The most remarkable and revealing speech of the health care debate was delivered by Paul Ryan, the new right-wing idol. In the preceding weeks, Ryan had largely cast his opposition to health care reform in the wonkiest of terms, assailing the administration's claims to fiscal responsibility. This time he did so in the language of first principles:



Should we now subscribe to an ideology where government creates rights, is solely responsible for delivering these artificial rights, and then systematically rations these rights?

Do we believe that the goal of government is to promote equal opportunity for all Americans to make the most of their lives? Or, do we now believe that government's role is to equalize the results of peoples lives?



The philosophy advanced on this floor by this Majority today is so paternalistic and so arrogant.

This is the expression of a fundamental philosophical divide. Liberals do not believe in equality of outcome in most spheres of life. There are myriad punishments for the losers of the free market that liberals can accept: less money, less vacation time, lower social status, more uncomfortable, dangerous, or physically draining work. But the denial of medical treatment should not be among those punishments.

Conservatives generally haven't challenged this premise head on. They may object to Democratic health care reform on the grounds that covering the uninsured can be done more cheaply and efficiently using other (more conservative) means, or on the grounds that we can't afford to cover the uninsured until health care costs have first been reduced. Ryan was challenging this view. He believes that access to medical care is a matter of personal responsibility -- something we should have the opportunity to acquire for ourselves, but not actually to have as a matter of right. Medical care is like a flat-screen television -- a nice thing if you can get it, but not society's responsibility to provide.

A couple weeks ago, I wrote about the radical opposition to redistribution that sits at the heart of Ryan's worldview. Ross Douthat objected that I was engaged in "caricaturing and misrepresentation." Douthat's conceded my most important points, brushing them aside by restating them in weakened form. I pointed out that Ryan would transform the federal tax code from a slightly progressive instrument into a sharply regressive one, a change that would "amount to the greatest shift of resources from the non-rich to the rich in the history of the United States, by far." Douthat replies, "Ryan’s proposed changes to the tax code — his reduction in the highest rates, and his addition of a consumption tax — would shift the tax burden down the income ladder, just as Chait says." Yes, that's a fairly big deal, isn't it?