If Paul Ryan’s office is right about the CBPP analysis of the Ryan Roadmap, I’ll be very disappointed. CBPP is an institution with a richly-deserved reputation for doing its work with great care.
The CBPP report does provide a very valuable service in its revenue estimates, which seems more plausible than others I’ve seen.
But note that attacks on the Roadmap haven’t primarily been about the revenue estimates, etc. Rather, they’ve centered on the idea that shifting to premium support and the Medicare Advantage model represents a dismantling of the welfare state, as does the use of personal accounts in a public retirement system. This is, in my view, highly misleading, and it’s easy to see why Ryan’s office might feel unfairly maligned.
In my view, the Roadmap is too optimistic on the revenue side and possibly too politically optimistic on the spending side, i.e., if we shift to a defined contribution model rather than a defined benefit, as I think we must, it is very plausible that upward political pressure on the contribution will be higher than the Roadmap assumes, consonant with health inflation overall. To be sure, the hope is that the shift to a defined contribution model will itself encourage a shift in the ecosystem that will help restrain health inflation, but we don’t have any guarantee of that, just as we have guarantee that the projections of how the Senate health bill will “bend the cost curve” in its second decade.