Paul Ryan is out with a new video defending his plan to end Medicare, and he's not backing off—he's doubling down:

Ryan says Medicare is the problem and individually-purchased private insurance is the solution.



According to Ryan, the key problem with Medicare is that "someone else pays the actual bill." As a result, he says, costs go up and quality goes down.

Ryan's solution? Instead of Medicare covering health care costs, individual senior citizens should "pay directly" for their own health care.

Ryan's argument is obviously nonsensical. He says that under his plan seniors will receive vouchers to pay for health care, but if the vouchers actually did cover the full cost of the plan, that would be the same thing as having "someone else" paying the bill—undercutting the premise of his argument. And if the vouchers don't cover health care cost, and seniors truly are forced to "pay directly" then Ryan isn't actually reducing health care costs, he's just transferring the burden from Medicare to individuals.

In addition to defending his plan to end Medicare, Ryan criticizes President Obama's plan to strengthen the Independent Payment Advisory Board (IPAB), a group of doctors and health care policy experts charged with reviewing payments for services covered by Medicare in order to reduce costs without lowering the quality of care. The fact that he criticizes it is nothing new, but at least it's the first time that Ryan as acknowledged President Obama does in fact have a plan for dealing with health care costs, and IPAB is one part of it.