I set aside his accusation that Ryan is a fanatical follower of Ayn Rand (apparently he has his staff read Atlas Shrugged) and focus instead on a few false assumptions in the argument against that the status quo is the yardstick of justice, and that a benefit program, once created, cannot be destroyed without committing some great injustice.
The empty promises of a Medicare program that is scheduled to devour one-fourth of the federal budget within 20 years and half of it by 2070 (or sooner) do not constitute a fulfillment of Catholic social teaching. Similarly, the replacement of these empty benefit promises with more realistic but less ambitious ones does not constitute disregard for the well-being of the most vulnerable.
I would only add that the alternative plan for Medicare -- that of President Obama -- is more aggressive rationing through one of the panels established under Obamacare. That should raise far bigger concerns than Ryan's plan. If you are at the mercy of a private insurer, at least the government is there to keep him honest. Under Obama's vaguely outlined plan, senior citizens in bad health will be at the government's mercy with absolutely no alternative and no one to turn to.
I did not have time to explore the more complicated question of Medicaid in my 600 word space, but it deserves a bit of ink. Have you heard all the tales of woe from Rhode Island, of poor people dying because of massive Medicaid cuts? Rhode Island has been in the middle of a Medicaid experiment that has saved the state more than 25 percent of its anticipated Medicaid budget, under a plan similar but not identical to Ryan's proposal.
It is not a pure block grant program, but the basic idea is similar to Ryan's. Instead of an open-ended commitment, the federal government set a Medicaid expenditure limit over five years. In return, Rhode Island was allowed to adopt more flexible care arrangements not allowed under the current federal rules, and to institute a competitive bidding system. Another large source of savings is an emphasis on in-home care instead of extremely expensive institutional care (i.e., nursing homes). The savings are already impressive, but they probably would have been greater but for interference by the Obama administration and the "maintenance of effort" requirements in the stimulus package. (You can read more details about what they did from the Galen Institute.)
The Rhode Island plan was negotiated by Gov. Don Carcieri, R, probably the most conservative governor in America when he was in office, and the roughly nine-tenths Democratic state assembly. It was bipartisan because it was born of necessity. Despite the substantial federal contribution, the program was killing the state's budget and endangering other priorities like education and public safety. (And Rhode Island's taxes are plenty high already, thank you very much.) My summary here really doesn't do the program justice, but let's just say it appears to be working well and we're not hearing any horror stories.
The bottom line is that lawmakers have a moral responsibility to be honest, and to prevent the kind of breakdown that other nations like Greece are currently experiencing. Heaven forbid we should come to the point of poor Japan, which has maxed out its debt (currently at 200 percent of its economy) and will be hard-pressed to pay for reconstruction after a genuine catastrophe.
So let's stop disregarding math, and drop the hyperbolic assertions about Ryan disregarding the poor and the old.