As I recall, last year's version of the Paul Ryan voucher plan for Medicare basically amounted to mailing seniors a check each year to pay for health insurance. The value of the check went up at the rate of general inflation, which is much lower than the rate of medical inflation. Within a few decades, this means that the checks would cover no more than half or two-thirds of the cost of insurance, and seniors would be forced to pay huge sums out of pocket. Democrats were unamused.

But here's an interesting thing. A few months ago I linked to a Yuval Levin proposal for Medicare reform that basically told his fellow conservatives to put their money where their mouths are. If conservatives really believe that competition is the key to holding down costs, he said, then let's make Medicare competitive. Levin proposed that each year Medicare would define a minimum benefit level, and then providers in each Medicare region would bid for business. The traditional fee-for-service Medicare plan would be among the bidders, and the second-lowest bid would become the value of a voucher sent to each senior. You could pay more for a more generous plan if you want to, but at all times "there would be at least one option that would cost less than the Medicare benefit, and seniors choosing that option would get the difference back as cash in their pockets; [and] there would be at least one plan that cost the same as the benefit, so that seniors could obtain it with only the same out-of-pocket costs they have today."

At the time, I suggested that liberals might very well be OK with this idea. After all, it's pretty much how Obamacare works. Within the insurance exchanges set up by PPACA, providers engage in competitive bidding based on a minimum coverage package defined by the government. The size of the federal subsidy for low-income families is set at the value of the second-lowest bid.

So here's what's interesting: this is basically what Paul Ryan is proposing this year. He's not quite willing to trust the free market completely, so his proposal also includes a cap on cost growth that's equal to GDP plus 0.5%. This is similar to the growth cap mandated in Obamacare. I have a problem with using this same number for Medicare, however, because it doesn't contain the word "per capita," and the retirement of the baby boom generation is going to increase the number of Medicare beneficiaries at a higher rate than the rest of the population.

Still, it's a start. The basic competitive framework is worth a look. The growth rate formula is negotiable. The regulatory apparatus is negotiable too. It's not prima facie ridiculous.

Now, given the slowdown in Medicare growth over the past couple of decades, along with the cost controls that are already part of Obamacare, I'm not really in favor of adopting a plan like this. I think we should give Obamacare a chance to work instead. Still, Ryan's plan is a step in the right direction. I'll give him that.

The Supreme Court ruled today against a Nestle patent on a test that helps doctors set drug dosages:

The high court, in a 9-0 ruling by Justice Stephen Breyer, said the patents were invalid because they made claims on laws of nature, which aren't patentable.

OK then. We've finally set an outside boundary: you can't patent God's inventions. That's a good start! Now how about if Congress eliminates all software and business process patents too? That would make the world a much better place.

Paul Ryan.

As a blogger, there are days you know you're doomed. Today, for example. Paul Ryan has released the latest Republican budget, and it's a blizzard of numbers, gimmicks, weird comparisons, and obfuscation. It's no more serious than any of Ryan's other budget proposals, no matter how many PowerPoint slides he includes, and yet, this is what everyone will be talking about. I'm pretty bored with Ryan, but I feel like I need to say something too anyway.

Other people with more fortitude than me will eventually pick through his numbers and deliver more precision about his proposals. As near as I can tell from a quick scan, though, it's not a lot different from his previous plans. He makes modest cuts in Medicare and Social Security over the next ten years, zeroes out Obamacare, keeps defense spending high, and then takes huge whacks at everything else.

The single most important number in Ryan's plan, as usual, is his top line limit on spending: 19% of GDP. He will, of course, justify this with a chart showing that this is about the average over the past 50 years, so it's perfectly reasonable that we should be able to stick with this for the next 50. But it's not. For starters, average expenditures over the past 30 years have been more like 20-21% of GDP, with the exception of a few years in the late 90s during the Clinton boom era. What's more, the country is aging. Nothing can stop that, and this means that spending on the elderly is going to go up no matter how good a job of reining in healthcare costs we do. This means that spending over the next 20-30 years is going to be in the range of 23-24%.

This is just pure demographics. There's really not much we can do about it. In fact, it's actually a best-case scenario.

