Wisconsin Congressman Paul Ryan, the House Republicans’ budget guru, is a smart guy. Chosen for a year-end Washington Post feature, he produced a chart showing federal spending as a proportion of the national income.

Projected into the future, major portions of the budget – defense, Social Security benefits – are essentially flat, which could be news to those who proclaim that “entitlements” are bankrupting the country. Discretionary spending, everything from Head Start to national parks, is actually declining.

What is shooting up, dramatically, is health care spending. Ryan comments, “Government spending drives the debt, and the growth of government health care programs drives the spending. Relentlessly rising health care costs, coupled with demographic changes, are driving the growth of these programs.”

Ryan’s conclusion, however, looks less brilliant. His proposal to turn Medicare, which provides guaranteed care for seniors, into a voucher program was so widely derided you no longer see him in the headlines.

The basic argument – that removing people from Medicare and Medicaid and shifting them to private insurance – is so faulty that only ideology can explain Republicans’ curious embrace.

The facts are clear. The state-federal Medicaid program, for the poor, disabled, and elderly, has the lowest costs per capita. Medicare is more expensive, not only because older people need more care but because we spend far too much on end-of-life care. But the most expensive method of all, by far, is the private insurance system. Once people understood that Ryan’s Medicare vouchers would fall thousands of dollars short of buying equivalent private coverage, the plan sunk like a stone.

Paul Ryan won’t get to try out his idea of privatizing Medicare. But in Maine, Paul LePage is throwing everything he has into a similar fight. A projected $221 million gap in the Medicaid budget is largely the governor’s own creation. Enrollment increases account for just $3 million. It was the administration’s inability to project costs correctly that created the crisis.

But LePage is bent on removing 65,000 Mainers from Medicaid nonetheless. His assertion that this was a “difficult decision” is disingenuous. He’s wanted this result since he launched his candidacy.

On Wednesday, he halted proceedings at the Appropriations Committee with this broadside: “Democrats can no longer ignore this fiscal mess that they have created through the years. Taxpayer funded, government-run health care is not universal nor is it free — it is paid for by hard-working taxpayers — and it must be saved for Maine’s most vulnerable.”

It’s a clear statement of LePage’s views, though hardly calculated to win the Democratic votes he needs. Legislative Republicans say they won’t back cuts for assisted-living centers. But neither they, nor the governor, have said what will happen to the thousands of Mainers who will lose health care.

Lance Dutson, president of the Maine Heritage Policy Center, which functions as LePage’s state planning office, zeroed in on one group the governor says is definitely not among the “most vulnerable”: adults without children who earn between 100 percent and 133 percent of the federal poverty level, or between $11,000 and $14,000. Dutson said these Mainers could help revive the individual insurance market by buying policies.

He did not explain what kind of policies they could afford, if they have anything left at all after paying for food and rent.

Maine Equal Justice Partners issued a study on this particular group – which must be covered by federal law on Jan. 1, 2014, just 18 months after LePage’s proposed removal. Nearly half, 47 percent, have a major disease, such as cancer, which seems high until you realize who these people are.

Typically, they have gone without health care for years, and one reason they earn so little money is that they aren’t healthy enough to work full-time. It’s a vicious circle created by a patchwork system that’s left one in six Americans without health care.

Although LePage has support from GOP legislators in his contention that Medicaid enrolls too many, they ignore the reality that removing government support will lead to still higher costs, and sicker people.

The problem is health care costs, period, to which a national solution is needed, well beyond the reforms voted in 2009 by Congress. LePage won’t win approval of huge enrollment cuts to solve the budget problem. He should start thinking about what will get the job done, such as postponing the tax cuts his finance chief, Sawin Millett, assured lawmakers last June we could afford.

The wealthiest Mainers haven’t contributed anything to see the state through these difficult times, and they don’t need additional rewards if that requires tens of thousands to go without.