Washington Post fact-check columnist Glenn Kessler carefully takes apart Paul Ryan's claim that he proposes to give Medicare recipients "a system just like members of Congress and federal employees have." Kessler presents his case to Ryan's spokesman, who, hilariously, offers up this lie-about-the-lie:
“We don’t think it’s fair to award Chairman Ryan any Pinocchios for saying that the new Medicare system will be similar to what members of Congress enjoy today, simply because the plan might be dissimilar in one respect, even as it is similar in most others. To my knowledge, the Chairman has never said that the new Medicare will bethe plan that members of Congress have.”
Kessler does not directly point this out in response to that blatant falsehood, but he does begin his column by quoting Ryan as calling his plan "just like" the one Congress gets. Ryan's promise to give future Medicare recipients a plan "just like" the one Congress gets is obviously a much stronger promise than saying it's "similar." If I take your car and promise to give you one just like it, you probably expect the exact same model. You do not expect to get a car that's similar in the sense of also having two-wheel drive and a CD player.
Ryan argues to Kessler that his plan is just as good as Congress's health insurance plan because, even though its value would progressively fall further behind the value of a full health insurance plan, the magic of market forces will hold down health care inflation and make the vouchers just as good as full health insurance:
“We believe — based on experience — the competitive elements of patient-centered reform will exert downward pressure on the cost of a private plan, and that therefore the government’s share of the tab will be higher,” said Conor Sweeney, a spokesman for Ryan.
It's a ridiculous claim. Keep in mind, the individual markets Ryan would shove Medicare recipients onto are -- as Republicans admit -- similar to what the Affordable Care Act sets up. The Affordable Care Act assumes that the creation of these exchanges will, by itself, has no impact at all on health care inflation. Ryan assumes they'll have a massive impact, slowing health care inflation well below the rate we've ever experienced. The assumption is so implausible that the only non-rightwing economist who supported the concept -- Alice Rivlin, who co-sponsored an earlier version of the plan -- denounces this plan for relying on even less plausible numbers.
Moreover, international experience shows that having individuals pay a higher share of their health care bills tends to increase, not decrease, the cost of the system, as The Economist's M.S. points out:
Now, I suppose Ryan could plausibly say his experiment in consumer-driven health care is so much more radical that it will be far more effective than international experience (or theory) might predict. But his plan places the entire risk of that experiment panning out upon Medicare recipients. If Ryan's plan somehow works miracles, they'll do fine. To whatever degree it falls short, they're on the hook for it. To say that such a plan is equivalent to a health insurance plan that's not dependent on a huge, implausible policy gamble panning out is a stretch to the point of outright deception.