Rep. Paul Ryan Stokes New Medicare Fight, This Time In Election Year

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It seems like only yesterday when House Budget Chairman Rep. Paul Ryan of Wisconsin introduced a federal budget that would change Medicare as we know it.

Actually, it was a year ago when Ryan, a Wisconsin Republican, offered, controversially, a federal spending blueprint that would transform Medicare from a single-payer health insurer for seniors into a program that would give them money to purchase insurance on the private market, so-called premium support.

House Republicans rallied around the budget while President Obama, congressional Democrats and progressives ceaselessly attacked Ryan, sometimes with well-reasoned arguments, but not always. Their core argument was that Ryan would turn Medicare into a voucher system.

In any event, Ryan's proposal allowed Democrats to raise voter concerns that Medicare would be gutted, contributing to a Democratic victory in an upstate New York special election in a traditionally Republican congressional district.

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Undeterred, Ryan and House Republicans are expected to make public Tuesday their latest budget proposal. And while full details aren't out, the expectation is that it will once again propose that Medicare become a premium-support program for people under a certain age.

Last Thursday, Ryan released a video meant to seize the high ground from Democrats who accused him of being irresponsible for producing that first budget. It was his critics who were the irresponsible ones, Ryan argued.

RYAN: "You know, I was here — in Congress — in 2008 when we had the economic crisis. It was a terrible time. Millions of people lost their jobs. Trillions of dollars of wealth: gone. "That crisis caught us by surprise. "Let me ask you a question: what if your President, your Senator and your Congressman knew it was coming? What if they knew when it was going to happen, why it was going to happen and more importantly, what if they knew what they needed to do to stop it from happening and they had the time to stop it? But they chose to do nothing about it, because it wasn't good politics? "What would you think of that person? It would be immoral."

National Journal's Nancy Cook reports that the budget is expected to cut domestic programs while leaving defense spending largely untouched:

"If the debt crisis is predictable in Ryan's mind, than so too are the contours of the House Republican budget to be released early this week. Pivoting off Ryan's plans from 2011, this budget is expected to emphasize lower spending for domestic programs, which could mean financial hits to everything from protecting the environment to agencies that regulate banks or programs that offer job training. "The budget will propose a change in the structure of Medicare and Medicaid, and it will offer absolute protection of defense spending, a move Democrats call politically disingenuous because it flies in the face of the sequester laboriously agreed to last year that mandates across-the-board spending cuts for both defense and discretionary spending beginning in 2013. "The details of how the Republicans plan to pay for delaying the sequestration remain unclear, as does the topline figure for spending."

Meanwhile, progressive groups were spinning up to take on Ryan II, a somewhat modified proposal that has a Democratic ally, Sen. Ron Wyden of Oregon. Paul N. Van de Water, a senior fellow with the left-leaning Center for Budget and Policy Priorities, wrote:

"The Ryan-Wyden plan would shift substantial costs to Medicare beneficiaries rather than protect them from cost increases, in part because the payment that beneficiaries would receive to help them buy coverage would likely fail to keep pace with health care costs. The plan also would likely lead to the gradual demise of traditional Medicare by making the pool of Medicare beneficiaries smaller, older, and sicker — and increasingly costly to cover. Finally, the plan would produce few budgetary savings beyond those that the health reform law calls for, since both plans have the same target growth rate for Medicare costs. The Ryan-Wyden plan is similar to Newt Gingrich's 1995 proposal that, according to Gingrich, would have caused traditional Medicare to 'wither on the vine.' "

Worth noting is that Ryan isn't punting during an election year. He and House Republicans are clearly showing a tolerance for the risks that come with campaigning on a controversial proposal at a time of superPACs.

In a way, it's not unlike Obama's decision to run on his controversial health care law, which polls poorly among many voters.

What seems safe to say is that while the positions taken by both Ryan and Obama will rile their committed critics, their bases are likely to be encouraged.