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Paul Ryan's Peculiar Definition of Bipartisanship

Paul Ryan at a news conference on Capitol Hill in Washington, D.C.
Paul Ryan at a news conference on Capitol Hill in Washington, D.C.Photograph by Luke Sharrett/The New York Times via Redux

In early 2011, Representative Paul Ryan (R-Wis.) was shopping around a Medicare plan, and he was in search of Democratic support. The previous year he’d released a proposal for privatizing Medicare that he had trouble selling to even his own party: Only 13 Republicans signed on. Clearly he needed to expand his base of support.

Ryan found a partner in Alice Rivlin. A former director of the Office of Management and Budget in the Clinton White House and a Washington Wise Woman, Rivlin was serving with Ryan on the Simpson-Bowles Commission that was looking for ways to bring the federal deficit and national debt under control. After an extended back and forth, the two came up with a proposal both could live with: Instead of getting rid of the fee-for-service model—Medicare as we know it, in which the government pays providers directly—and opening everything to the free market, Medicare would compete directly with private plans regulated by government exchanges. And rather than pegging the growth rate of Medicare to the Consumer Price Index, as Ryan had proposed, Ryan appeased Rivlin with a more generous cost cap.