debt


CBO’s Long-Term Budget Projections

The Outlook Is Even Worse Than It Looks

Last month, the Congressional Budget Office released its annual update to its long-term budget projections, and as I explain in a post on the Health Affairs blog, the unsustainable debt and deficits forecasted by the CBO are due to the familiar causes of growing entitlement spending, especially in health care.

The cause of the soaring deficits and debt is familiar:  rapid increases in entitlement spending (on top of the five decade run-up that has already occurred), driven by the aging of the population, rapidly rising health care costs, and spending associated with expanded health entitlements under the Patient Protection and Affordable Care Act (PPACA).  CBO expects that 54 percent of the federal spending increase on the major entitlements over the next twenty-five years will be attributable to the aging of the U.S. population.

Twenty-eight percent of the increase will be due to “excess cost growth” in health care – meaning cost escalation per capita in excess of GDP growth per capita.  The rest of the spending increase is due to the expansion of Medicaid and the new premium credits enacted in the PPACA.  When looking at just the health care entitlements, 40 percent of the federal spending increase is due to excess cost growth, 35 percent from population aging, and 26 percent from the PPACA program expansions.

You can read the rest of the post here.

posted by James C. Capretta | 12:41 pm
Tags: entitlements, debt, deficit
File As: Health Care

Why the Still-Looming Debt Crisis is a Health Care Crisis

Yuval Levin and I have a new article up at The Weekly Standard on why the debate over spending cuts versus tax increases doesn¸’t get to the root cause of the still-looming debt crisis — namely, spiraling health-care costs:

Simply put, our coming debt crisis is a health care cost crisis. In 1971, the government spent 1 percent of GDP on Medicare and Medicaid. Four decades later, spending on these two programs has more than quintupled to 5.6 percent of GDP last year. In its latest long-term outlook document, published in June, the Congressional Budget Office projected that spending on these programs, and on the new entitlements created by Obama-care, will reach 10.4 percent of GDP by 2035 and 13 percent by 2050. In the meantime, all other government spending combined (including Social Security, defense, domestic discretionary spending, and everything other than interest on the debt) will actually decline, from 17 percent of GDP today to 14.6 percent in 2035 and 14 percent in 2050....

[President Obama’s proposed cuts to Medicare] might produce marginal savings for a time, but they would not come close to addressing the heart of the problem. They would lock in place the immensely inefficient open-ended payment structure of Medicare (which is the chief driver of health care cost inflation) and the new health care law’s architecture, with the federal government calling the shots in the health sector. Under such circumstances, cost cutting can only be achieved at the expense of quality care​ — ​and even so it rarely happens. Worse yet, such trivial steps would make real reforms less likely, by letting our leaders persuade themselves they have dealt with entitlements when in fact they would have only bought a little time.

To fix health care and the federal budget, reformers must set their sights on a much more fundamental shift, away from central planning and toward a genuine marketplace in health care ​—​ with cost-conscious consumers subjecting insurers and providers to competitive pressures.

Read the whole article here.

posted by James C. Capretta | 1:15 pm
Tags: debt, Medicare
File As: Health Care

The Debt Deal: A Temporary Truce

I have a new post up on The Corner detailing why the debt deal is only a patch, and the real fights are still to come:

Fittingly, the “deal” that has emerged from the protracted, months-long stand-off on the debt limit isn’t so much a deal as it is a (very) temporary truce between the parties. Because, while its passage will result in some real and desirable spending reductions in exchange for a bump up in allowable federal borrowing, it also purposely sets the stage for new confrontations in the months ahead — confrontations that will bring to the surface all of the reasons this battle has been so heated, and which weren’t resolved at all by [the deal]....

For starters, it’s clear that both sides will find it exceedingly hard to live with the automatic cuts that will go into place if no plan comes out of the joint committee, or if the plan that does come out is defeated in the House or Senate. Keith Hennessey estimates that the automatic 2013 cut in defense could reach 10 percent. That’s not responsible, and most Republicans would find it extremely difficult to swallow.

Indeed, the Democrats are hoping that enough Republicans will balk at this prospect that the joint committee will be able to recommend a “balanced package” – meaning something with tax hikes. But as Hennessey notes, the automatic cuts in domestic spending would be nearly as deep as they would be for defense — perhaps 8 percent in 2013. And so it’s not clear who would feel the most pressure. Are rank-and-file Democrats really ready to go along with automatic, across-the-board cuts in education, labor, and health programs? Moreover, the president is the commander-in-chief. No one will get more blame than he will get if the military is hamstrung, and the country more vulnerable, from the cuts that would be imposed by political gamesmanship.

