The Editors are right to note that IPAB, despite all the Democrats’ denials, is a rationing measure. But rationing should not be a dirty word. The alternative to rationing is uncontrolled expenditure. Ryan himself described the situation correctly: “Rationing happens today! The question is who will do it?” If you moved to a premium-support model, the answer would be “consumers and private insurers.” But since single-payer Medicare is going to be around for decades to come (if not forever) some of that rationing will have to be done by the government.