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Rep. Paul Ryan
"Really, people love it! Give it a chance, GOP!" (Kevin Lamarque/REUTERS)

Rep. Paul Ryan has taken it upon himself to finally come up with the "replace" part of the "repeal and replace" mantra the Republicans ran on in 2010, in their campaign against the Affordable Care Act. Speaking at Stanford University's conservative Hoover Institution, the idea guy for the GOP, finally came up with a plan. Ryan didn't reach very far for this once, which seems essentially to just be vouchers for everyone.
House Budget Committee Chairman Paul Ryan says it's time for Republicans to rally around a comprehensive "replacement" to President Barack Obama’s signature health care reform legislation—with the government giving a limited contribution to help Americans get health coverage.

That's the model Ryan wants to apply through Medicare, Medicaid and employer-sponsored health insurance. It's the approach he used earlier this year for Medicare and Medicaid in the House-passed budget, but he now wants to expand it to workplace health insurance by giving people a refundable tax credit to help them buy coverage.

See, the basic problem with our system, Ryan says, is that we just get too damned much health care and—I think this is what he's saying here—aren't paying enough for those services: "At its core, the health care problem is one of inflation, driven by the overutilization of services, dramatic underpayments and massive inefficiency." I'll give him inefficiency in our system, but the 50 milion uninsured Americans (which Ryan apparently doesn't address at all) would take issue with his other premises.

The unveiling of this plan was coupled with an exhortation of his fellow Republicans to embrace his budget, to not let the fact that his plan for Medicare is hugely unpopular with the American people deter them from running on it. He says that the Democrats' "scare tactics" have proven ineffective.

"[W]e took a few dings at first, we survived," Ryan admitted. "The Democrats' tried the same old scare tactics for a few months, and in the first special election that took place after our budget passed, we learned a costly lesson. We learned that unless we back up our ideas with courage, and defend them in the face of attacks, we will lose. But once we learned that lesson and started to get our message out... well, a funny thing happened: People listened. They learned that our plan did not affect those in or near retirement; that it guaranteed coverage options like the ones members of Congress enjoy; and that choice and competition would drive costs down and quality up. They also learned more about the Democrats' plans for Medicare, and they didn't like what they heard."

He's taking this evidence from the three special elections held this year, and his argument is less than convincing, as Dave Weigel points out. The Democrat in NY-26 won largely on Medicare; NV-02 stayed Republican, and in the race to replace Rep. Anthony Weiner, the winning Republican didn't support the Ryan plan.

Nonetheless, Ryan is undeterred. He's managed at least to convince CNN that the massive unpopularity of his Medicare plan actually means it's popular, so maybe he figures he can bluff the rest of the country.

Originally posted to Joan McCarter on Wed Sep 28, 2011 at 08:45 AM PDT.

Also republished by Daily Kos.

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