As progressives pounce on Rep. Paul Ryan's new budget proposal, they should also give the man a little credit. The plan he unveiled is a daring attempt to define an actual conservative governing philosophy. That's a big improvement on the reactionary and crotchety anti-government platitudes served up by the Tea Party.
And while progressives will rightly reject Ryan's overall plan as draconian and unfair, they ought to keep an open mind about some of its most audacious elements, especially his ideas for controlling public health care spending.
For better or worse, the House Budget Committee Chairman has produced a coherent vision for limited government. It would sharply cut domestic spending, returning it to 2008 levels, reduce federal deficits by more than $4 trillion over the next decade, and hold federal spending below 20 percent of gross domestic product. It would further roll back the state and buttress "individual responsibility" by repealing Obamacare.
Ryan embraces President Obama's Fiscal Commission proposal to cut tax expenditures and use the proceeds to bring the top individual and corporate income tax rate down to 25 percent. But unlike the commission's approach, which commits a chunk of the savings to deficit reduction, Ryan makes his revenue neutral in obeisance to the prime ideological imperative of today's GOP: Taxes must never, on any account, be raised.
Ryan's most controversial proposals are also his most intriguing. In what he describes as a continuation of the bipartisan welfare reforms of the 1990s, he would convert Medicaid, which provides health insurance to poor families, into a block grant. Currently its costs are shared by the federal and state governments. As critics like Ezra Klein point out, a block grant is a device to limit federal health spending, shifting costs to states and individuals. It's true that a block grant alone doesn't constitute "reform" of Medicaid. But in tandem with reforms in health care delivery, especially efforts to move from fee-for-service to capitated "accountable care organizations," a block grant could dampen inflationary pressures and protect taxpayers against the automatic and unsustainable growth of public health care spending.
Similarly, Ryan proposes to control Medicare costs by replacing open-ended subsidies with a "premium support" model. Under this approach -- essentially a voucher, despite Ryan's denials -- Washington would give Medicare recipients a set amount (varying according to income and health status) they could use to buy insurance from competing private plans. Although Republicans wrongly assume that competition alone will drive down health costs -- again, changing incentives to focus medical spending on the value rather than the volume of care is the key -- premium support at least puts a governor on the engine of mandatory public health care spending, the main driver of America's debt crisis.
Some liberals undoubtedly will see it as a plot to destroy Medicare. But recall that a bipartisan Medicare reform commission President Bill Clinton created in 1998 came close to embracing premium support. It's also been endorsed by leading Democrats, including former CBO chief Alice Rivlin, and is part of the Rivlin-Domenici deficit reduction plan. In fact, as part of a more comprehensive strategy to contain health care costs, a Medicaid block grant and premium support for Medicare could serve a progressive purpose, by preventing rapid entitlement spending growth from squeezing vital public investments in children and families, scientific research, infrastructure and a clean environment.
On Social Security, Rep. Ryan disappointingly punts, proving no bolder than the White House. And as certified fiscal hawk David Walker points out, the Ryan plan does not include substantial savings in defense spending, and raises not a penny in new revenues to help the nation whittle down its enormous debts.
In other words, it's an unbalanced plan, morally and politically, that gives the Pentagon and the wealthy a pass, and concentrates the pain of deficit reduction on middle and low-income families. The Fiscal Commission's approach, broadly endorsed by 32 Republican and 32 Democrats senators -- if not yet by Obama himself -- is infinitely preferable as a starting point for a serious debate.
Nonetheless, the Ryan plan puts conservatives' ideological cards on the table and helps clarify the trade offs that must be made to strike a bipartisan deal. And it contains some ideas for ensuring that public budgets aren't swamped by runaway health costs -- ideas that progressives ought not to reject out of hand.