David Brooks notes that Paul Ryan’s biggest mistake was voting no against the final report of the deficit commission in December 2010. As Brooks puts it:

To put it another way, Ryan was giving up significant debt progress for a political fantasy.

I agree that Rep. Ryan’s bravery is greatly overrated, and in this case when his vote and leadership could have brought the fiscal commission to an up or down vote in Congress, he walked away. Brooks has it wrong on Ryan’s logic, however. He says

Ryan voted no for intellectually coherent reasons. He argued that the single biggest contributing factor to public debt is the unsustainable growth of Medicare. Yet the Simpson-Bowles plan did nothing to restructure Medicare, and it sidestepped health care issues generally.

The statement that the fiscal commission report had nothing to address Medicare is absurd. The commission chairman’s mark assumed the implementation of the Affordable Care Act, took faster, more direct steps to limit the tax advantage of employer paid health insurance than the cadillac tax, had more aggressive cuts to Medicare than anyone has called for so far, called for a new physician payment system to end the SGR charade, mandated a move of dual eligibles to managed care, would have implemented the malpractice reforms that Republicans wanted, and called for a strengthened Independent Payment Advisory Board (IPAB) by allowing it to focus on hospitals beginning in 2014. Here is a summary post I wrote in Spring 2011 on the health policy provisions of the deficit commission report with a link to the report itself.

You don’t have to like or agree with the ACA, but it does plenty to reform Medicare (see title III). And the deficit commission went even further by correctly saying that the ACA was the only horse we have to ride so lets ride it, and here are some more steps to go further. I generally like reading David Brooks and think he is typically thoughtful, but in this case a crucial part of his narrative is just not based in reality.

As an aside, it is interesting that 4 of the 5 House members voted no, while 4 of the 5 Senate members voted yes. While the Senate is generally noted to be the bastion of gridlock, if we ever do have some sort of grand bargain, it seems mostly likely to bubble out of the Senate.

[Cross-posted at The Reality-based Community]

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Don Taylor is an associate professor of public policy at Duke University, where his teaching and research focuses on health policy.