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Paul Ryan Is Not Ready to Give Up on Health Care
After the vote, Ryan lays out a way ahead.


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Robert Costa

‘This is the closing of the first chapter of America’s health-care saga,” Rep. Paul Ryan says from his office, which is adorned with reminders of contests of the non-political kind: hunting mementos and a Green Bay Packers helmet. “We are witnessing the beginning of a whole new kind of health-care politics, the likes of which we have never seen before.”

Ryan, a 40-year-old Wisconsin Republican, says Republicans have a fight on their hands, and he is ready for combat. As Democrats scrambled this past week for votes, he’s been listening to Metallica on his iPod and strategizing about how best to counteract Obamacare. Sunday night’s passage, he says, “was a rude awakening and a big wake-up call,” but also a call to action for Americans — and, especially, for the GOP.

“We need to establish a set of metrics and benchmarks to measure the sector going forward, keeping a close eye on all of the Democrats’ claims,” Ryan says. “From cost to quality, we will need to be vigilant in making sure that their assertions are actually substantiated with facts, and I have every reason to believe they won’t be.” Repealing Obamacare should be the goal, he says, “but with the political plurality you need to do that — a new president, 60 senators, and a majority in the House — that is a pretty tall order.”

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While Democrats celebrated a legislative victory last night, Ryan, the House Budget Committee’s top Republican, believes the GOP has “won the cost argument” on health care. “It is just intuitive,” he says. “We are going to insure everyone else in America and we are going to save money? That just doesn’t add up in people’s minds.”

What also does not add up is President Obama’s confidence that the American people are going to accept his health-care program and the vision it encapsulates — and that debate, Ryan says, has just begun. “Health care is really the issue that speaks to the relationship between the citizen and the government in America,” he says. “It shapes the fiscal trajectory and the economic trajectory. This whole debate has been a proxy fight about what kind of country America will be — whether we’ll become a cradle-to-grave welfare state or stay a free-market democracy. The Democrats who are being told that the worse is over should know that the battle has not even begun. It’s up to us to now bring the case to the American people — a real moral, philosophical, and economic case — asking about our values, our founding principles, and if we really want to move toward a Western European–style system.”

“Just look across the pond at how terrible things have become,” Ryan says. In Britain, even Conservative leader David Cameron is politically unable or unwilling to criticize the National Health Service, and Ryan calls that “a pretty pitiful thing to watch.” President Obama knows this, Ryan says, and wants government health care to achieve the same level of entrenchment here at home. “What’s really happening here is the president is saying to the American people that you’re stuck in your current station in life, you’re frozen, and the government is here to help you cope with it. But that’s not who we are. We are a dynamic society where people have the will and incentive to make the most of their lives, to reach their potential. With this bill, that whole mindset, the American idea is upended.”

What about the practical consequences of Obamacare? “Soon, we’ll see individual-market insurance companies go out of business and dump their people,” Ryan says. “Tax increases on capital are going to hurt the economy in 2011. These arbitrary Medicare cuts will adversely affect the providers and therefore their beneficiaries. You’ll have the Internal Revenue Service beefing up its enforcement of this new mandate, which people have no clue is coming. And you’re going to have employers dump employees in this exchange once it’s up and running — funneling everyone into a government-run rationing system. Then we’ll see a big spike in insurance rates, and the Democrats are going to wager that they can just blame the insurers for that, and therefore that means they will need to institute insurance price controls or have a public option. Our side is going to say, ‘Look at what you just did to ruin our health-care system,’ and focus on repeal.”



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