Let’s say it’s 2027 and I’ve just turned 65. I fill out a Medicare application on-line and opt for a plan with superior heart coverage (my father died of a heart attack), not too much knee coverage and physical therapy (my job doesn’t require heavy lifting), no cancer heroics (my mother turned them down and I wish to follow her example), and lots of long-term disability. Is that so terrible an approach? Is it obviously worse than having the Medicare Advisory Board make all of those choices for me?
Rationing yourself is much more tolerable than having government rationing it for you. Matt Yglesias:
[I]n terms of the “welfare” aspect of Medicaid by far the largest set of poor people it covers are poor children …. Poor kids tend to struggle with a lot of problems and are in many ways disadvantaged in the competitive economy by the time they’re out of diapers. It seems to me that investing in their basic health care is a no brainer way of leveling the playing field somewhat and ensuring that the country is making the most of our human resources.
Matt fails to say what he would do instead. It seems to me that any criticism of Ryan should explain a realistic alternative to what he has proposed. Just hammering him on cuts is not enough, given the debt that hangs over the future generations. If Matt, like Chait, wants simply to raise taxes, he should say so. J.D. Hamel:
Of all the things I can’t stand about politics, the tendency to emotionalize a difficult topic is probably the worst. Budget cuts hurt—just ask our friends in the United Kingdom. But budget cuts are coming, because our entire welfare system depends on a false premise: a rapidly growing population. It’s a pretty simple concept: the taxes from young workers support the benefits of elderly dependents, so the system works fine so long as the young significantly outnumber the old. Our system is stressed because the number of retirees is growing at a faster pace than the number of workers.
Paul Ryan is unveiling the Republican’s 2012 budget proposal. Credit where it’s due: He didn’t dodge. His budget privatizes and voucherizes Medicare, dismantles Medicaid and turns it into a system of block grants, reforms the tax code, sets caps on federal spending, and much more. Like many such plans, it says more about how much government can spend than about how it will get spending down to that level while still providing the promised services, but it is, nevertheless, a dramatic proposal that will define the budget debate for the rest of the year. It’s also completely, almost gleefully, unacceptable to Democrats
Further analysis from Klein here. Douglas Holtz-Eakin:
Critics from the left will quickly attack “premium support” for Medicare and “block grants” for Medicaid as cheap attempts to shift costs to seniors and the poor who are ill-equipped to handle the burden. In fact, premium support will likely be means-tested to reflect economic circumstances, risk-adjusted to give those who are ill more support, and indexed to reflect rising prices. The reform will protect those in or near retirement and then shift to a system that essentially mirrors what Congress has right now. Seems hard to object.
A plan dedicated almost entirely to slashing social spending in a country that’s already the stingiest spender in the developed world, while simultaneously cutting taxes on the rich in a country with the lowest tax rates in the developed world — well, what could be more serious than that?
Paul Ryan may be Barack Obama’s worst nightmare. On the day after Obama launched his re-election bid with a soft, ambiguous, and oddly passive ad imploring people to come to his rescue, Ryan and his team have released a sharp, focused three-minute video on his plan to rescue America from its looming debt and entitlement crises. Obama and his fellow Democrats have chosen not to lead for short-term political gain. Ryan fills the leadership vacuum in three minutes, explaining the nature of the crisis in easily-understood terms, and the solution to it — cutting spending.
There’s a lot to say about Ryan’s rollout, but the immediate point to be made is that the optics of it have been carefully thought through and are very slickly done. Ryan’s sales pitch will rely on repetition of the phrase “path to prosperity,” on persuading the public that these proposals spread the pain around to everyone, and on creating a profound sense of crisis as a means to selling the public on ideas that are deeply unpopular and ideologically far out of the mainstream.
The Ryan budget will not be enacted this year, but it will immediately reframe the domestic policy debate. His proposal will set the standard of seriousness for anybody who wants to play in this discussion. It will become the 2012 Republican platform, no matter who is the nominee.
The president’s walking away from the deficit commission he set up was, to my mind, one of those moments when his caution was not about the substance of the issue but the politics. He knows we need to cut entitlements and defense or face fiscal collapse. And yet he has allowed Paul Ryan to move into the vacuum Obama created on the most important domestic issue of the day. Ryan’s 
context of heterosexuality, the relationship between romantic love and the peopling of the earth allows us to see how friendship is less useful or necessary, in the narrow sense of those terms.
The Dish 