Why Rep. Paul Ryan’s budget plan is so flawed: Just over a year ago, I wrote a column praising Rep. Paul Ryan’s Roadmap. I called its ambition “welcome, and all too rare.” I said its dismissal of the status quo was “a point in its favor.” When the inevitable backlash came, I defended Ryan against accusations that he was a fraud, and that technical mistakes in his tax projections should be taken as evidence of dishonesty. I also, for the record, like Ryan personally, and appreciate his policy-oriented approach to politics.
So I believe I have some credibility when I say that the budget Ryan released last week is not courageous or serious or significant. It’s a joke, and a bad one.>For one thing, Ryan’s savings all come from cuts, and at least two-thirds of them come from programs serving the poor. The wealthy, meanwhile, would see their taxes lowered, and the Defense Department would escape unscathed. It is not courageous to attack the weak while supporting your party’s most inane and damaging fiscal orthodoxies. But the problem isn’t just that Ryan’s budget is morally questionable. It also wouldn’t work.
Don’t take it from me. Take it from Robert Reischauer, who directed the Congressional Budget Office from 1989 to 1995 and now leads the Urban Institute. “If this is a competition between Ryan and the Affordable Care Act on realistic approaches to curbing the growth of spending,” Reischauer says, “the Affordable Care Act gets five points and Ryan gets zero.” But Ryan would repeal the Affordable Care Act and replace it with his own wishful plan. In doing so, he makes it harder, not easier, for us to balance the budget….
It’s been fashionable for commentators to admit to Ryan’s failings and wonder why Democrats haven’t proposed anything of their own. The chorus has grown loud enough that Obama is scheduled to give a speech Wednesday outlining his alternative. But unlike Ryan, Democrats not only have a plausible proposal for controlling health-care costs, they have a law.
The Affordable Care Act, as Reischauer says, isn’t perfect…. Nevertheless, it’s built atop a theory that actually makes sense, because it focuses on making medical care cheaper rather than changing who pays for insurance. The law has three big ideas for controlling costs… pay doctors for quality… increase the amount of information available about which treatments work best… and… pay providers more to keep people out of the hospital than to treat them once they get in it. If any or all of these strategies work, costs will go down, but not because the premiums seniors pay have gone up.
And the law takes the next step by including some big ideas for how to spread cost controls through the health system: a board of experts empowered to reform Medicare even when Congress is paralyzed or worrying about other things; exchanges where people can easily compare insurers based on cost and quality (the same model Ryan uses in Medicare, incidentally); electronic medical records that give doctors easy access to the latest information about drugs and treatments.
One refrain we’ve heard about Ryan’s budget is that it may be flawed, but at least it’s a starting point. Maybe so, but it’s the wrong one. Taking Ryan’s zero and making it into a five would be a lot harder than taking the Affordable Care Act’s five and making it into a seven — and the Affordable Care Act has the advantage of already being law, not just a glimmer in a congressman’s eye.