In 2008, John McCain rolled the dice by choosing Sarah Palin. That maverick move tarnished a good man’s legacy. It was breathtakingly irresponsible to place a manifestly unqualified and intemperate person in a position where she might be just one septuagenarian’s heartbeat away from the presidency.
Mitt Romney – nobody’s maverick – picked a smarter and more temperate running mate this time around. Romney deserves real credit for appointing Representative Paul Ryan. Now we can have a campaign that matches what this election is really about.
As economist Hank Aaron and I discussed here before, the 2012 election is one of the most important in memory. This year’s campaign has always been larger than the competition between two men. It’s about two different visions of American government. Ryan’s extreme conservatism makes the choice explicit: Do Americans wish to hand over the car keys to an energized, emphatically conservative House Republican majority exemplified by Mr. Ryan?
If you follow health policy, you’ve heard much about the Ryan budget, his various proposals (now somewhat moderated) to eventually turn Medicare into a de facto voucher program, whose support for individual Medicare recipients is unlikely to keep pace with people’s actual medical expenses. If you want to learn more about the wonky Medicare details, my Incidental Economist colleague Austin Frakt has been all over Medicare for the past two years. Austin, especially, is an essential resource. His premium support series is a terrific introduction to proposed changes in Medicare, as is this New England Journal of Medicine piece. Ryan’s also proposed to privatize Social Security and to dramatically curtail the non-entitlement, non-defense components of the federal government.
Ryan’s most extreme Medicare and Social Security proposals are opposed by huge middle-class constituencies. So the political process should protect these social insurance programs from more serious damage. I’m more frightened by Ryan’s proposals concerning Medicaid, Food Stamps, and other programs that serve the most politically and economically vulnerable Americans. More than 60 percent of the cuts proposed by Mr. Ryan come from programs that serve low-income people.
As I discuss here, I’m dismayed by the language Ryan uses in describing these issues: “We don’t want to turn the safety net into a hammock,” and as Jonathan Chait puts it, “Ryan’s philosophical opposition to a government that forces the ‘makers’ to subsidize the ‘takers.'” Ryan still uses these terms in his speaking and writing about social policy. A pampered millionaire known to purchase $350 dinner wine, Ryan may not be the best judge of poor people’s lives.
Ryan’s proposals, embraced by Mitt Romney, would shift significant costs and risks onto states and individual patients and social service recipients. Ryan’s proposals would cut federal Medicaid spending by one-third by 2022 and by more after that. No one quite knows how such large cuts would play out.
As Jonathan Cohn emphasizes today over at the New Republic, independent researchers estimate that Ryan’s Medicaid proposals would lead between 14 and 27 million low-income Americans to lose health coverage. That’s not counting people who would lose coverage because Romney and Ryan are committed to repealing health reform.
The Ryan budget also requires deep cuts to nutrition assistance and many other programs supported by the federal government from highway repair to K-12 education, environmental protection, public health, and law enforcement.
These tough proposals are justified on the grounds that our deficit problems require severe cuts to bring the budget into balance. Ironically, though, Ryan and Romney’s zeal to constrain the size and scope of government is not matched by a corresponding zeal to balance the federal budget. Like President George W. Bush, they support large tax cuts tilted to the affluent that are predicted to severely strain federal finances. The Ryan plan includes four new tax cuts that would cost an estimated $4.6 trillion in lost federal revenue over the next decade. Just to take one not-quite-random example, Representative Ryan’s plans are estimated to reduce the tax rate on Mitt Romney’s own $20+ million annual income to about 0.82 percent.
The New York Times‘ editorial page today argues that
Mr. Ryan has drawn a blueprint of a government that will be absent when people need it the most. It will not be there when the unemployed need job training, or when a struggling student needs help to get into college. It will not be there when a miner needs more than a hardhat for protection, or when a city is unable to replace a crumbling bridge.
And it will be silent when the elderly cannot keep up with the costs of M.R.I.’s or prescription medicines, or when the poor and uninsured become increasingly sick through lack of preventive care.
Americans must decide if that’s what we really want. That’s what was always at stake in 2012. We might as well debate things straight up.
Looking across the internet, there are so many great resources on these issues: Jonathan Cohn, Matthew O’Brien, Paul Van de Water, Edwin Park and Matt Broaddus, Jonathan Chait, Robert Greenstein, David Frum, Ryan Lizza, Michelle Goldberg, Jamelle Bouie, Catholic bishops, Dylan Matthews, and the New York Times (to name a few).
Harold Pollack is Helen Ross Professor of Social Service Administration at the University of Chicago. He has written about health policy for the Washington Post, New York Times, New Republic, The Huffington Post and many other publications. His essay, “Lessons from an Emergency Room Nightmare,” was selected for The Best American Medical Writing, 2009.