THE federal government has been described as a gigantic insurance company with a side business in security. Its largest fiscal obligations, outside of defence, involve protecting Americans from various risks: unemployment, destitution, illness and lack of education. Paul Ryan's budget is, ultimately, an alternative to that vision—one in which the federal government would shift many of those risks to the states or to Americans themselves.

That is what emerges, in its own antiseptic way, from the Congressional Budget Office's analysis of Mr Ryan's proposal.

Since the proposal is most specific and sweeping on health care, that's what the CBO dwells on. Starting in 2022, Medicare beneficiaries would receive a voucher to pay for private insurance. In the first year of the plan, a beneficiary would pay 61 cents for services that he would have paid 27 cents for under traditional Medicare, while the government contribution is unchanged: 39 cents. Why are they, in combination, paying more for the same services? Because private plans cost more than traditional Medicare. Thereafter, the value of the voucher grows more slowly than health care costs so by 2030 the government is paying just 32 cents while the beneficiary is paying 68 cents for that same set of services.

The federal government, instead of matching the states in paying for Medicaid, would, starting in 2013, switch to block grants that grow in line with population and overall (not health care) inflation. Federal Medicaid spending would be 32% lower in 2022 and 49% lower in 2030 than currently projected. The CBO says:

States would have additional flexibility to design and manage their programs to achieve greater efficiencies in the delivery of care. Because of the magnitude of the reduction in federal Medicaid spending under the proposal, however … states would probably need to consider additional changes, such as reducing their spending on other programs or raising additional revenues. Alternatively, states could [save money by] cutting payment rates for doctors, hospitals, or nursing homes; reducing the scope of benefits covered; or limiting eligibility… [I]f states lowered payment rates even further, providers might be less willing to treat Medicaid enrollees. As a result, Medicaid enrollees could face more limited access to care…. [B]eneficiaries could face higher out-of-pocket costs, and providers could face more uncompensated care as beneficiaries lost coverage for certain benefits or lost coverage altogether.

These cuts have the intended effect. Federal spending on health care is dramatically lower than it otherwise would be. Total federal spending drops to 20.25% of GDP in 2022 and 14.75% by 2050. The budget swings from a deficit of 2% in 2022 to a surplus of 4.25% in 2050. The federal debt declines instead of soaring. The catastrophic consequences of unrestrained entitlement spending are avoided.

However, a huge asterisk must be appended to these figures: much of the CBO's estimates of revenue and spending are not the result of evaluating particular policies.

Mr Ryan's staff simply instructed the CBO to assume revenues remain at 19% of GDP. “There were no specifications of particular revenue provisions that would generate that path”, it says. This can be risky. When the CBO analysed Mr Ryan's Roadmap for America's Future, it accepted Mr Ryan's instructions that revenues would rise to 19% of GDP. When the Tax Policy Center analysed the specifics of the Roadmap, it concluded that tax revenue would fall below 17% of GDP. It also concluded that its benefits would accrue overwhelmingly to the most affluent 20% of American families, mostly because Mr Ryan exempted capital gains and dividends from taxation. By contrast, the Bowles-Simpson plan does not, and thus its tax proposal is mildly progressive.

The CBO also notes that Mr Ryan's staff specified that all spending other than health care, Social Security, interest, defence and security decline from 12% of GDP in 2010 to 6% in 2021, then grow with inflation thereafter. That would cover, among other things, federal civilian and military retirement, food stamps, Supplemental Security Income, parts of the earned-income and child-tax credits, and most veterans' programmes. At a press conference today, Republicans did say that food stamps, housing and some other programmes would, like Medicaid, be moved to block grants.

A commenter on my previous post criticised me for using the CBO's unflattering score of Barack Obama's budget in my charts while using Mr Ryan's own figures for his budget. That's a fair point, but now that we have the CBO letter, it doesn't help much because Mr Ryan's budget lacks so many important details.

The larger picture, however, is quite clear. The federal government's health care bill would become much more predictable and manageable under Mr Ryan's budget. For individuals and states, the opposite would be true.