Why does the Milwaukee Journal Sentinel's coverage of Paul Ryan suck?

In today's Milwaukee Journal Sentinel we learn that Paul Ryan is "praised" for his alternative health-care plan.

Who's doing the praising? A guy from the Heritage Foundation and a former McCain advisor.

Shocking that two rightwingers would praise Ryan.

The story says:

Ryan's proposal, part of what he calls "A Roadmap for America's Future," would replace the existing Medicare benefit for people under 55 with a voucher that could be used to buy private insurance. The payment, which Ryan has said would initially average $11,000 a year, would be adjusted for inflation and tied to income.

That would lessen the fiscal challenges facing the Medicare program because health care spending outpaces overall inflation. But at the same time, it could lower costs by putting pressure on doctors and hospitals to become more efficient.

The story fails to note that the way Ryan's plan really lowers cost is by balancing the budget on the backs of poor seniors.

Shocking news: Paul Ryan misleads on Obamacare

Deficit chickenhawk Paul Ryan's star turn during the health care summit set tongues wagging in the right wing blogosphere, including this guy, and Wingnutty Investors Business Daily smirked that no one had refuted Paul Ryan's arguments.

That may be because Paul Ryan's critiques, while dishonest, are indisputably well crafted.

Meanwhile, Ezra Klein has that response that so many on the right were waiting for:

To sum up, then, Ryan makes some good points about the true cost of the bill and realities of the federal budget. But he purposefully omits any mention of the bill's expected savings, disingenuously attaches the price tag of a broken Republican policy onto the health-care reform bill, and selectively stops extrapolating trends when they don't fit his points. It's a presentation designed to make the bill look less fiscally responsible than it really is.

But don't listen to me. Robert Reischauer is the head of the Urban Institute. He's also one of the CBO's most revered former directors, in no small part because his relentlessly honest cost estimates helped doom Bill Clinton's bill in 1994. I reached him earlier today and asked whether he thought this bill made fiscal sense. "Were I in Congress and asked to vote on this," he replied, "I'd vote in favor." The bill isn't perfect, he continued, "but it at least has the prospect for creating a platform over which more significant and far-reaching cost containment can be enacted."

Barney Frank embarrasses Paul Ryan

Barney Frank asks an obvious question. From the fall of 2009:

You know what bugs Paul Ryan about the Democratic health care plan?

It's not one provision or another. It's the fact that it's based on the "notion and philosophy of paternalism" ... "it's the arrogant notion that the federal government can better organize...the health care sector...than we as individuals can" ... it's "collectivist"

These are some of Paul Ryan's more substantial arguments in a video at the Paul Ryan Facebook site.

Paul Ryan's choice

Matthew Yglesias revisits Paul Ryan, following write ups by two conservatives (including Ross Douthat):

In essence, there’s a choice facing the country. We can maintain something like the tax rates that have prevailed for the past 40 years, which is what Ryan does, or else we can maintain something like the policy status quo that’s prevailed for the past 40 years, which is what Ryan doesn’t do. I think it’s pretty much inevitable that the future will involve some “give” on both points—higher taxes and changes to Medicare, in other words. What you mostly hear from the right, though, is the idea that we can make taxes lower and basically leave the country in the same place if we just cut down on earmarks. Ryan’s proposal inches toward conceding that that’s not the case, that the only way to keep taxes low is to radically revise not just the nature of Medicare as a program but the underlying principle that there’s a responsibility to ensure that seniors’ medical needs are taken care of in a comprehensive way.

Paul Ryan "might as well just claim gremlins will devour the deficit"

No. 1 Oshkosh blogger The Chief lays out what's wrong with Paul Ryan:

I have the same problem with this year's edition of the Ryan budget that I did with last year's: he takes as givens policies that would require legislative miracles in order to become law. Privatize Medicare? That's the GOP equivalent of creating a single-payer health care system. Same thing with privatizing Social Security accounts. Ryan may as well just claim that Gremlins will devour the deficit.

The big news is that the math potentially works. If that's true, then I've been wrong about criticizing Ryan for relying on the retread GOP think tank ideas with out assembling them in a coherent order that can produce results. The big problem still remains, however, that much of Ryan's budget is still composed of retread GOP think tank ideas that are extremely controversial and don't just materialize with the wave of a wand.

