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Ryan Proposes End to Great Society (Except for the War Part)

This item by Ed Kilgore was originally published on April 5, 2011.

The wave of conservative hype greeting the release of Rep. Paul Ryan's draft budget resolution is a pretty clear indication the Republican Party is about to take a deep breath and go over the brink into a direct assault on the programs and commitments that gave the United States a small replica of the modern welfare state common in the rest of the developed world. So excited are they that the New York Times' David Brooks, who normally likes to position himself as an eagle soaring above the grubby machinations of both political parties, just can't contain himself:

Over the past few weeks, a number of groups, including the ex-chairmen of the Council of Economic Advisers and 64 prominent budget experts, have issued letters arguing that the debt situation is so dire that doing nothing is not a survivable option. What they lacked was courageous political leadership -- a powerful elected official willing to issue a proposal, willing to take a stand, willing to face the political perils.

The country lacked that leadership until today. Today, Paul Ryan, the Republican chairman of the House Budget Committee, is scheduled to release the most comprehensive and most courageous budget reform proposal any of us have seen in our lifetimes. Ryan is expected to leap into the vacuum left by the president's passivity. The Ryan budget will not be enacted this year, but it will immediately reframe the domestic policy debate....

The Ryan budget will put all future arguments in the proper context: The current welfare state is simply unsustainable and anybody who is serious, on left or right, has to have a new vision of the social contract.

Wow, you can almost hear the soaring music of a Tim Pawlenty ad when you read that passage! As Brooks would have it, Ryan's assault on "the welfare state" isn't really debatable; it's based on Revealed Truth that all honorable people will accept and only scoundrels will deny. Anyone second-guessing this leader who has exposed Barack Obama's cowardice must come with his or her own six-trillion dollar package of cuts for benefits affecting those people whose aspirations to luxury items like health insurance are now "unsustainable."

But while Brooks and others praising Ryan's budget are laughable in lauding the "courage" of a safe-seat congressman throwing red meat to his party's base while taking on the poor and disabled and delighting private health insurers and anyone paying corporate taxes--they are right about Ryan's audacity.

The simple way to put it is that Ryan's budget steers clear of taking on the signature New Deal social program, Social Security, but takes dead aim on the Great Society's accomplishment of a partial set of guarantees for access to health care.

By any meaningful measurement, Ryan's proposal would kill Medicare by privatizing it and capping its costs, and kill Medicaid by making it simply a soon-to-be-phased-down grant to states with no obligation to provide a set of minimum benefits for the poor and disabled.

On the first point, Josh Marshall nicely explains why privatizing Medicare destroys its very rationale:

We all know about pre-existing conditions. You're a cancer survivor so no insurer will cover you. Or you have one of the myriad possible conditions that make you a bad risk. And no insurer wants to issue a policy for someone who odds say is likely to cost a lot of money. Well, guess what, people over 65 all have a preexisting condition: they're old!

Now, not that people aren't living longer and longer lives. And plenty of folks in their late 60s are in better health than folks 10 or 20 years younger. But by and large, we all know how this life thing works. When you hit your mid-60s or so, things start breaking down. And eventually, you die. That's a bald way to put it. But we all understand that this is true. The simple truth is that for all the problems with private health insurance for the young and working age populations, it just doesn't work for seniors.

We tried it. That's why we ended up creating Medicare.

We created Medicaid (originally a Republican alternative to universal health coverage) to ensure that people with insufficient funds to purchase health services or insurance or whose health costs outstripped their ability to pay would not, to put it pretty bluntly, get even sicker and/or die. Ryan's "block grant" proposal would end any personal claim on health services for any American, and would simply subsidize state health care programs for the indigent and the disabled (a subsidy guaranteed to be a fat target in futue federal deficit reduction efforts once the "problem" is thought of as a state responsibility). Here's a mild estimate of what that would involve from the Center for Budget and Policy Priorities:

States would most likely use their additional flexibility to cap Medicaid enrollment and put people on waiting lists once the cap was reached (which they cannot do today), significantly scale back eligibility for millions of low-income children, parents, pregnant women, people with disabilities and seniors -- driving many of them into the ranks of the uninsured -- or cut services substantially, with the result that many of the nation's poorest and most vulnerable people could become underinsured.

With respect to Medicaid, the downward spiral of eligibility and benefits contemplated by Ryan's proposal would occur after the immediate disqualification of an estimated 15 million Americans who would obtain Medicaid coverage under the provisions of last year's health reform legislation, which Ryan would repeal. That's quite a giant leap backward for anyone supporting the basic idea of universal health coverage.

Against the background of a budget that will apparently leave defense spending pretty much as it is, while applying any savings from closing tax loopholes to the lowering of top and corporate rates, Ryan's Medicare/Medicaid proposals are astoundingly unbalanced. For all the talk about his "courage," it's also noteworthy that Ryan insulates today's seniors (who happen to be more heavily Republican in their voting preferences than at any time in recent memory) from any changes in Medicare, while targeting a Medicaid-eligible population with few GOP voters.

To conservative ideologues who think America went fatally wrong in the Great Society years--except, of course, for the establishment of a National Security State supporting a vast array of overseas military commitments that helped our allies afford their own welfare states--Ryan's budget makes perfect sense. In taking on Ryan, it's imperative that Democrats begin by making it clear exactly what is at stake.