But has Ryan ever put together major legislation with any real chance of passage? Yes, he made a name for himself with big budget proposals that received adoring press coverage. But these were never remotely operational — they were filled not just with magic asterisks — tax loophole closing to be determined later, cost savings to be achieved via means to be determined later — but with elements, like converting Medicare into a voucher system, that would have drawn immense flack if they got anywhere close to actually happening.
In other words, he has never offered real plans for overhauling social insurance, just things that sound like plans but are basically just advertisements for some imaginary plan that might eventually be produced. Actually pulling together a coalition to get stuff done? Has he ever managed that?
What I’d say is that Ryan is not, in fact, a policy entrepreneur. He’s just a self-promoter, someone who has successfully sold a credulous media on a character he plays: Paul Ryan, Serious, Honest Conservative Policy Wonk. This is really his first test at real policymaking, which is a very different process.
.. Everything else about the AHCA looks slapdash, like something thrown together in a few days by people who hadn’t thought at all about what a flat tax credit and a widened age band would mean for, say, people in Alaska with its expensive insurance, or low-middle-income Trump voters in their 60s. I have no inside information, but this sure looks as if they were still dithering about the whole principle of their Obamacare replacement until at most a few weeks ago, and didn’t work with CBO because they had nothing to work with.
.. In other words, maybe this looks like amateur hour because it is. Ryan isn’t a skilled politician inexplicably losing his touch, he’s a con artist who started to believe his own con
The Republican health plan fixes a problem Paul Ryan feels passionately about
This idea is, to many liberals, perverse. It means that Ryancare doesn’t give the neediest families enough help to afford decent insurance while blowing a substantial chunk of change on families who don’t really need much help.
.. One school of thought holds that a major problem with the Affordable Care Act is that it creates a structure where a hypothetical near-poor person has very little financial incentive to increase his labor market earnings. Ryan’s American Health Care Act restructures the subsidies in a way that doesn’t accomplish anything from a health insurance point of view, but does directly address this labor market issue.
.. But Ryan has a pretty consistent and somewhat metaphysical theory of poverty whereby helping poor people by directly providing them with additional material resources doesn’t count. What he wants is for the government to help poor people become more like middle–class people and raise their labor market earnings.
Hence, in Ryan’s view, all means-tested benefits create what he calls a “poverty trap,” where the existence of benefits reduces the incentive to bootstrap your way up the income ladder.
Paul Ryan’s Health-Care Vise
As with the majority of House Republicans, most members of the Freedom Caucus have only ever served under a Democratic President. They were elected to oppose Obama and everything he stood for and they spent most of his Presidency attacking Republican leaders who they believed thwarted those efforts. They have no experience legislating.
.. An early version of the Ryan plan replaced these subsidies with less generous refundable tax credits, which many conservatives dislike because Americans who pay no taxes would still be eligible for the credits.
.. Ryan’s response was to leave the expansion in place until 2020
.. Proponents of the Medicaid expansion see the deadline as creating a health-insurance time bomb that will detonate in a few years.
.. Health-care reform has long been stymied by the insurance industry. Bill and Hillary Clinton took on the industry in 1994 and were badly defeated. In 2009, Obama decided to buy the industry off by including a provision forcing every American to buy its product—the dreaded individual mandate.
.. Ryan and Trump have insisted they would keep those popular regulations while killing the mandate, which forces the uninsured to pay a tax penalty. Their solution is that the uninsured would pay a penalty to insurance companies. Specifically, insurers would be allowed to charge anyone with a two-month gap in coverage up to a thirty-per-cent surcharge on a new policy. For many Americans, the surcharge in Trumpcare could end up being more than the current tax penalty in Obamacare.
.. When Lyndon Johnson created Medicare he essentially made up and lowballed the long-term costs of the program. Without a true estimate, it was difficult for fiscal conservatives, medical groups, and other opponents to attack the plan, and it sailed through Congress.
.. In 2009, Obama became so frustrated by the C.B.O., whose cost estimates had an enormous impact on the health-care debate, that during an Oval Office meeting he said he didn’t want to hear the C.B.O. mentioned, so his aides referred to it as “banana.”
.. Ryan needed to shape a bill that would survive this process, and as a result, he left out some of conservatives’ most long-standing health-care-policy ideas. (For instance, most conservatives support changing a law that prevents insurance from being sold across state lines, arguing it would make markets more competitive and bring down costs, but Ryan didn’t include the change in his plan.)
.. Ryan has produced a bill that nobody would ever propose as a sane solution to the problems with Obamacare. Its only chance is speed. If Ryan can rush and muscle it through the House and Mitch McConnell can do the same in the Senate, it might end up on Trump’s desk. But the more scrutiny this House bill is subject to, the more likely it is to share the fate of most efforts at health-care reform and die somewhere on its journey to the Senate
Paul Ryan: The Flimflam Man
the Ryan plan would reduce revenue by almost $4 trillion over the next decade. If you add these revenue losses to the numbers The Post cites, you get a much larger deficit in 2020, roughly $1.3 trillion.
.. And that’s about the same as the budget office’s estimate of the 2020 deficit under the Obama administration’s plans. That is, Mr. Ryan may speak about the deficit in apocalyptic terms, but even if you believe that his proposed spending cuts are feasible — which you shouldn’t — the Roadmap wouldn’t reduce the deficit. All it would do is cut benefits for the middle class while slashing taxes on the rich.
.. The Tax Policy Center finds that the Ryan plan would cut taxes on the richest 1 percent of the population in half, giving them 117 percent of the plan’s total tax cuts. That’s not a misprint. Even as it slashed taxes at the top, the plan would raise taxes for 95 percent of the population.
.. most of the alleged savings in the Ryan plan come from assuming zero dollar growth in domestic discretionary spending, which includes everything from energy policy to education to the court system. This would amount to a 25 percent cut once you adjust for inflation and population growth. How would such a severe cut be achieved? What specific programs would be slashed? Mr. Ryan doesn’t say.
.. After 2020, the main alleged saving would come from sharp cuts in Medicare, achieved by dismantling Medicare as we know it, and instead giving seniors vouchers and telling them to buy their own insurance.
.. There’s also the unwillingness of self-styled centrists to face up to the realities of the modern Republican Party; they want to pretend, in the teeth of overwhelming evidence, that there are still people in the G.O.P. making sense. And last but not least, there’s deference to power — the G.O.P. is a resurgent political force, so one mustn’t point out that its intellectual heroes have no clothes.
But they don’t. The Ryan plan is a fraud that makes no useful contribution to the debate over America’s fiscal future.