cost controls in the Affordable Care Act -- Ryan, by the way, would eliminate those, too.

Weisberg argues that Ryan's Medicare voucher is actually pretty generous:

starting with a value of $15,000 per year, per senior—the amount government now spends on Medicare—Ryan's vouchers should provide excellent coverage. His change would amount to a minor amendment to the social contract, not a fundamental revision of it.

Well, sure. That's because the starting value does not actually save any money. It only saves money over time as the value of the voucher slowly falls below the cost of health insurance. Weisberg might argue for Ryan's policy of slowly withdrawing the government commitment to provide health care for the old, but then he can't really argue that it provides "excellent coverage."