So I know a lot of people are scratching their heads over why Paul Ryan is making the GOP vote on his budget proposal when the predictable outcome was this

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Now, again, I am just an outside the Beltway academic but it seems to me that if you really want to replace Medicare without a voucher system then you have to get people to vote to replace Medicare with a voucher system.

If you can’t get people to take this vote or you can’t build a congressional majority of people who would be willing to take this vote then your chances are sunk.

Moreover, time is not on the GOP side here. Not only are demographics moving in the Democrats favor but the general ethos towards universal health care is growing.

Even Tea Party folks that I talk to on the ground tie themselves in knots over this issue. They say things like: of course no one should have to go without chemotherapy because they can’t afford it, but . . .

My long point is that the moment someone says that the analysis is over. You simply must be willing to let people go without treatment or there is no real issue.

No slight of hand or rearranging pieces on the chess board is going to change the fact that if you devote real resources to medical care you will devote fewer to other things.

Further there is no close at hand innovation to make us think that people are going to stop getting sicker as they get older. Thus no matter how effective any one treatment is you are always fighting an uphill battle of increasing costs.

All of that being said, I really didn’t think the Ryan plan was going to work. However, if you did think it was going to work it makes sense to go all in. And, really to keep going all in no matter how badly you lose.

What else are you going to do? What would be the point of winning if you couldn’t accomplish this?

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