Republicans and their allies spent most of the debate over health care reform accusing Democrats and their allies of trying to “ration” health care. But Paul Ryan’s budget illustrates the reality these critics would never admit: Their plans to slow down health care spending could also lead to rationing.

By scaling back the insurance coverage both Medicare and Medicaid provide, the Ryan plan would force many if not most people on these programs to become more selective about what medical care to get. Seniors facing high costs would almost surely opt to skip recommended and necessary treatments and, as the Congressional Budget Office observes, that could slow the development of cutting-edge therapies. (See Suzy Khimm at Mother Jones and Julie Rovner at National Public Radio for fuller explanations.)

But look, this shouldn’t come as a shock. If you define rationing in the broadest sense possible, as not enabling people to get any medical care they want at any time, then every health care system--and every scheme for reforming a health care system--will ration care in one way or another. The question is who makes the decision, by what criteria, and under what pressure.

Conservatives and liberals have honest disagreements about the best answers to those questions. Maybe one of these days we can have that debate. (I'll try to have more to say about this later.)