Paul Ryan wants to ration health care and has weird ideas about the health care market

Ezra Klein has an interesting conversation with Paul Ryan, though, frankly he gives Ryan too much credit (proposing a draconian bi;l that is politically unfeasible but gets you great headlines because most people don't actually know what's in it is not exactly a profile in courage).

Two points:

Paul Ryan comes right out and says he wants to ration health care -- a point that
Charlie Sykes is unlikely to raise on his show.

Paul also has weird ideas about the health care market:

Ryan: So what I’m saying is that rather than having government ration care to manage decline, let’s take those market signals that work in every sector of the economy to reduce cost and improve competition. I got Lasik in 2000. That’s a cash surgery. It cost me $2,000 an eye. Since then, it’s been revolutionized three times and now costs $800 an eye. This sector isn’t immune from free-market principles.

Klein: The Lasik thing is interesting because it gets to the question of whether health care is a market. When I think of getting Lasik, or buying a television, I can walk out of the store. That’s what gives me as a consumer my power in the market. But if I have chest pains and my doctor prescribes a bypass, how do I walk out of the store?

Ryan: In Milwaukee, the price of bypass ranges from $47,000 to $100,000. Nobody knows where to go for quality, or the prices. So wouldn’t it be good for the prices and quality metrics to be publicized? And let people make a decision. There’ll always be some level of co-pay or deductible or co-insurance that’s going to push people towards the best value. Then, when you have those chest pains and you’re being rushed in the ambulance, you’ll be rushed to a hospital that’s all along been competing for business and has been improved by that process. You’ll get better health care than you otherwise would. That’s how you improve the system.

Klein: You’re arguing that the benefits of competition accrue, and so even if you don’t choose at the moment of emergency, there’s still an effect from a higher-functioning market.

Ryan: Absolutely. I don’t know anything about cars. I look at Consumer Reports and their ratings. What matters is that someone who knows about cars went and figured this out. The car company is competing for the really tough customer who goes under the hood. I’m not saying every American has to be that consumer. But enough people have to so the rest of us can benefit.

"I have chest pains!"

"I'll take you to Joe's!"

"Nah, take me to Bob's, Joe's charges too much and skimps on the anaesthesia!"

I can't vouch for the spread in heart bypass costs cited by Ryan, but safe to say not all bypasses are the same nor are all patients the same whereas a Corolla of a Corolla wherever you buy it. Moreover, there is a severe limit on the accrual of the benefits of competition given that health care is a highly localized market (unless you're a medical tourist). And given that there's a limited number of providers in any geography, they will most likely mysteriously settle on a price that affords them a healthy profit -- not that there's collusion, per se, it just works out that way. Klein is a smart guy, he should have shredded Ryan on that point.

Paul Ryan wants to ration health care

Matthew Yglesias takes a look at Paul Ryan's Road Map to a Ditch and finds it wanting ... if not repulsive to most Americans:

Rather than have the government pay for your health care, the government will give you a voucher with which to buy private insurance. Initially, the voucher will be worth the same amount as the average cost of providing health care to people. But the insurance company will have higher administrative costs than Medicare, and it will have profit margins and such that Medicare doesn’t have, and it will pay more for services than Medicare does. So on day one you’ll lose your Medicare coverage and instead get a voucher that costs the government the same amount, but buys you much less in the way of health care services.

The way the government saves money over the long run, however, is that over time the voucher won’t keep up with the cost of health care. As the CBO explains in its analysis (PDF) of Ryan’s outline, the voucher will be “indexed to grow at a rate halfway between the general inflation rate, as measured by the consumer price index for all urban consumers (CPI-U), and the rate of price inflation for medical care, as measured by the consumer price index for medical care (CPI-M).” That means the value of the voucher “would increase at an average annual rate of 2.7 percent for the next 75 years, in comparison with the average annual growth rate of nearly 5 percent that CBO expects for per capita national spending for health care under current law.”

In other words, Ryan is proposing to ration care for seniors. He’ll take the baseline level of per capita medical costs for seniors in 2020 and then draw a curve representing 2.7 percent annual growth and say that any costs above that won’t be covered. If grandma’s got a bunch of money, then she can spend her money. If not, then the plug is pulled.

As Yglesias also notes, the plan wouldn't kick in until 2021, "which helps Ryan avoid needing to think about implementation details."