Does Ryan now believe health-care reform’s Medicare cuts are sustainable?

With the CBO report out and the experts having had more time to drill into the details, some elements of Paul Ryan’s budget that initially looked confusing are coming clear — or at least clearer.

For instance, I asked how Ryan was able to assume repealing the Affordable Care Act will save $1.4 trillion over the next 10 years when the Congressional Budget Office says keeping Affordable Care Act saves more than $200 billion over the same period. The answer, it turns out, is that Ryan is separating the law’s spending and the law’s savings — and then he’s only repealing the spending and the taxes. He’s keeping all the Medicare cuts that the GOP ran against in 2010.

This presents a different problem, however. Ryan has repeatedly said that the cuts to Medicare are not sustainable. So, too, have his policy gurus. Conservative health wonk Jim Capretta, who Ryan’s staff has often directed me to when I’ve called with questions about their health-care proposals, directs a project called ObamaCareWatch, which warned, “the official Medicare actuaries have determined that approximately 15 percent of hospitals will be driven out of business in less than ten years if these cuts go through and called the cuts ‘clearly unworkable and almost certain to be overridden by Congress.’”

Now Ryan is implementing these same cuts. And his privatization plan doesn’t provide him an out: It doesn’t begin till 2022, by which point his budget, according to his own experts, will have driven 15 percent of hospitals out of business. (For the record, I don’t think these cuts will drive 15 percent of hospitals out of business, as I think various delivery-system reforms will help us muddle through.)

Ryan also told CBO to assume, for the purposes of scoring his budget, that he’s going to find $300 billion to fix doctor’s payments, though he hasn’t yet said how he’ll do it. Put those two policies together and you see that the Medicare savings his budget presents over the next 10 years are the Medicare cuts he and his experts derided as unrealistic and a $300 billion doc fix that he hasn’t supplied an offset for yet. I get the feeling that if Obama tried to claim savings based on similar strategies, Ryan, in his position as chairman of the House Budget Committee, wouldn’t be particularly happy about it.