Jonathan Cohn at the New Republi c explains the significance of Rep. Paul Ryan's budget proposals for the way we provide health care, especially to our elderly. Cohn is, as regular reads know, the smartest commentator on health care policy in the country. And, he sees the forest for the trees in Ryan's plan: This is not about improving health care costs. This is about letting the rich get richer and letting the vast majority of Americans fend for themselves. It is social Darwinism.