Yesterday, on “CNBC’s Morning Joe,” Paul Ryan claimed Alice Rivlin, Clinton’s OMB director, as an ally: “Alice Rivlin and I designed these Medicare and Medicaid reforms” he announced.  “Alice Rivlin is a proud Democrat at the Brookings institution. These entitlement reforms are based off of those models that she and I worked on together.”

I have followed Rivlin’s career since her days in the Clinton administration, and always admired her intelligence, honesty and integrity. To say that I was dismayed to hear that she had teamed up with Ryan to endorse his plan to end Medicare is an understatement.

But last night, Politico.com’s Meredith Shiner reported that in an interview with POLITICO, Rivlin revealed that she has told Ryan that she “cannot support the final version of the [Medicare] measure” that he has been advocating .

“We talked fairly recently and I said, ‘You know, I can’t support the version that you have in the budget,” Rivlin told POLITICO. “I don’t actually support the form in which he put it in the budget.”

When informed that Ryan had used her name to advocate his plan, Rivlin replied: “That’s not quite fair. We had worked together but the version that’s in the budget resolution is not one that I would subscribe to.”

She went on to explain that a plan that she would back would “let seniors have the choice between keeping their current form of Medicare or choosing to enter the [private insurance pool that Ryan calls for.] “I prefer keeping the old version as a choice,” Rivlin said.

POLITICO reported that “The other main difference is in the rate of growth in subsidies for beneficiaries entering the new exchange system: “In the Ryan version, he has lowered the rate of growth and I don’t think that’s defensible,” Rivlin declared. “It pushed too much of the cost onto the beneficiaries.” 

This morning, the Washington Post’s Ezra Klein called Rivlin, and asked more questions. (Kudos to Klein for picking up the phone and following through.) Below, an excerpt from the transcript of their conversation that Klein published late this afternoon. You’ll find the entire interview in Klein’s column.

 Ezra Klein: What struck me when I dug into the details of Ryan’s budget is that he changed the target Ryan-Rivlin had set for Medicare [increases in spending]  to from GDP+1% to the rate of inflation. That seems pretty hard to achieve.

Alive Rivlin: That’s a reason for me saying very strongly that I don’t support the version of Medicare premium support in the Ryan plan. It’s both because the growth rate is much, much too low, and because it doesn’t preserve [traditional] fee-for-service Medicare as the default option.

EK: It also doesn’t do much to actually make the delivery of health-care cheaper. I think that when people look at health-care reform from a budgetary perspective, they tend to rely on blunt financial tools, like simply giving people less insurance. But that just shifts costs to the people and their families. To make costs slow across the system, you need to make it cheaper to treat sick people.

AR: I entirely agree with that. And there’s a great deal in the Affordable Care Act in terms of research, pilot programs, alternative payment structures, alternative delivery systems, research on the effectiveness of treatments, that is needed. That’s why we need to keep the Affordable Care Act and strengthen the parts that hopefully give us more cost-effective care in the future. If you just control the federal spending without changing the delivery system, you just get cost shifting.”

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It seems clear, from Klein’s interview, that Rivlin recognizes that we cannot just shift the rising cost of healthcare to seniors, and that the ACA actually does include many provisions that could radically transform how heath care is delivered, reducing costs, without in any way undermining the quality of care