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Paul Ryan Says Alice Rivlin Would Like His Medicare Plan. Alice Rivlin Disagrees

Jonathan Cohn:

Paul Ryan Says Alice Rivlin Would Like His Medicare Plan. Alice Rivlin Disagrees: When Paul Ryan introduced his proposal for converting Medicare into a system of “premium support,” he reminded everybody that it closely resembled another Medicare proposal—one he’d developed with Alice Rivlin, the Brooking scholar and former Clinton Administration advisor. “Alice Rivlin is a great, proud Democrat,” Ryan said. “This path to prosperity builds upon those Ryan-Rivlin plans that we put in here.”…

Rivlin says she cannot support the new Ryan plan for two key reasons—and she has spent the last 24 hours telling anybody who would listen about them…. Rivlin… wouldn’t force people into private insurance. The new Ryan plan would.

The other key difference is the money. In a premium support system, the value of the voucher grows by some fixed formula. Ryan-Rivlin set that formula at GDP+1…. But the voucher in the new Ryan plan would increase in value even more slowly than the voucher in Ryan-Rivlin. Instead of rising at GDP+1, it would rise at inflation….

“In the Ryan version, he has lowered the rate of growth and I don’t think that’s defensible,” Rivlin said. “It pushed too much of the cost onto the beneficiaries.” As Ezra Klein observed, “it’s totally unrealistic. … either those savings aren’t real or we’re assuming America is going to abandon seniors and the disabled in a way that has no recent precedent.”…

Ezra just posted a full interview with Rivlin, in which she not only reiterates her rejection of the new Ryan plan but explains why she supports, as an alternative on health care, the Affordable Care Act:

...there’s a great deal in the Affordable Care Act in terms of research, pilot programs, alternative payment structures, alternative delivery systems, research on the effectiveness of treatments, that is needed. That’s why we need to keep the Affordable Care Act and strengthen the parts that hopefully give us more cost-effective care in the future. If you just control the federal spending without changing the delivery system, you just get cost shifting.

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