Evidence of Intellectual Fraud in Ryan's Budget

Ryan's Debt Graph

CBO's Debt Graph

Sources: Ryan's Budget, p. 6 (http://paulryan.house.gov/uploadedfiles/pathtoprosperity2013.pdf) and CBO Report on Ryan's Budget, p. 15 (http://cbo.gov/sites/default/files/cbofiles/attachments/03-20-Ryan_Specified_Paths_2.pdf).


In recent days there have been too many trees sacrificed to laud the supposedly visionary, serious, courageous Ryan Budget. (Washington Post: “Ryan is articulating clear convictions about fiscal austerity and offering an intellectual vision” (http://www.washingtonpost.com/politics/romney-ryan-rally-supporters-in-nascar-country/2012/08/12/3692324c-e491-11e1-8741-940e3f6dbf48_story.html), etc. )

I read his initial evidence (http://paulryan.house.gov/uploadedfiles/pathtoprosperity2013.pdf). It is a pack of lies.

Of course, this is a political document. It’s primarily focus-group tested rhetoric about how “this budget offers a blueprint for safeguarding America from the perils of debt, doubt and decline” (p. 7) and complementary, unproven allegations about how severely cutting health care for the elderly and poor will somehow help society (this is a moral judgment). I’m not interested in trading political barbs or rehashing talking points. It’s much better to look at factual evidence.

The first thing we should know is that the Ryan Budget is designed to address supposedly high levels of federal debt, which in Austrian School economic theory, lead to higher interest rates and stifle borrowing and business growth. What have the bond markets said so far about the spike in debt the federal government has experienced over the past decade? Oh, that’s right, Treasury bond yields are at the lowest levels ever recorded (http://www.federalreserve.gov/releases/h15/data.htm). But let’s move on to the actual budget.

The first footnote we get to (p. 6) cites a CBO study comparing Obama’s budget to Ryan’s until 2022. Why do you stop at 2022, Mr. Ryan? The cited CBO Report (http://cbo.gov/sites/default/files/cbofiles/attachments/03-20-Ryan_Specified_Paths_2.pdf) notes that “Those calculations do not represent a cost estimate for legislation or an analysis of the effects of any given policies. In particular, CBO has not considered whether the specified paths are consistent with the policy proposals or budget figures released today by Chairman Ryan as part of his proposed budget resolution. The amounts of revenues and spending to be used in these calculations for 2012 through 2022 were provided by Chairman Ryan and his staff. The amounts for 2023 through 2050 were calculated by CBO on the basis of growth rates, percentages of gross domestic product (GDP), or other formulas specified by Chairman Ryan and his staff.” So the first graph is a letter to Santa Claus. Let’s move to the second one, which extends beyond 2022 and thus doesn’t merely allow Ryan staffers to pull numbers out of thin air.

The second footnote we get to (“Source: OMB/CBO;” p. 6) is a startling graph showing federal debt rising from its post-World War II average of around 40% of GDP (70% now) all the way to 900% by 2080. Scary! The Ryan Budget decreases debt to 0% by 2050. Salvation!Luckily I am familiar with these things called footnotes and this curiosity called the federal budget. The reference is found here (http://cbo.gov/publication/43289) and the report is here (http://cbo.gov/sites/default/files/cbofiles/attachments/03-20-Ryan_Specified_Paths_2.pdf). If you look at the CBO Budget Report that he relies on, you will find that the estimates do not go to 2080. Hmm, this is curious. Why do they stop in 2050, Mr. CBO? Well, on page 3, Mr. CBO tells us that: “The results discussed here stop in 2050 because uncertainty about the economy and the budgetary effects of given policies in the more distant future makes calculations beyond that point less meaningful.” So these 2080 estimates that Ryan cites are just a fabrication. Oh, and there are two scenarios that the CBO cites. The rosier one is not mentioned in the Ryan Budget. In 2050, the CBO estimates that the Ryan Budget will have a debt/GDP ratio of 10%, which is bizarrely, and without evidence, rounded down to 0% in 2051.

