Miller: Paul Ryan right to challenge the Medical Industrial Complex

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The striking thing about Paul Ryan's ascent is the gulf between his proposals and the way the media have characterized them. Since Mitt Romney named Ryan to the ticket on Saturday, the news has been filled with talk of the "fiscal conservative" (NPR), "intent on erasing deficits" (New York Times), who has become "the intellectual heart of the Republican Party's movement to slash deficits" (The Post).

All of this is demonstrably false. Ryan's con has succeeded largely because Democrats haven't sensed the political salience of assailing his plans from the right; instead, they've chosen to slam only Ryan's regressive priorities and Medicare scheme.

This strategic error allows the presumption that Ryan, and thus Romney, are the true apostles of fiscal responsibility in this race, a value important to the voters who will decide November's outcome. But the con has worked in part because budgets make journalists' eyes glaze over, and once the phony Ryan meme took hold two years ago it became hard to dislodge.

Now that Ryan is on the ticket, however, the stakes are too high not to expose the fraud. In that spirit (and at the risk of taxing readers who've heard my Ryan rants before), I offer one wonk's guide to what every citizen should know about Ryan's plans. Otherwise, like the talented Mr. Ripley, Ryan will continue to get away with (fiscal) murder.

Ryan is not a "fiscal conservative."

A fiscal conservative pays for the government he wants. Ryan never has. His early "Roadmap for America's Future" didn't balance the budget until the 2060s and added $60 trillion to the national debt. Ryan's revised plan, passed by the House in 2011, wouldn't reach balance until the 2030s while adding $14 trillion in debt. It adds $6 trillion in debt over the next decade alone -- yet Republicans had the chutzpah to say they wouldn't raise the debt limit! (I remain mystified why President Barack Obama never hammered home this reckless contradiction by insisting that the GOP "raise the debt ceiling just by the amount it would take to accommodate the debt in Paul Ryan's budget.")

Ryan is an extreme "small government conservative." Ronald Reagan ran government at 22 percent of gross domestic product when our population was much younger. Ryan and Romney want to run government at 20 percent of GDP even as the number of Americans on Social Security and Medicare doubles. Even if we slow these programs' growth, it's impossible to shrink the federal role in an aging society this sharply without eliminating vast swaths of what Americans have come to expect from government -- not to mention shortchanging already lagging investments in research and development and infrastructure. Over time, Ryan's "vision" would decimate most federal activities beyond Social Security, Medicare and defense.

When I asked Ryan last October why he thought -- in his words -- "the historic size [of government as a share of GDP], or smaller," was sound policy when we'd shortly be doubling the number of seniors on the biggest federal programs, he replied, "Because we can't keep doing everything for everybody in this country."

Ryan says that on our current path we will "transform our social safety net into a hammock, which lulls able-bodied people into lives of complacency and dependency." But I've never understood what hammock Ryan is talking about. If programs for seniors haven't been a "hammock" until now, simply doubling the number of people eligible for them can't turn them into a "hammock" tomorrow. We have an aging population challenge and a health-cost challenge. We don't have a "hammock" challenge.

Ryan is not a truthteller.

Ryan boasted on Saturday that he and Romney have "the courage to tell you the truth." But political courage means telling your base things they don't want to hear. The truth Ryan and Romney won't tell - which explains the staggering debt in Ryan's plan - is that taxes need to rise as the boomers retire. (The truth Democrats won't tell is that raising taxes on the rich alone won't suffice.) But on Medicare ... I can hear the Democratic groans coming, but Ryan deserves credit here. Ryan leaves Medicare on its current outsized trajectory for the next decade, as spending soars from $560 billion to $950 billion. Because of our uniquely inefficient health-care sector, which leaves us spending twice per capita what other wealthy nations spend, the voucher he calls for thereafter would suffice to buy seniors terrific care everywhere but here. Even if his approach is imperfect, Ryan is right to challenge our Medical Industrial Complex to change.

So, Democrats, if you must demagogue (and I know you must), I say: Demagogue responsibly. Blast the GOP for trimming Medicare growth to cut taxes for the rich -- but don't damn the idea of slowing Medicare's growth "the right way." In a few years the cash going to Medicare that's not needed for quality care will be the reason we're too strapped to invest in poor kids.

Matt Miller, a senior fellow at the Center for American Progress and co-host of public radio's "Left, Right & Center," writes a weekly online column for The Washington Post.

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