It was not a high point for intellectual discourse within the American right.
Amidst this cacophony, Paul Ryan appeared like a beacon of light. Personable and soft-spoken, capable of stringing together numbers in a way that sounds impressive, Ryan was the yin to a movement drunk on its own yang. And he soon milked his own novelty — a tea partier! who is also a policy wonk! — to become the toast of the political commentariat.
Conservative writer Bill Kristol touted Ryan as the GOP’s ideal presidential candidate — asking his readers “Why not the best?” Liberal wonkblogger-turned-voxsplainer Ezra Klein touted the “virtues of Ryan’s roadmap,” the future speaker’s aggressive plan to shrink entitlements. After Ryan’s election to the speakership seemed inevitable, the Christian Science Monitor profiled him under the fawning title “Paul Ryan: Budget wonk to Congress’s rescue?”
As Alec MacGillis wrote in a piece that was far more skeptical of Ryan’s policy chops, “Paul Ryan stands as the Republican Party’s big thinker, its philosopher prince.”
But Speaker Ryan’s reputation for wonkitude is not deserved. Indeed, his proposals typical follow a familiar pattern — a pattern Ryan repeated on Wednesday with a package of health reforms Jonathan Cohn and Jeffrey Young described as a plan to “replace 20 million people’s health insurance with 37 pages of talking points.” Ryan offers sweeping, ambitious ideas that would radically transform the fundamentals of America’s social contract. Then, when genuine policy wonks point out that Ryan’s numbers don’t add up, or that his ideas would have absurd consequences, Ryan often responds with a new proposal that is just like the first — only vaguer.
If details enable Ryan’s opponents to discredit his ideas, then Ryan defends himself by refusing to offer details. As Tara Culp-Ressler notes, Ryan’s latest set of health care proposals “doesn’t include information about exactly how many people would be covered, exactly how much the proposal would cost, or exactly how much assistance Americans would receive in the form of tax credits to help them buy insurance.”
Paul Ryan’s ambition, in other words, is matched only by his innumeracy. He builds cathedrals to dyscalculia, and fills them with a worshipful press corps. But his is a false faith, resting upon ideas that do not withstand scrutiny.
Comrade Paul Ryan
“I earned capital in this campaign, political capital,” a jubilant George W. Bush announced in 2005, shortly after he vanquished his Democratic opponent John Kerry. “And now I intend to spend it.”
He intended to spend it on a proposal to partially privatize Social Security — a proposal that proved wildly unpopular and that never became law.
Yet, despite this idea’s unpopularity, a junior congressman named Paul Ryan believed that he’d amassed even more capital than a recently elected President of the United States. Ryan’s plan to privatize Social Security was so ambitious it made the Bush White House blush. President Bush’s director of strategic initiatives, Peter Wehner, labeled the plan “irresponsible.”
The Ryan Social Security plan would have allowed the average worker to shift about half of their contributions to Social Security into a private account, or about 6.4 percent of their earnings. These funds would then be invested into a mix of stocks and bonds until the worker retired, at which point the money in this account would be used to purchase an annuity.
There were many hiccups with this proposal, including the fact that it would have blown a $280 billion hole in the funds available for current retirees — a hole that would need to be filled in each year with additional taxes. The biggest unintended consequence, however, was that it would have achieved something the Communist Party of the United States of America could have never imagined in its wildest dreams.
It turns out that, if you take 6.4 percent of every worker’s paycheck who participates in this program, you wind up with a whole lot of money. In fact, you wind up with so much money that, if you invest these funds in stocks and bonds, the sheer mass of these investments will eventually push all other investors out of the market. As Dylan Matthews explains, under Ryan’s Social Security plan, “investments in the stock and bond markets would skyrocket such that by 2050, every single stock or bond in the United States would be owned by a Social Security account. This would mean that the portfolio managers at the Social Security Administration would more or less control the entire means of production in the United States.”
Paul Ryan set out to inject more capitalism into America’s core entitlement program, and he wound up proposing a plan that would literally transform the United States into a communist nation. Workers of the world, unite. You have nothing to lose but your chains!
Ending Medicare, Period
A few years after Ryan called for the bulk of America’s business sector to be held collectively in a government-run trust, the future speaker turned his sights towards Medicare.
One of the most overlitigated questions in American politics is how to fairly describe Ryan’s proposal. The Democratic Congressional Campaign Committee initially described Ryan’s Medicare plan as a proposal to “end Medicare,” a claim that was savaged by credulous fact checking organizations. Politifact even labeled claims that Republicans who supported Ryan’s Medicare plan “voted to end Medicare” its 2011 “lie of the year.” Eventually, many Democrats settled on the mealy mouthed phrase “end Medicare as we know it” to describe Ryan’s plan.
But Politifact’s 2011 “lie of the year” was entirely true. Ryan’s proposal — or, at least, the version of the proposal that existed in 2011, didn’t just end Medicare as we know it, it would have ended Medicare. Period.
The core of Ryan’s Medicare proposal is a plan to eliminate traditional Medicare, a government-run health insurance program for seniors, and replace it with a voucher that seniors can use to help purchase a private health plan. Though Ryan’s proposal would have delayed implementation of the plan by 10 years, the immediate impact of the plan, once it did take effect, would have been to massively increase out-of-pocket costs for American seniors:
Then, it gets worse for retirees. Although Ryan’s vouchers would gain value in absolute dollars over time, his 2011 proposal provided that they would gain value more slowly than the rate of health inflation — thus, they would cover less and less of a retirees’ insurance premiums with each passing year. According to the Congressional Budget Office, “by 2080, Medicare would be cut 76 percent below its projected size under current policies.” Thus, a child born in 2015 would receive less than one-quarter of the resources provided to today’s seniors when that child became eligible for Medicare.