So if we cut spending to 19%, it means that the entire budget outside of Social Security, Medicare, and Defense (which Ryan also doesn't want to cut much) has to be cut by half or more. Ryan will do his best to cover this up, but there's no way around the numbers. The country is aging. We're going to spend more on the elderly. If we cut spending levels at the same time, everything non-elderly gets whacked hard. That's the basic story. It's not a path to prosperity, it's a path to penury.

More later on some of the details of Ryan's plan.

UPDATE: So what does "whacked hard" really mean? It means hard. Details here.

The New York Times is tightening the noose:

There are enough back doors through the NYT paywall that this may not matter for a lot of people. But this move suggests that those back doors may start to disappear over time, just like the number of free articles is likely to decline. It looks like the Times is dead serious about making sure you pay them if you want to read their content.

A few days ago I wrote a post about whether oral contraceptives ought to be available without a prescription. They're pretty safe, it turns out, and several studies suggest that women are a whole lot more likely to use them continuously if they don't have to go in for a doctor's exam every year and aren't limited to buying just a month's supply at a time. Anna Reisman adds some more detail to this issue today, but the most intriguing bit came at the very end of her post. It's a link to a map showing where oral contraceptives require a prescription and where they don't. Here it is:

Here's what's interesting: although prescriptions are required in most of the rich world, there are plenty of middling-income countries where they aren't, including Portugal, Mexico, Brazil, South Africa, Greece, Turkey, South Korea, Russia, and several others. Surely this means that loads of data is available about health outcomes where prescriptions aren't required. Do women in Portugal have a greater number of dangerous pill-related interactions than women in Spain? Do women in South Korea have more allergic reactions than women in Japan? Do women in Greece have more problems with antibiotics than women in Italy?

It's not surprising that rich countries have more formal regulations in place than less-rich countries. But surely this provides us with a wealth of information about whether there are any systematic negative effects from allowing women access to over-the-counter oral contraceptives. So where are the studies?

So I finally got around to reading this weekend's big Washington Post tick tock about last year's debt ceiling negotiations. Jon Chait goaded me into it by writing a post saying that everyone was missing the real bombshell in the piece. Yes, the deal traded $800 billion in tax increases for $1.7 trillion in spending cuts. Nothing new there. Yes, the deal got derailed after the "Gang of Six" unveiled a more ambitious proposal that suggested Republicans could live with more than $800 billion in tax increases. Nothing new there either. The real news, he says, was that the $800 billion in revenues was mostly just a phantom in the first place, and Obama was willing to sell out the left by accepting this:

In Boehner’s offer Friday night, the taxes came with strings attached. The Republicans wanted Obama to give up plans to raise the tax rate paid by the wealthiest Americans, now set at 35 percent. Instead, they wanted that rate to go down....Another key caveat: Much of the $800 billion would have to come from overhauling the tax code — not from higher tax rates. The Republicans believed lower rates and a simpler code would generate new revenue by discouraging cheating and spurring economic growth. If the White House would agree to count that money, the Republican leaders said, then they might have a deal.

That last condition was a problem. For years, Democrats have mocked the Republican argument that tax cuts pay for themselves by boosting the economy....So there were issues to work out that Sunday but also reason for optimism. In its counterproposal, the White House appeared to accept the $800 billion tax offer and a lower top rate....When Boehner brought up economic growth, arguing that his caucus would not accept tax increases under any other terms, the Republicans saw Geithner as receptive, Jackson said. “It was literally one of the last things discussed when they came in on that Sunday. And Geithner said, ‘Yes, we accept that,’ ” Jackson recalled. “We viewed it as a breakthrough.”

On this point, the two sides are in dispute. Geithner and other administration officials say it never happened. They strenuously deny agreeing to count revenue from economic growth, a process known as “dynamic scoring.” Treasury spokeswoman Jenni LeCompte said the Republicans “were kidding themselves” if they thought the White House would concede that point. “That’s always been a total non-starter for Secretary Geithner and this administration and always will be,” she said.

