Has Rep. Ryan Changed His Mind About The Affordable Care Act?

December 15, 2011 4:12 pm ET — Kate Conway

Rep. Paul Ryan

House Budget Committee Chairman Paul Ryan (R-WI) is no fan of the Affordable Care Act, but his new Medicare proposal, a joint effort with Democratic Sen. Ron Wyden (OR), suggests he might not be as averse to the substance of the law as his rhetoric suggests.

In an op-ed written immediately after the Affordable Care Act's passage, Ryan urged lawmakers to "repeal the entire faulty architecture of the government behemoth and replace it with real reform." One of his primary complaints was what he characterized as the law's failure to "invit[e] market forces into health care," and he claimed (despite a CBO analysis to the contrary) that the law would only worsen federal debt.

Yet the Ryan-Wyden proposal copies a major part of the Affordable Care Act. Unlike Ryan's politically toxic previous Medicare reform proposal, which would have replaced Medicare with a voucher system and achieved savings by restricting the government's contribution such that it could not keep up with rapidly rising health care costs, on this go-round some of the proposed cost savings are based on setting up competition between plans. Seniors would be able to choose to use federal money to purchase a plan either through Medicare or from a private insurer. The amount of money allotted each person would be determined in a yearly review of all the competing eligible plans, with the subsidy equaling the cost of the second-least-expensive plan. Ezra Klein explains:

The competition is driven by tying the subsidy to the second-least expensive plan in the market. That way, the system gives beneficiaries a financial incentive to choose the cheaper plan. That is exactly-- exactly! -- how the Affordable Care Act works. The difference here is that the system will include a massive public option in Medicare, which is something conservatives refused to allow in the Affordable Care Act.

That puts Ryan in a tricky place: If he's still trying to pretend to be a "serious" budgetary figure, it'll be hard to simultaneously attack the Affordable Care Act as a boondoggling budget-buster while claiming the same principles will work monetary wonders in his own bill. Here's Ezra Klein again:

[I]f you believe that a competitive-bidding process will save far more money than the CBO says it will -- and that happens to be the belief underlying all of Ryan's Medicare plans -- then you should believe that the Affordable Care Act will save far more than the CBO says it will. Competitive bidding either works or it doesn't. But it can't only work for seniors. In fact, many health-care experts think seniors are the population among which it's least likely to work, as many of their health costs are already locked in, and people with many health problems and established relationships with doctors don't want to switch plans midstream.

Mother Jones' Kevin Drum sums it up: "Basically, Obamacare moves our current private insurance system in the direction of government support with competitive bidding, while Wyden-Ryan moves our current federal Medicare system in the direction of private support with competitive bidding." The question remains, is Ryan intellectually honest enough to reverse his rhetoric on the Affordable Care Act and acknowledge its similarities to his new plan?

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