So, while Ryan wouldn’t have ended Medicare in the sense that he would have simply snapped his fingers and made every American senior’s health care go away, his proposal was designed to gradually phase out the program over time.
When this proposal was released, many of Ryan’s opponents assumed that Ryan offered a plan that would slowly eliminate Medicare because his goal was to eliminate Medicare. In 2012, however, Ryan released a new budget proposal that made a significant concession to his critics. The 2012 plan included deep cuts to Medicaid, food stamps and other programs intended to serve the least fortunate, and it retained the overall structure of Ryan’s proposal to voucherize Medicare, but it also provided that the value of these vouchers would keep up with health inflation.
Only Paul Ryan can know whether he decided to make this shift because his 2011 proposal proved too unpopular or because he genuinely did not realize that his plan would phase out Medicare until real health policy wonks pointed this fact out to him. There is one piece of recent evidence which suggests that the later theory may be true, however — the package of health reforms Ryan announced on Wednesday.
Meet The New Better Way, Same As The Old Better Way
Ryan’s latest package of health care proposals is part of a broader set of ideas the speaker has packaged under the label “A Better Way: Our Vision For A Confident America.” Ryan’s vision for a confident America, however, looks a whole lot like the McCain-Palin 2008 vision for a confident America in many of its particulars. And the ideas that are not recycled from the McCain-Palin campaign are largely recycled from Ryan’s own past proposals — although with few details and fewer, if any, actual numbers.
A Better Way retains Ryan’s plan to voucherize Medicare, although it is very insistent that the plan should be described as a “premium support” program and “not a voucher program.” For what it’s worth, a Better Way also appears to reject the 2011 proposal to phase out Medicare. Now Ryan says that the value of the voucher should be determined “based on the average bid of participating plans.”
Yet, while A Better Way does not call for Medicare to be phased away into nothingness, it utilizes a structure similar to Ryan’s 2011 Medicare phase-out elsewhere in its proposals.
Borrowing an idea from the McCain-Palin health plan in 2008, A Better Way replaces the network of tax credits and regulations enacted by the Affordable Care Act with a tax subsidy that can be used to help purchase health insurance. Like Ryan’s 2011 vouchers, however, it does not appear that this subsidy will keep up with health inflation. “Obamacare’s credits are tied to health care premiums,” Ryan complains in the paper laying out his latest health proposals. His plan, by contrast, “provides a fixed amount grown over time.” Though Ryan is not specific about how much this “fixed amount” will grow each year, the fact that its value is not “tied to health care premiums” suggests that it will lose real value in the same way as his 2011 vouchers.
Beyond these ideas, A Better Way is a dog’s breakfast of old ideas, vague outlines of proposals, and bold promises that are often contradicted by other proposals elsewhere in the overall package of reforms. To give just one example, Ryan’s paper places state regulators on a pedestal. These regulators, Ryan claims, “should be empowered to make the right tradeoffs between consumer protections and individual choice, not regulators in Washington.” “The federal role,” Ryan adds, “should be minimal and set a few broadly shared goals, while state governments determine how best to implement those goals in their own markets.”
Yet, despite this stated goal, Ryan later offers a proposal that would effectively gut state regulation of the health insurance industry and impose a federally mandated, laissez faire regime on state insurance markets throughout the nation.
Possibly the vaguest section of a white paper laden with nebulous proposals is Ryan’s call to permit consumers to buy insurance “across state lines.” “Current law obstructs people from purchasing a plan licensed in another state,” Ryan claims in five-sentence section of his white paper. Under his plan, by contrast, “consumers would no longer be limited to coverage options available only in their state.”
While Ryan offers few details about how this idea would work, it is a restatement of an idea that has been around at least since the McCain-Palin campaign in 2008. Like Ryan, McCain and Palin proposed allowing consumers to buy health insurance “across state lines” in 2008. To understand just what such a proposal would entail, however, it is important to understand exactly why many Americans historically have not had the option of buying health insurance in another state’s market.
Even prior to Obamacare, many states had laws setting minimum standards for health insurance. Forty-nine states plus the District of Columbia, for example, required health plans to cover reconstructive surgery after breast cancer, maternity stays, and mammograms. Thirty-one states required insurers to cover well child care. Forty-four states and the District of Columbia provided an appeals process for denials of coverage.
Allowing consumers to buy insurance “across state lines” means permitting them to buy insurance even if it does not comply with the laws of the state where they live. It is a proposal to eliminate state regulation of health insurance, by allowing insurers to avoid regulation simply by relocating to the state with the least consumer-protective laws. Indeed, Ryan previously acknowledged that this would be the impact of his proposal to allow insurance sales to cross state borders. In 2011, he touted his plan to allow cross-state insurance sales because it would mean that an individual’s health plan would not need to include “health benefits mandated by their home States.”
So Ryan’s latest health care package is at war with itself. It rails against top-down decrees from Washington, all while imposing a structure on states that would effectively neuter their insurance laws. And it’s only the latest in a comedy of errors that includes a proposal to phase out Medicare and an accidental effort to nationalize the means of production. Nor are these the only examples of Ryan’s allergic response to math — we haven’t even discussed the multi-trillion dollar “magic asterisk” Ryan relies upon to pay for his tax proposals.
It’s time to stop treating this man like he’s a policy wonk. Or even like he knows anything at all about how America’s policy infrastructure works.
Author: Ian Millhiser