Liberal attacks on the Medicare plan have not caught up with these changes. Last year, Democrats argued that since health-care costs rise faster than inflation, a subsidy that rises only with inflation will leave seniors paying an ever-higher share of those costs. They’re making the same argument this year. But the new plan is immune to this critique: Seniors will always have an option to pay no more than they are paying now. Ryan can be said to be “ending Medicare as we know it” only in the sense of stopping it from being quite as centrally micromanaged, and unsustainable, as it is now.
As ambitious as Ryan’s plan is — it would accomplish more conservative reform than the last three Republican presidents combined — it has unfortunate omissions. It says nothing about Social Security reform, and thus fails to restrain the growth in benefits for well-off seniors. Liberals would have given Ryan no credit for addressing Social Security, but it would have been the right policy. The plan is either too vague about tax reform or not vague enough: It makes no sense to commit to a tax code with a 10 percent and 25 percent rate but to remain silent on deductions and even on the level of income to which each rate would apply. The plan says nothing, for example, about the tax treatment of health-care coverage. But if Obamacare is to be repealed, that treatment should be changed to allow a market for insurance purchased by individuals to grow. In at least one area, meanwhile, the plan goes too far, imposing federal limits on malpractice suits, an area that states have traditionally and rightly governed.
Ryan and the Republicans have, nonetheless, put forward a plan to bring the federal debt under control and to avoid massive tax increases. Neither the president nor his Democratic allies have done these things. The contrast is very much to the former’s credit and the latter’s shame.