The forgotten history of Ryan's Medicare reform

In 2008, amid the poverty of ambition of the late Bush presidency, Mr. Ryan released “A Roadmap for America’s Future,” a 71-page document that was the first plan in years to take arithmetic seriously. The then-obscure Wisconsin congressman dropped by the Journal to sell his vision, no press secretary, no handlers. “I want to be the Paul Revere of the fisc,” he said, according to my notes from the meeting. …

Back then, Mr. Ryan was the only Republican to give a reform agenda definition. The roadmap earned all of eight cosponsors and never got a committee vote. Mr. Ryan was drawing from a rich intellectual well. Premium support was first proposed by Stanford economist Alain Enthoven in the New England Journal of Medicine in 1978. He observed that the pervasive methods of direct economic regulation of health care did not contain costs and suggested that “managed competition” would do a better job. …

But Mr. Ryan did what a million blue-ribbon panels never could: In late 2010 and 2011, he led an internal struggle to educate and convince the risk-averse Republican caucus to get behind his plan. Newt Gingrich’s notorious remark about “right-wing social engineering” gives a flavor of the objections. The main doubters were the careerist old guard.