According to David Brooks, in the days following the release of Representative Ryan's plan to essentially end Medicare and Medicaid to help finance more tax breaks to the wealthy:

"the Democrats are on defense because they are unwilling to ask voters to confront the implications of their choices."

I can't claim to have done a comprehensive survey, but all the Democrats I know think that they were handed the political gift of lifetime, as Representative Ryan has explicitly proposed doing exactly what Democrats have accused Republicans of wanting to do for decades: eliminate health care programs that are essential for middle class workers in order to give more money to their wealthy contributors.

Things may be different on Mr. Brooks' planet, but here in Washington there is no shortage of politicians willing to denounce a plan that would require most seniors to spend most of their income on health care, if they want an insurance package equivalent to the one provided by Medicare. The more obvious shortage is of Republicans who are openly willing to embrace the Ryan plan and say, "yes, we are the party that wants to eliminate Medicare and give more tax breaks to the richest people in the country."

Brooks again ignores the most obvious point that health care is not a sidebar in this story, it is the story. If the United States paid the same amount per person for its health care as do people in other wealthy countries, then we would be looking at huge budget surpluses not deficits.

He also tries to pass off to NYT readers nonsense from his Tea Party friends:

"The president’s health reform plan relies on a centralized board of technocrats to restrict choices. The Ryan plan relies on a premium support model that would allow individuals to exercise greater control over what sorts of procedures they would not be covered for."

Can we get out the extra large ridicule box for this one? There is nothing, as in zero, in President Obama's health care plan that prevents any individual from getting any health care procedure that he or she wants to pay for. The "centralized board of technocrats" he mentions would determine the procedures that Medicare would pay for, not the procedures that individuals could receive.

Obviously this will be a very serious restriction for people who cannot pay for expensive procedures on their own, but Ryan's plan does not change this situation one iota. It gives people a choice of insurance companies, each of which will rely on a board of technocrats to restrict choices.

Using the Tea Party terminology, if President Obama's plan is viewed as creating death panels, then Mr. Ryan's plan gives seniors a choice of death panels and, according to the Congressional Budget Office, we pay trillions more for this choice.



Some folks have asked me about the generational equity concerns raised by Brooks who tells readers that:

"two 56-years-olds with average earnings will pay about $140,000 in dedicated Medicare taxes over their lifetimes. They will receive about $430,000 in benefits. This is an immoral imposition on future generations."

There are two important points here. First, most of that $430,000 is over-payments to drug companies, hospitals, doctors and other health care providers. If these two 56-years-olds were buying their health care in Canada, Germany, or any other country with comparable health care outcomes, they would pay less than half as much for their care. Should my older brother feel that he has done me an injustice because the government gets overcharged for his health care? Maybe on Planet Brooks, but that's not an easy one to see here on Earth.

The other point that Brooks seems to have missed is that people are getting richer through time. The lifetime earnings for two average 26-year-olds will be more than $1.3 million greater on average than the average lifetime earnings for today's 56-year-olds. If the 26-year-old gets to pocket this much more cash, simply by virtue of being born later, is there any reason for the 56-year-old to feel they have committed an injustice because they got a better deal on their Medicare?

Now, there is a serious issue of inequality that must be considered. As a result of the fact that a larger share of income is being distributed to those at the top, most 26-year-olds may see little of this $1.3 million gain in earnings. But this is an issue of intra-generational inequality, not inter-generational inequality. On this dimension, Representative Ryan's plan is a huge leap in the wrong direction.