President Obama and his party's leaders have suffered a string of bad weeks. Deliberations at the U.S. Supreme Court raised serious questions about whether the president's massive health care takeover could ever be compatible with our constitutional republic of limited and separated powers. The press exposed yet another attempt by his administration to hide the true cost of that takeover until the election by using a slush fund to delay its true consequences for seniors from being felt. And in the House of Representatives, Obama's budget -- which would impose a $1,700 annual average tax hike for each household in America, increase spending and accelerate the nation toward a debt crisis -- was rejected by every single Democrat and Republican in a 0-414 vote.

Congressional Democrats would prefer not to be held accountable in an election year for the massive increases in taxes, spending and borrowing proposed in the Obama budget. But the problem runs deeper than mere election-year politics. In fact, this weekend marked the third anniversary of the last time the Democrat-controlled Senate passed a budget.

The simplest explanation for this total abdication of leadership is that, after jamming into law massive expansions in the size and scope of government, they don't want to commit publicly to the kind of tax increases and health care rationing that would be required to sustain their vision of government.

The president's proposed tax increases have been well-covered, here and elsewhere. But one often overlooked aspect of his unanimously rejected budget was his attempt to give even more power over Medicare to the Independent Payment Advisory Board.

IPAB, a creation of the president's health care law, is a board of 15 unelected and unaccountable bureaucrats. They would have power to cut Medicare in ways that, in the words of Medicare's own chief actuary, would "jeopardize access to care for beneficiaries." Obama's latest budget proposes to save money by giving this board "additional tools" to restrict seniors' access to their benefits.

This government-centered approach to health care stands in stark contrast to the patient-centered solutions advanced by House Republicans. While the president's health care law empowers 15 bureaucrats in Washington, our budget puts 50 million seniors in control of Medicare. These patient-centered reforms to protect and strengthen Medicare begin with repeal of the president's disastrous health care law, whose cuts would deny care for current seniors. Our bipartisan plan ensures no changes for those in or near retirement, and offers guaranteed coverage options, including a traditional Medicare option, to make good on Medicare's critical promise to seniors for generations to come.

In health care, as in any other economic arrangement, control of money is power. When it comes to ensuring affordability and saving the nation from bankruptcy, the question is: Who gets the power? A centralized federal government embodied in 15 bureaucrats, or 50 million seniors, each empowered to hold providers accountable in a true marketplace? Patient power will always serve the needs of the people far better than a bureaucracy that manages the decline of a government-run system already on the verge of bankruptcy.

As the accompanying graphic shows, the contrast could not be clearer. On one side is the government-centered approach. It will not control costs, but it will cut access to care, ultimately breaking promises to seniors who rely on this critical program. On the other side is our vision, which puts seniors in charge, forcing insurance companies to compete for their business to efficiently and effectively deliver the quality care they deserve.

Only one of these plans will save and strengthen Medicare for current and future generations, averting the bankruptcy of these critical programs and preventing a debt crisis that would threaten the economic security of all Americans. Our budget trusts the American people to make the right choice -- about their own health care, and about the future of our country.

Rep. Paul Ryan, R-Wis., is chairman of the House Budget Committee. He tweets from @RepPaulRyan.

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