Having slammed Paul Ryan's budget in a previous piece, David Frum now tries to list what he likes about it. Not an unworthy exercise, but it’s worth noting that a lot of Frum's positive points assume we’ll eventually fold Ryan's plan into the structure laid down by health-care reform.
Frum praises Ryan's plan for abandoning the "death panels" meme and advocating on behalf of efficiency in health-care spending. He also notes that Ryan's Medicare restructuring plan actually endorses the health-care act's exchanges and suggests moving Medicare and Medicaid entirely onto them.
It's an interesting thought experiment, but let's face facts: Republicans don't want to build on health-care reform because that's an implicit endorsement. They want to repeal it. They're not interested in creating a consistent, rational, or humane health-care system. They're just concerned with spending less, and the vouchers and block grants are just a smoke screen to hide that fact. Ryan doesn't get his reductions through the structural changes to how Medicare and Medicaid spend money. He's getting the reductions by slashing the raw amount they have to spend.
All of which goes to show: The only way to salvage positives from Ryan's plan is assume values, priorities, and commitments that Ryan and his party manifestly do not hold.
