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April 03, 2014 3:49 PM Ryan Quietly Scraps Per Capita Cap on Medicare Spending

By Ed Kilgore

Wanna see an unusually strong demonstration of the fading political power of Austerian Fiscal Panic? As TPM’s Sahil Kapur reports, the new (and last!) Paul Ryan Budget quietly drops a key provision related to the famous Medicare premium support proposal:

His new blueprint eliminates the cap on Medicare spending per beneficiary. Ryan’s budget last year maxed out spending on a given Medicare patient at nominal growth in GDP per capita — which is currently forecast at 3.7 percent — plus 0.5 percentage points. (A previous year’s budget was even lower.) The cap had been in his earlier budget proposals to guarantee long-term savings within the Medicare program, which Ryan said justified the dramatic change.

Ryan still claims long-term Medicare savings, but bases them on CBO health care inflation estimates, not the kind of guarantee a cap offers. More to the point, Republicans being attacked for messing with Medicare can point to the change and claim there’s no longer any ever-compounding benefit cut baked into the cake, even though the idea of a defined contribution rather than a defined benefit system persists.

Most of the GOPers we are talking about, of course, voted for or otherwise endorsed the earlier versions of the Ryan Budget, so they aren’t off the hook. But again, it’s revealing that being perceived as a granny-basher is now considered a bigger political risk than being perceived as a fiscal wimp. It will be interesting to see if any Tea Folk specifically add this to their list of grievances against Ryan.

Ed Kilgore is a contributing writer to the Washington Monthly. He is managing editor for The Democratic Strategist and a senior fellow at the Progressive Policy Institute. Find him on Twitter: @ed_kilgore.

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