• A choice, not an echo

    I guess my wonky post on the econometric uncertainties regarding capital punishment will have to wait.

    In my view, Mitt Romney’s announcement of Representative Paul Ryan as his running mate is a good thing. The pick makes explicit the deep substantive differences between the two parties.

    You’ll hear a lot about the Ryan budget, Medicare premium support, and House Republicans’ fiscal policies. TIE has been all over these issues. Austin, especially, is an essential resource. His premium support series is a terrific introduction to the issues in play, as is his New England Journal of Medicine perspective piece “Why this is not the time for premium support.”

    Then there is the social safety net for poor people. In this arena, Mitt Romney and Paul Ryan propose to shift significant costs and risks onto states and individual recipients. Aaron and I have written extensively about this, too. See, for example, here, here, and here. If you doubt where I myself am located, this joint piece or this should clear things up.

    Looking across the internet, there are so many great resources. Jonathan Cohn, Paul Van de Water, Edwin Park and Matt Broaddus, Jonathan Chait, Robert Greenstein, Ezra Klein, David Frum, and Ryan Lizza are essential resources. Happy reading.

    • Let’s not over complicate things. Paul Ryan is a Randian objectivist. His budget is designed to make the life of the average American much less secure – necessitating an increase in work, suffering or both.

      He has proposed 5 trillion dollars in spending cuts. 62% of these fall on low-income support programs (food stamps, medicaid, pell grants, etc.). These spending cuts are needed to pay for a massive tax cut aimed squarely at those who need it the least.

      Yesterday, I was 80% sure I would vote for Obama but consistently told my (young, liberal) friends that there was a 20% chance that Romney would be more capable of delivering effective governance and that he could win my vote if the Republican party got on board with technocratic governance. Today, I am certain I will be voting D in November. Ryan’s budget is terrifying.


    • I wonder if this means the PCA finally gets scored?


    • absent in this discussion are democrat (substantive) proposals to reform medicare and other entitlements- to the extent they exist at all

      • Erik, the Affordable Care Act included many efforts to reform Medicare and to control health care costs more generally. IPAB, ACOs, and other measures may prove insufficient. But these were substantial measures.

    • with all due respect, i don’t know of any one who thinks those measures are “substantial” in light of the bill’s major expansion of coverage. if we use Massachusetts as a rough proxy, there will certainly need to be more robust cost measures than the administration is currently trying. in addition, they essentially backloaded the bill so costs escalate as the years go on- i don’t think these are honest measures to keep costs in line.

      • Hi Erik,

        I’m inclined to agree with you that the Medicare cost-cutting in the ACA won’t go far enough in the long run. If anything, ACOs and the like may only make the situation worse if, instead of changing market incentives to reward performace, they instead rig markets by concentrating power amongst ever larger provider systems. But, I’m willing to give the Democrats the benefit of the doubt, for now, because we fortunately have a few years to test these changes before the wave of Baby Boomer retirees really hits. If by, say, 2020, when my parents are ready to retire, health spending continues to grow at the present rate, then it may be time to try something more radical. At which point I may consider vouchers, or defined-contribution if you prefer, as acceptable reforms for Medicare.

        On a slight aside, I though back in 2009 that the Wyden-Bennett proposal was the best possible way to reform the present system to accomodate universal coverage and control costs without radically reconfiguring the entire system. I sometimes think of the Exchange parts of the ACA, in combo with some form of Wyden-Ryan, to be a potential end-run way to get Wyden-Bennett and a more efficient, and humane!, health care system.