The CBO Report on the Ryan Budget is only 17 pages long and about half of that is pretty graphs and tables. Page 15 has the same damn graph as Ryan’s page 6 but the numbers are completely different. It’s pretty hard to fuck up reading this thing. I imagine that an intellectual leader and House Budget Committee Chairman would have read this thing backwards and forwards, named his dog Fiscal, slept with the federal budget under his pillow and so on.

In other words, we can tell the first “evidence” in Ryan’s Budget is a pack of lies just by reading his footnotes. Even if Cindy Lou Who did this, I’d send him or her to the principal for academic dishonesty. 
To say this man is somehow an intellectual leader is to believe in a profound fraud.

Public opinion polling indicates that majorities of every demographic group studied think that maintaining Medicare and Social Security benefits are more important than reducing the budget deficit – every group except for two: Republicans with $75,000+ annual income and self-identified Tea Party conservatives (http://pewresearch.org/pubs/2051/medicare-medicaid-social-security-republicans-entitlements-budget-deficit).

To say that politicians are liars is like talking about red fire trucks. Neither is it very interesting to note that partisan political hacks dominate the editorial pages and 24-hour squawk boxes. What is interesting is what the dissemination of these lies through our legislative and electoral process says about who controls the country and whether or not we live in a democracy.

The Incongruous Cheesecake Factory Metaphor in Atul Gawande's "Big Medicine" Piece

Surgeon, author and medical error expert Atul Gawande has a new piece in this month's New Yorker focusing on best practice in medical care. Another of Gawande's articles prompted an Oval Office strategy meeting that helped formulate major cost controls in Obamacare. In other words, while we may not agree with everything Gawande has to say, we should read him because he has the President's ear and we are interested in future policy actions.

The current New Yorker piece essentially argues for standardization and quality control while focusing on improving patient outcomes. He spends a great deal of time discussing food at the Cheesecake Factory, where, in a fit of slurpishness he revels:

"The typical entrée is under fifteen dollars. The décor is fancy, in an accessible, Disney-cruise-ship sort of way: faux Egyptian columns, earth-tone murals, vaulted ceilings. The waiters are efficient and friendly. They wear all white (crisp white oxford shirt, pants, apron, sneakers) and try to make you feel as if it were a special night out. As for the food—can I say this without losing forever my chance of getting a reservation at Per Se?—it was delicious. The chain serves more than eighty million people per year."

Let's just say that quality control is not exactly unique to the restaurant industry or politically controversial. In other words, who gives a shit whether the Cheesecake Factory can cut down on cost?

To tie it back to the health care industry where (unsurprisingly) there are plenty of people engaged in patient-outcome and cost-control research, he summarizes work by his colleague John Wright, an orthopedic surgeon who relies on comparative outcome data to find out what knee implants work best. If implants cost more while not improving outcomes, his surgical team is basically forbidden from using them. And data used by Knight came from Australia's single-payer, national health care system? OK, Atul, this all makes sense. What's the point of spending half your time talking about the Cheesecake Factory?

Atul has a gift for language and metaphor. As a single-payer advocate (a system that in all other countries leads to much less cost and much better patient outcomes), Gawande is undoubtedly aware of the communications constraints (socialism!) faced by advocating single-payer health care.

Talking about the Cheesecake Factory is just a way to sell the idea. It's a way to talk about Australia and national data-collecting through the back door. Although there's certainly better or pithier ways to phrase it for public consumption, the public doesn't read the New Yorker. The Cheesecake Factory is a Trojan Horse: it's a way to talk about single-payer while attempting to ensure the reader doesn't think about Big Government and consequently dismiss the idea.

So, serious readers, forget about how chefs make that perfect veggie burger. There's already plenty of research about quality control in health care settings. Health policy folks know what works better than the American system. When we read Gawande, we just have to keep in mind what he's trying to sell.