For those closely observing the attacks on Medicare and Social Security, Ryan Lizza’s New Yorker profile piece in the August 6 issue is a must read. Lizza spent a lot of time with US Rep. Paul Ryan, R-WI, the chairman of the powerful House Budget Committee, who has pushed his ideas for privatizing Medicare into mainstream GOP thinking. If he gets his way—and the votes—the program that provides healthcare for nearly 50 million seniors and people with disabilities would become radically different.

Why read this piece? Lizza gave the reason high in the story:

To envisage what Republicans would do if they win in November, the person to understand is not necessarily Romney, who has been a policy cipher all his public life. The person to understand is Paul Ryan.

Lizza chronicles Ryan’s rise from an ordinary congressman representing the blue-collar city of Janesville, in southeastern Wisconsin, to major Republican thinker and shaper of party ideas. “Sitting in his office more than three years ago, Ryan could not have foreseen how successful his crusade to reinvent the Republican Party would be,” Lizza reported. “Nearly every Republican in the House and the Senate has voted in favor of some version of his budget plan.”

The plan would reduce federal spending for many programs, including programs for the poor and Medicare, an entitlement that cost the government about $551 billion last year. They are targets for Ryan’s voucher plan, which would shift much of the responsibility for paying for healthcare from the government to seniors themselves. Ryan’s plan, now called his Path to Prosperity, a version of earlier documents, also envisioned the repeal of the Affordable Care Act and effectively cutting Medicaid by a third. Lizza reported that doing that means the program, which pays for healthcare for the poor, would not keep up with rising medical costs.

The proposal stems from Ryan’s deeply ingrained conservative philosophy, framed by reading the works of Ayn Rand, Ludwig von Mises, Milton Friedman, and Friedrich Hayek. Lizza recounts Ryan’s own political philosophy as being

Only by taking responsibility for oneself, to the greatest extent possible, can one ever be free. Only a free person can make responsible choices between right and wrong, saving and spending, giving or taking.

Ryan’s budget, Lizza believes, allows more Americans to do just that. But Lizza didn’t delve into what would happen if those affected by his budget cuts don’t have money to make the responsible choices he advocates. It’s unlikely Ryan suffered financial hardship growing up even though his father, a lawyer, died young, and his mother went back to school to become an interior designer—Lizza reported that Ryan belongs to an Irish clan, which along with two other families were known as the Irish Mafia and helped develop Janesville in the postwar era. The Ryans were major road builders. Ryan, Inc. is a national construction firm started by his great grandfather.

Perhaps Ryan’s family background and his conservative philosophical grounding helped mold him into the man to watch in the next Congress. Lizza depicted him as hard-nosed and unwilling to compromise, in line with fellow GOP lawmakers, as Brookings Institution political scientist Thomas Mann told CJR last week.Republicans are “now the primary source of stalemate,” Mann said. Accordingly, Lizza reports, Ryan helped scuttle three budget deals; last summer, when a group of Democratic and Republican senators produced an agreement for dealing with the deficit, “Ryan’s detailed criticism helped sink it”; he reportedly pressured House Speaker John Boehner to reject a potential deal with the president.

Ryan is not opposed to all government spending. Lizza brought up the matter of Ryan’s hometown, which is trying to reinvent itself after a GM plant closed. Federal dollars have flowed into Janesville to help with its transformation into a distribution hub for major companies like John Deere. When Lizza pointed out that federal government spending programs were at the heart of his town’s recovery, the Beltway’s chief budget cutter did not disagree. “Of course, we believe in government, we think government should do what it does really well, but that is has limits, and obviously within those limits are things like infrastructure, interstate highways, and airports,” he said.

If Ryan has his way, those limits may not include much healthcare for seniors and the poor along with, perhaps, lower Social Security checks for just about everybody.

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Trudy Lieberman is a fellow at the Center for Advancing Health and a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR’s healthcare desk, which is part of our United States Project on the coverage of politics and policy. Follow her on Twitter @Trudy_Lieberman.