Meh. The story doesn't say that Obama accepted the notion that the new revenue would mostly come from dynamic scoring. It says the two sides disagree about who accepted what. Big surprise. And anyway, even this isn't new. Here's Jay Newton-Small a few days after the deal fell apart:

Late last Sunday morning, House Speaker John Boehner and his No. 2, majority leader Eric Cantor, found themselves in White House Chief of Staff Bill Daley’s West Wing office talking with Treasury Secretary Tim Geithner about how tax reform, if done right, could produce $800 billion in new revenues over the next 10 years through growth and by closing loopholes. Sensitive to an anti-tax promise taken by most of the House Republicans, the negotiators felt this would be a way to raise revenues without breaking the pledge.

In other words, Cantor was hellbent on raising revenue without breaking the Republicans' no-higher-taxes pledge. Instead, some of the additional revenue would come via higher growth and some would come from broadening the tax base by closing loopholes and reducing tax expenditures. Did they end up agreeing on this? Nobody knows.

To be honest, I'm not sure there's anything new in the WaPo piece. There are a few details here and there, and a bit more recreated dialog, but nothing substantive. It's the same story we've heard from the very beginning: It was a lousy deal; the revenue increases were dubious; it got derailed after the Gang of Six released its plan and Obama asked Boehner for more revenue; and it got scuttled completely when Boehner refused to accept Obama's offer to go back to the original deal. Unless I'm missing something, we already knew all this.

Earlier today, David Axelrod described Mitt Romney's wall-to-wall advertising campaign in Illinois as a Mittzkrieg. The Romney campaign immediately cranked up the high dudgeon meter to 11:

At a time when there is so much talk about the need for civility in political discourse, it is disturbing to see President Obama's top campaign advisor casually throw Nazi imagery around in reference to a Republican candidate for President. Holocaust and Nazi imagery are always inappropriate in the political arena. Axelrod should apologize for his offensive language.

We call on Debbie Wasserman Schultz, the chairman of the Democratic National Committee, to publicly rebuke Axelrod for his language. We hope that the National Jewish Democratic Council will join us in denouncing Axelrod's comment, as they have frequently denounced Holocaust imagery in politics in the past.

That's it. I've had enough. I officially declare that it's now OK to use World War II imagery anytime you want. It's OK to make Nazi references. It's OK to compare people to Hitler. Go ahead! You have my blessing.

This whole thing is ridiculous, and I'm sick of it from all sides. WWII references are handy shorthand because everyone immediately understands them. There's nothing wrong with this. If you go overboard, people will mock you. If your analogies are wrong, people will correct you. If you literally say that someone is as bad as Hitler, you will be called an idiot. (Unless, of course, you're really talking about someone as bad as Hitler. But that's a pretty short list.) But the mere fact that you used a WWII/Hitler reference? Not an issue any longer.

It's probably still wise to take it easy on Holocaust imagery. But merely making a comparison of some modern-day event to something that happened in WWII, or something that Hitler did, or some well-known practice of Nazi Germany? If it's the obvious analogy to use, then use it. And let's all quit the pearl clutching, OK?

I got an iPad last week, and I intend to use it primarily as a book reader. Naturally I wanted to download a book and try it out, so I bought Matt Yglesias's new Kindle single, The Rent is Too Damn High. So far, I'm very pleased with the book-reading abilities of the iPad1, but I wonder if publishers are setting too high a price for these miniature volumes? Matt's book is $3.99, and in one sense that's cheap. It's about the price of a magazine, and has a roughly similar amount of content. On the other hand, you could also say it's more similar to a single magazine article — a long one, granted — and people aren't generally willing to pay four bucks for one article.

Unless you're a big name, or you happen to generate some serious buzz, it seems as if these kinds of books might do better as impulse buys. Maybe 99 cents, or $1.99. On the other hand, the real investment here is time more than money, and for anyone willing to spend three or four hours reading something like this, three or four dollars shouldn't be much of a hurdle.

I guess I'm not sure. Maybe all I really wanted was a chance to write the headline for this post. But I'm curious to get some feedback. Has price ever deterred you from downloading any Kindle singles? Or is this a non-issue?

1My big problem with the original Kindle was that it sucked for nonfiction books. Tables, charts, and images of all sorts rendered so badly as to be nearly illegible. But the Kindle app for the iPad appears to have solved this problem. My test case was A Farewell to Alms, and although some of the images were surprisingly low-res, they were all readable. And the tables were all readable too: columns actually lined up properly and pages are big enough to have enough to room show the entire thing. So far, so good.

