RUTHFULLY YOURS

During the negotiations over raising the debt ceiling, President Obama reportedly warned Republican leaders not to call his bluff by sending him a bill without tax increases. Republicans in Congress ignored this threat and passed a bill that cuts more than a dollar in spending for every dollar it increases the debt limit, without raising taxes.

Yesterday, Mr. Obama signed this bill into law. He was, as he said, bluffing.

Nevertheless, the president still hasn’t shown us his cards. He still hasn’t put forward a credible plan to tackle the threat of ever-rising spending and debt, and his evasiveness is emblematic of the party he leads.

Ever since they abused the budget process to jam their health-care takeover through Congress last year, the Democrats have simply done away with serious budgeting altogether. The simplest explanation—and the president’s real bluff—is that they don’t want to commit publicly to the kind of tax increases and health-care rationing that would be required to sustain their archaic vision of government.

The president’s February budget deliberately dodged the tough choices necessary to confront the threat of runaway federal spending. It was rejected unanimously in a Senate controlled by his own party.

View Full Image

Since then he has offered a lot of rhetoric but no real plan to avoid a spending-driven debt crisis. His speeches and press conferences are no substitutes for actual budgets with specific numbers and independently verified projections of future deficits and debt. Meanwhile, it has been over two years since the Democrat-controlled Senate passed any budget at all. This is a historic failure to fulfill one of the most basic responsibilities of governing.

This leadership deficit has thrown the federal budget process into chaos at the worst possible time. Even though Congress has cut spending by a significant amount, it still hasn’t dealt with the drivers of our debt—primarily federal spending on health care.

The math is scary, yet simple: In the years ahead, spending on programs such as Medicare, Medicaid and the Democrats’ new health-care entitlements is projected to skyrocket relative to the size of the economy, even as federal spending on everything else is projected to decline (see the nearby chart).

Even well-intentioned proposals such as the one put forward by the Senate’s Gang of Six lacked specific reforms to curb the health-care spending. Actually, it took steps in the wrong direction by explicitly requiring policy makers to “maintain the basic structure” of government health-care programs. That structure is unsustainable.

Medicare reimburses all providers of care according to the same formula, even if the quality of the care they provide is poor and the cost is high. This top-down delivery system exacerbates waste, as none of the primary stakeholders has a strong incentive to deliver the best-quality care for the lowest cost. Medicaid has fallen victim to the same trend: an open-ended commitment that drives up costs, coupled with a flawed federal-state matching formula that is breaking state budgets.

Supporters of the Democrats’ new health-care law claim that the law will fix these problems. But we are already seeing evidence that its maze of mandates, dictates, controls and tax hikes will actually push costs even further in the wrong direction.

View Full Image

Getty ImagesPresident Obama signing the Budget Control Act of 2011 in the Oval Office on Tuesday.

Even the president seems to understand that the status quo of these programs is unsustainable. As he put it during a press conference on July 11, “If you look at the numbers, then Medicare in particular will run out of money, and we will not be able to sustain that program no matter how much taxes go up.”

On this point, Mr. Obama and I couldn’t agree more. Where we disagree is over how best to confront this problem.

The president’s health-care law represents an attempt to double down on the failed policies of the past. Despite claims that new methods of reimbursing Medicare providers will tame costs, the fact is that the federal bureaucracy has tried most of the measures before, without any success.

Worse, the law would create a new 15-member board of bureaucrats empowered to bypass Congress to make deep cuts in payments to Medicare providers. Time and again, such provider cuts have had two consequences: Providers have either increased the volume of services they provide for each condition, or they have stopped accepting Medicare patients altogether.

There is a better way—structural reforms that empower patients with greater choices and increase the role of competition in the health-care marketplace. The budget passed by the House of Representatives in April, “The Path to Prosperity,” outlined the beginnings of such an approach by repealing the president’s health-care law and proposing reforms that would make Medicare and Medicaid stronger and solvent for current and future generations.

In other words, we’ve put our cards on the table: According to the Congressional Budget Office (CBO), our plan puts the federal budget on the path to balance without resorting to job-destroying tax hikes. It will eliminate the shadow of debt that is discouraging job creation while advancing pro-growth tax reforms to get the economy moving again.

By contrast, the president and his party’s leaders have refused to submit specific, credible budget plans that tackle health-care costs while restoring economic growth. Unwilling to reconsider their failed bureaucratic approaches to health and retirement security, the Democrats can only propose tax increases, and lots of them.

The CBO’s latest Long-Term Outlook in June estimated that total tax revenues would have to double by mid-century in order to finance our current spending path. Health-care costs rose about 8% in 2011 and are projected to rise by 8.5% in 2012. At this rate, taxes would have to rise again and again just to keep up with health-care spending. Is it any wonder that the president and his party are afraid to produce a budget that requires such ruinous levels of taxation?

The president tried to use the debt-ceiling negotiations to secure the first of many tax increases that his party needs to pay for its legacy of unfunded promises. He failed. Instead, Republicans won the policy debate by securing the first of many spending restraints we need to avoid a debt-driven economic calamity.

Much hard work remains. But this work will be harder still if leading Democrats remain unwilling to lay their cards on the table and give the American people the debate they deserve.

Mr. Ryan, a congressman from Wisconsin, serves as chairman of the House Budget Committee.