OBAMA/RYAN VS LBJ/TRUMP:

The tools appear to be in place. Even with the threat of a filibuster by Democrats in the Senate, GOP leaders could use a parliamentary maneuver to make big Medicare changes on a simple majority vote in both chambers. But the path remains fraught with challenges. Trump has never shown much interest in entitlement reform and, at times, even has spoken about protecting Medicare. And Ryan also must navigate a maze of competing interests among GOP lawmakers, including Senate Republicans who have voiced lukewarm support, at best, for Ryan's favored Medicare changes.

It's a game that Ryan has long played successfully. To earn his colleagues' support over the years, as POLITICO detailed earlier this year, the speaker has made a series of compromises, resulting in contradictory or mathematically tenuous proposals. But now that the GOP has a unified government, the stakes--and rewards--are much higher. To finally accomplish his dream of privatizing Medicare, Ryan must figure out how to reconcile these competing priorities--without losing the support of ever-cautious lawmakers or Trump.

Ryan has long been interested in addressing some of the biggest challenges facing the country, including the tax code and entitlement programs. He's a devotee of supply-side economics and a deficit hawk intent on reforming Medicare, Medicaid and Social Security, which are responsible for the majority of federal spending. They are the linchpins of the safety net, but Ryan considers them too expensive. The very first bill he introduced in Congress, in February, 1999, was a resolution that Congress should take action to make Social Security sustainable. (It never received a vote.) But for most of Obama's presidency, using his perch as the top Republican on the Budget Committee, Ryan has focused on changing Medicare.

His preferred strategy, called "premium support," would change Medicare from a single payer system in which the government pays directly for seniors' health care to one where beneficiaries could use their government benefits to buy private insurance. Supporters say it would inject much-needed competition into the health care space, leading to lower costs and better coverage. Critics respond that this would end Medicare as we know it; instead of being able to count on basic health care after 65, seniors would be forced to navigate a maze of insurance options, like Obamacare customers today. They also argue that Medicare is less expensive than private insurance and that seniors would receive substandard care under a premium support system.

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