als at Roland Garros. Monfils did finally beat Federer last year, however, edging a tight three-setter in the Paris Masters in Bercy and while that hardly represents a "winning run" it does offer hope. "Well, it does matter knowing, for me, knowing I managed to beat him here in Paris," Monfils told reporters when asked if that would fuel his confidence against the 2009 champion who is yet to drop a set here this year. "Obviously it's going to be favorable because it's going to help me relax." While Monfils was involved in what he described as a "mental fight" with the tenacious Ferrer, Federer has been enjoying some rest having waltzed through the draw so far. While Monfils said he was feeling tired, he said the motivation of playing at his home slam in front of his own fans would help him recover his energy. "From the moment you get to Roland Garros, whether you're tired or not, whether you're injured or not I mean, even when I twisted my ankle, I told my physiotherapist, no, don't worry, Monfils said, referring to some ankle stiffness overnight. "Even if I had a broken ankle, I would get on the court and I would still run. I'll be on the court tomorrow, and I'll fightoverwhelm the Ryan vote. But for the time being, the anti-Ryan backlash suggests that Republicans will have to do some policy rethinking--not just political spinning. Why? Because the basic reality of the Ryan Plan overwhelms any possible spin: The Ryan plan is a major cut in Medicare. And while the plan is hazy in places--it is, after all, not just a health care plan, but also an overall fiscal and economic plan for the next forty years--it provides enough numbers for critics to pounce on fiercely. Indeed, for a more rigorous estimate of the Ryan plan’s impact over the long run, we can turn to the Congressional Budget Office--not necessarily a friend of Republicans, to be sure. As CBO puts it, current federal health programs--Medicare, Medicaid, the Children’s Health Insurance Program, and the new subsidies for ObamaCare--account for about five percent of U.S. gross domestic product (GDP). And according to current projections--absent any Ryan-ish changes--federal health spending would nearly triple, to 14 percent of GDP by 2050. Such a spending surge is obviously not sustainable. Yet under the Ryan plan, federal health spending would not only not increase; it would in fact fall, to around 4.75 percent in 2050. Liberal critics, such as The Washington Post’s Ezra Klein, have responded by taking the CBO calculations and claiming that the Ryan plan would mean a two-thirds cut in per-patient Medicare spending by 2050.  That assessment may or may not be accurate, but one fails to find any refutation to it on the House Budget Committee’s website.  An observer has to question: Although restraining growth in health spending is desirable, is it really plausible to see federal health spending fall as America ages? Indeed, the percentage of the population over the age of 65, according to the Census Bureau, is projected to increase from 13 percent today to 20 percent in 2050. And whereas the overall population is projected to grow about 40 percent in the next four decades, the number of Americans over the age of 85 will grow more than 500 percent. Inherently, the health care of all those oldsters is going to be expensive. And how, exactly, will Ryan control Medicare costs? How will his fiscal vision accommodate this “grey wave” of demography and yet still cut health care spending? On these questions, the Ryan plan lacks many specifics, although the document is nonetheless emphatic on one ideological principle--patient choice. “Real reform” for Medicare, Ryan writes, “must eliminate this unsustainable waste and reduce inefficiencies and costs by giving beneficiaries themselves more control over their own health-care benefits and decisions.” In other words, the miracle of the marketplace will control health care spending. Even more broadly, Ryan asserts that the same market mechanisms that work in other parts of the economy will work just fine for health: In health care, as in any other economic arrangement, control of money is power. When it comes to controlling health-care costs and saving the nation from bankruptcy, the question is: Who gets the power? One centralized federal government, or 50 million empowered seniors holding providers accountable in a true marketplace? Patient power will always serve the needs of the people far better than bureaucrats.  And so the Ryan plan argues that future Medicare recipients--if the plan were enacted tomorrow, it would kick in for seniors in 2022--should be empowered to choose their own health insurance plan. Maybe, but maybe not. Anyone who thinks that health care is just like “any other economic arrangement” might wish to read economist Kenneth Arrow’s 1963 essay, “Uncertainty and the Welfare Economics of Medical Care.” In that piece, the Nobel Prize-winner argued that the “asymmetric information” between the doctor and the patient makes bargaining difficult, if not impossible. That is, given the imbalance of information, the patient is in no position to negotiate intelligently with a doctor or other health care provider. It is true, of course, that some medicines and treatments can be haggled out in the marketplace. As treatments become widely available, or even generic, it’s possible to comparison-shop for the cheapest pill. Indeed, even some once-complicated treatments, such as Lasik, have become inexpensive over time, thanks to fierce competition.  But the Ryan plan would work better for 25-year-olds than 65-year-olds. Older people have more serious problems; it’s hard to dicker in the midst of stroke or cancer. And many old people, of course, are mentally debilitated, even incapacitated, by chronic maladies such as Alzheimer’s Disease (AD). In fact, not only does the nature of AD undercut one’s ability to shop around, but there’s no real treatment for the disease, other than 24/7 care, once dementia sets in. Today, the average case of AD costs more than $30,000 a year, for a total of $170 billion--the bulk of that cost borne today by Medicare. According to the American Journal of Public Health, the incidence of AD is predicted to triple in the coming half-century,  and it’s difficult to see how the Ryan plan would make AD care cheaper. And so, for a 45-year-old who might have a parent with AD--dealing with care, worrying about his or her own susceptibility to the disease--the Ryan plan could look uncertain, even scary. That, at least, is what the polls show decisively. So what should Republicans do? Clearly, they need to reassess--and they already are doing so. As Republicans are now saying, the Ryan plan is non-binding, only symbolic, simply “a direction that we’d like to go in.” Interestingly, in the meantime, the best defense of the Ryan plan has been not a defense at all--but rather a reversal of field, a ferocious counter-attack on the Democrats. In an astute editorial, “The Other Medicare Cutters,” The Wall Street Journal made the point that whatever seniors might think of the Ryan plan, the Democratic plan is worse. After lamenting “liberal distortions” of Ryan, the Journal pivoted and took it to the Democrats, noting that