‘Even if he agreed with me, he couldn’t say so’

As part of my reporting for tomorrow’s column, I spent some time this afternoon chatting with budget expert Alice Rivlin. Rivlin was the first director of the Congressional Budget Office, co-chair of the Bipartisan Policy Center’s widely admired plan for deficit reduction, and, alongside Paul Ryan, co-sponsor of the Ryan-Rivlin Medicare reform (pdf) that’s attracted so much interest on the right.

Ryan-Rivlin would turn Medicare from a program in which everyone gets Medicare into a program in which everyone gets a check to purchase some Medicare-certified private insurance, and that check grows much more slowly than the current rate of health-care inflation. “The objective,” Rivlin told me, “is to get genuine competition on an organized exchange among comprehensive health plans so they will compete and arguably produce better health care for less money.”

What’s odd about the right’s embrace of Ryan-Rivlin is that the plan basically turns Medicare into the Affordable Care Act. It’s the same idea — regulated exchanges offering certified insurance products populated by subsidized buyers. If Ryan-Rivlin will unleash ferocious innovation that holds costs down, then so too should the Affordable Care Act. So at the end of our conversation, I asked Rivlin, who supported PPACA, if I was missing something. She laughed. “I keep talking to Paul and trying to convince him of that,” she said. “But even if he agreed with me, he couldn’t say so.”

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