EK: Speaking of the Affordable Care Act, you’ve said before that the theory behind the exchanges in Ryan-Rivlin and the theory behind the exchanges in the Affordable Care Act are identical. That would mean Republicans who believe in Ryan’s model should be more optimistic about the Affordable Care Act. But Ryan has said the two of you simply disagree on how to build the exchanges. Can you explain to me the disagreement you have that would make Ryan-Rivlin different from the ACA?
AR: No. I can’t. I think he’s sort of backed himself into an intellectual corner here.
EK: When you would talk to him, did he seem to recognize that?
In the conservative imagination, the Affordable Care Act is the definition of overreaching, freedom-destroying big government, and Ryan is the embodiment of Freedom. So the notion that Ryan's health care plan -- at least the version he con-sponsored with Rivlin -- sets up a system extremely similar to the Affordable Care Act just doesn't compute. But it's true! And, of course, Ryan's Medicare plan may be worse than Medicare but it's not that bad -- at least not the version Rivlin supported. The version on display yesterday is pretty bad.