Many millions of working-age Americans would lose health insurance. Senior citizens would anguish over whether to pay their rent or their medical bills, in a way they haven’t since the 1960s. Government would be so starved of resources that, by 2050, it wouldn’t have enough money for core functions like food inspections and highway maintenance. And the richest Americans would get a huge tax cut.

This is the America that Paul Ryan envisions. And now we know that it is the America Mitt Romney envisions.

Of course, we should have known that already. Romney committed himself to the Ryan agenda during the presidential primaries, both by embracing the Ryan budget rhetorically and specifically proposing key features of Ryan’s agenda, starting with a tight cap on federal spending. But if anybody doubted that Romney was serious about these commitments, the Ryan pick should put those doubts to rest. Maybe Romney sincerely believes these ideas are right for the country and maybe he feels that endorsing them is necessary to please his party’s base. It really doesn’t matter. It’s the way he intends to govern.



But will the voters get it? Ryan’s has a carefully cultivated image as a wonk hero, somebody who deserves to be taken seriously because he understands policy minutiae and cares about reducing the deficit. The image is a little misleading: As my former colleague Jonathan Chait has written in New York magazine, during the Bush Administration Ryan supported creation of the Medicare drug benefit and other policies that substantially increased the deficit. But Ryan's image helps to insulate him, and his ideas, from the charge that he’s proposing what would amount to the most radical revision of governing priorities in our lifetime. Pointing out the very real, very painful consequences his budget would have somehow seems impolite.



With that in mind, here are five things everybody should know about Ryan and his agenda, based mostly on non-partisan authorities such as the Congressional Budget Office, the Kaiser Family Foundation, and the Center on Budget and Policy Priorities.

1. Ryan really believes in ending Medicare as we know it. The essential promise of Medicare, ever since its establishment in 1965, is that every senior citizen is entitled to a comprehensive set of medical benefits that will protect him or her from financial ruin. The government provides these benefits directly, through a public insurance program, although seniors have the right to enroll in comparable private plans if they choose. But the key is that guarantee of benefits, and it’s what Ryan would take away. He would replace it with a voucher, whose value would rise at a pre-determined formula unlikely to keep up with actual medical expenses.

Ryan's early proposals had no safeguards to make sure the voucher was adequate. His most recent one has safeguards, a more reasonable spending line, and preserves the government-run plan as an option. But the safeguards are weak, at best, and the government-run program would struggle to survive. Over time, more and more seniors would find the voucher too small to buy the insurance they need.