1965 civil rights march from Selma to Montgomery, Alabama.

Ed Kilgore writes a post today mocking right-wing fear of betrayal by insufficiently dedicated conservative judges, a brand of paranoia that got its start with Eisenhower's appointments of Earl Warren and William Brennan to the Supreme Court:

These disasters (from a conservative point of view) were hardly isolated. Richard Nixon appointed Roe v. Wade author Harry Blackmun; Gerald Ford's brief presidency produced long-time Supreme Court liberal John Paul Stevens, and Poppy Bush put the ultimate Stealth Liberal, David Souter, on the High Court, an act for which the later nomination of Clarence Thomas was a very loud apology. Worse yet, St. Ronald Reagan was responsible for Sandra Day O'Connor, and depending on where Anthony Kennedy lands on a series of big upcoming cases, his appointment, too, could wind up earning a conservative Day of Infamy.

You'd have to say everything about Mitt Romney makes him suspect as the kind of Republican president who might make an insufficiently right-wing Court appointment. And this is precisely why I'd bet the farm (if I had one) that by the time November rolls around the Federalist Society wing of the conservative movement will have extracted so many private and public blood oaths from Romney on the subject that should he even think about a less-than-orthodox nominee, Satan would appear in the West Wing and snatch Mitt right down to hell.

It's actually sort of unfair to ridicule this. The truth is that by 1990 conservatives had very good reason to be tired of "conservative" Supreme Court nominations that turned out to be either moderate or downright liberal. Souter was the last straw, especially since his nomination was viewed as caving in to liberal attacks on a genuine conservative, Robert Bork. If the shoe were on the other foot, liberals would feel the same way. I would, anyway.

In a way, though, that's why I think Ed is wrong in his conclusion. The Bork/Ginsburg/Thomas trifecta, combined with a long history of moderate appointments, came to a head in the early 90s. Since then, there's been no daylight among Republicans on the need to nominate only absolutely reliable conservatives to the Supreme Court. Romney may indeed make both public and private promises on this score, but he won't need any coaxing. Even moderate Republicans are pretty much on board with the movement conservative agenda on Supreme Court nominees.

There is, in a way, a broader unfairness here too. We tend to mock conservatives for endlessly keeping the culture war alive, but the truth is that it was we liberals who started it. We're the ones who, among many, many other things, banned school prayer, legalized abortion, fought for gender equality, and are currently pressing to legalize gay marriage. You'll be unsurprised to learn that I think we were right to do all these things and right to keep fighting for them. But make no mistake: we're the ones demanding change, and we're the ones who keep fighting for it. Every time I hear some liberal complaining about the way that conservatives keep turning everything into a new front in the culture war, I feel a twinge of chagrin. Why are we complaining? We're the ones who really own the culture war, and we should be proud of it. It was a war worth starting and a war worth winning.

Via Ryan Avent, the European econ blog site Bruegel highlights this rather astonishing fact:

As Ronny Patz noted in a recent post [], European blogs are still very much “unconnected”. That is, they use hyperlinks far less than their American counterparts or do it and in a way that doesn’t create two-way debate. In brief, Europe has bloggers, but no blogosphere: it lacks a living ecosystem to exchange and debate. Of most leading European blogs, only 1 in 5 were linked to other online content. This is a pretty striking number but one that is somewhat consistent with the use that Europeans make of blogs (ie. just another media but not an interactive one).

The Bruegel folks suggest there are both institutional reasons for this (European economists mostly publish in their home country newspapers) and cultural reasons (European economists don't like to argue as much as American economists). And language plays a role. Still, it's very peculiar. Can it really be true that European economists aren't much interested in publishing online even after years of seeing how vibrant the American econ blogging scene is? Do they really shy away from arguing with each other? "European economists seem to prefer spreading knowledge rather than stirring debate," say the Bruegel bloggers.

That's.....admirable, if true, I suppose, but it doesn't quite smell right. I don't know anything about European economists in particular, but it's certainly never been my experience that Europeans in general are more reticent than Americans. They always seemed to me like they had plenty of opinions and just as much love for bar stool arguments as Americans.

I wonder if there's more to this?