Throughout the bitter debate over health care reform, talking points about "rationing" and "cuts to Medicare" have been the twin pillars of Republican fear mongering. For example, Senate Minority Leader Mitch McConnell in June warned of reform that "denies, delays, or rations health care," only to falsely charge weeks later that Democrats "are going to pay for this plan by cutting Medicare, that is cutting seniors." But with the publication of the Republican "shadow" budget by Rep. Paul Ryan (R-WI), the GOP is now proposing exactly what just weeks ago it claimed to decry: rationing Medicare:

Last year, 137 House Republicans voted to convert the Medicare program that provides 46 million Americans with health insurance into a system of vouchers. (In September, Sarah Palin penned a Wall Street Journal op-ed which similarly called for "providing Medicare recipients with vouchers that allow them to purchase their own coverage.") Now, as Ezra Klein, Matthew Yglesias and TPM all noted, the GOP's Paul Ryan is making the privatization of Medicare the centerpiece of a new Republican deficit reduction gambit.

Of course, because the value of Ryan's vouchers fails to keep up with the out-of-control rise in premiums in the private health insurance market, America's elderly would be forced to pay more out of pocket or accept less coverage. The Washington Post's Klein described the inexorable Republican rationing of Medicare which would then ensue:

The proposal would shift risk from the federal government to seniors themselves. The money seniors would get to buy their own policies would grow more slowly than their health-care costs, and more slowly than their expected Medicare benefits, which means that they'd need to either cut back on how comprehensive their insurance is or how much health-care they purchase. Exacerbating the situation -- and this is important -- Medicare currently pays providers less and works more efficiently than private insurers, so seniors trying to purchase a plan equivalent to Medicare would pay more for it on the private market.

It's hard, given the constraints of our current debate, to call something "rationing" without being accused of slurring it. But this is rationing, and that's not a slur. This is the government capping its payments and moderating their growth in such a way that many seniors will not get the care they need.

On Tuesday, Ryan acknowledged as much.

Sadly for the Republican brain trust, he failed to follow the script that only Democratic reforms lead to "health care denied, delayed and rationed."

"Rationing happens today! The question is who will do it? The government? Or you, your doctor and your family?"

Of course, Ryan left out the real culprit - the private insurance market. But with 50 million uninsured, another 25 million underinsured, one in five American postponing needed care and medical costs driving over 60% of personal bankruptcies, Congressman Ryan is surely right that "rationing happens today."

But the Republican plan to "slash and privatize" hardly ends there. Despite insistence by the Republican leadership that the party is not officially advocating it, the Ryan alternative budget follows Rep. Jeb Hensarling's announced desire to privatize Medicare. As TPM documented:

Rep. Paul Ryan, (R-WI) the ranking Republican on the budget committee, recently detailed the Republican plan for Social Security that preserves the existing program for those 55 or older. For younger people the plan "offers the option of investing over one-third of their current Social Security taxes into personal retirement accounts, similar to the Thrift Savings Plan available to federal employees."

If that sounds vaguely familiar, it should. After all, George W. Bush's disastrous drive to privatize Social Security helped undermine his presidency. Now, in the wake of a Wall Street meltdown that evaporated the retirement savings for countless thousands of Americans, the Republican wunderkind Ryan is calling for an encore.

In Paul Ryan's defense, his so-called "A Roadmap for America's Future" was scored by the Congressional Budget Office as erasing the long-term deficit entirely, and produce surpluses by 2080 (!). While the Post's Klein stated, "I wouldn't balance the budget in anything like the way Ryan proposes," he also admitted:

"The audacity is breathtaking. But it is also impressive."

Audacious, indeed. After months of scaring the American people into believing that President Obama and the Democrats would ration health care and gut Medicare, Paul Ryan's Republican Party now proposes to do both.

(This piece also appears at Perrspectives. For a look back at the hilarious April Fool's Day unveiling of Ryan's 2009 budget "marketing document," visit here.)

UPDATE: In the latest pathetic twist in the Republican budget saga, House Minority Leader John Boehner is now trying to distance himself from Paul Ryan's document. Claiming "it's his," Boehner nevertheless replied "Off the top of my head, I couldn't tell you" when asked what in it he disagrees with.

If this storyline sounds familiar, it should. Boehner did the same thing last year after presenting Ryan's "The Republican Road to Recovery" with great fanfare:

"Two nights ago, the president said we haven't seen a budget yet of the Republicans. Well, it's not true, because here it is Mr. President."

For more, visit the American Road Map web site at http://www.roadmap.republicans.budget.house.gov/