He’s writing in response to the lead of my column today, so I might as well explain this at longer length. Ryan’s Roadmap wasn’t a plan I would’ve supported. But it was a lot better than the budget Ryan recently produced. For instance: Where Ryan’s budget repeals the Affordable Care Act and leaves the uninsured to rot, Ryan’s roadmap had a health-care plan that relied on converting the regressive deduction for employer-provided health insurance into a progressive refundable tax credit available to all Americans, exchanges with auto-enrollment where the insurance offerings had to meet the same standards in the Federal Employee Health Benefits Program, etc. Frankly, it looked a lot like the Affordable Care Act, only with fewer subsidies and no individual mandate.
His plans for Medicaid and Medicare also made more sense. His Medicare plan was similar to the proposal in his budget, but the vouchers grew at a rate between inflation and medical-cost inflation. That’s a lot more realistic than simply growing at the rate of inflation, as they do in his budget. And his Medicaid proposal, rather than simply handing Medicaid over to the states and capping federal payments, actually federalized more of the program and gave Medicaid beneficiaries the option of taking $15,000 and purchasing insurance on the exchanges.
The worst part of his proposal was the tax section. Ryan said he was shooting to raise 19 percent of GDP through taxes — higher than the average throughout the Bush years — but independent analyses scored his tax proposals at 16.8 percent of GDP. Ryan’s office said his tax proposal was developed in consultation with the Treasury Department, and if, when the Joint Tax Committee actually scored it, it was under 19 percent of GDP, they’d make the changes necessary to hit their target. That seemed like a fair enough answer, and it was far from the first time that I’d seen a policy plan cooked up in some congressman’s office use optimistic assumptions that required modification when the proposal drew more scrutiny. Hardly a fireable offense.
If I were writing social policy, Ryan’s Roadmap is not how I’d do it. But it was a plausible conservative vision for how to move forward on a variety of front. His health-care plan, for instance, would clearly have been better for the uninsured than the non-PPACA status quo. His budget, conversely, would clearly be worse. So what happened? I think Ryan was free to try and be a policy wonk a year ago, and now he’s sold that out to develop fiscal policy that’s acceptable to a broader swath of the Republican Party. That’s why I’ve criticized him so harshly for his budget: Where the Roadmap elevated the discussion, his budget degrades it by relying on absurd assumptions and a cruel distribution of cuts.
I think Krugman is right to critique me — and some others — for really wanting to see conservative politicians take some of these policy questions more seriously. I do want that! It’d be good for the country. My personal rule is that I give legislators the benefit of the doubt until they demonstrate they don’t deserve it. The Ryan who developed the Roadmap and was willing to go on record saying that the future of health-care reform would require “rationing,” and the question was just who would do the rationing, deserved it. The Ryan whose budget gets its short-term Medicare savings from Affordable Care Act cuts he argued were unsustainable and its long-term savings by privatizing Medicare and shifting the costs onto seniors all the while assuming cost control at fantasy levels doesn’t.