Read the whole post here.

posted by James C. Capretta | 1:15 pm
Tags: debt limit, debt deal, debt
File As: Health Care

The Path Forward on the Debt Limit

I have a new piece up on National Review Online making the case for how the debate over the debt limit ought to proceed now, in the wake of the House passage of Speaker Boehner's plan. Here's an excerpt:

It’s been apparent for days now that Senator Reid and his Democratic colleagues aren’t going to simply pass the Boehner plan as-is, especially now that it includes the balanced-budget-amendment requirement. To get this bill through the Senate and to the president’s desk, the GOP is going to have to give the Democratssomething. And that something is almost certainly what the president has said is his bottom-line demand at this late hour: an assurance that there will not be another debt-limit showdown before the November 2012 election. That could be accomplished by dropping the balanced-budget-amendment requirement and substituting for it a modified version of the McConnell proposal from a few weeks ago. Under that formulation, the president could unilaterally increase the debt limit next spring if the “super committee” set up by the Boehner plan does not produce another $1.6 trillion or so in deficit reduction. Republicans would have the opportunity to vote against this second debt-limit increase, but they would need a two-thirds majority to override the inevitable presidential veto.

Many House Republicans will be very upset if this is the compromise that comes out of the Senate and goes back to the House for another vote before Tuesday. But they shouldn’t be. Because, even with such a compromise in the final legislation, the bill would represent a significant strategic victory for the GOP. The president would be denied what he wanted most out of this process — which is GOP acquiescence to a massive tax hike. All of the deficit reduction would come from spending cuts. There would be no “grand bargain” for Obama to tout going into 2012, and no tacit approval of Obamacare from GOP agreement to minimalist entitlement “reforms.” Most especially, the GOP would be seen as acting responsibly to defuse the potential for turmoil and chaos post–August 2.

Some in the GOP may lament that giving the president this out will take the pressure off the “super committee” to actually produce another round of real deficit reduction. That shouldn’t be a concern. Indeed, it should be a relief to the GOP if the “super committee” is rendered toothless — because nothing good will ever come of it. With this president in the Oval Office, there’s no chance that genuine entitlement reform will get enacted, as the Bowles-Simpson commission demonstrated (Obamacare was left entirely in place in the commission’s plan). It is more likely that a disaster would ensue when one wavering Republican on the “super committee” agreed to a “grand bargain” along the lines of what the president was pushing in June and July. That would force both the House and the Senate to vote, up or down, on the “super committee” recommendations, meaning there would be a very real chance that a massive tax hike would pass with very little on the entitlement side in return.

You can read the whole piece here.

posted by James C. Capretta | 5:26 pm
Tags: debt limit, debt

What Real Leadership Looks Like

House Budget Committee Chairman Paul Ryan has laid out a vision for twenty-first century governance that will become the GOP program for 2011, 2012 and beyond.

It is unquestionably the boldest budget plan ever offered (including Reagan’s first budget), focused first and foremost on bringing federal spending commitments into line with the revenue generated from a pro-growth tax system. It reforms entitlement programs, starting with Medicare and Medicaid of course, but not ending there. Farm payments, welfare programs, and corporate subsidies all are reformed and refocused to reduce costs to taxpayers and work as they should. Outdated programs are thrown out. The bureaucracy is cut down to size. No corner of the budget is spared from scrutiny, including defense. The challenge of unlimited government, and runaway spending, deficits, and debt is immense — but the Ryan plan more than meets it.

A lot more can and will be said about the plan’s details in coming days, including by me. But for today, it’s important to focus on what this plan means in the big picture.

For starters, it completely recasts the struggle between the political parties. Everyone knows that what the president and his allies really want to do is raise taxes. They might agree to some tinkering around the margins on entitlements for show. But in their heart of hearts they believe the solution is higher rates of taxation.

The problem is they don’t have the guts to say so in public. They know that’s the surest way to permanent minority status. And so they are hoping for a more indirect route to their goal, using guile to lure gullible Republicans (see here) into agreeing to their approach without ever having to sell it to a tax-averse electorate.

The Ryan plan blows this kind of plotting by Democrats to smithereens. There’s no tax increase in the Ryan plan, and there’s no debt crisis. What’s required is far-reaching entitlement reform and serious spending discipline. By staking out that position, Ryan and his comrades have improved their leverage immensely. There’s no need to agree to tax hikes to solve the budget problem. What’s needed is for Democrats to get serious about spending reform, as Ryan has.

Moreover, with a Republican plan on the table, the media will surely start to ask Democrats, “Hey, where’s your plan?” This will force them to either come clean with their tax-hike vision, or become the party that pushed the country toward a debt-induced economic crisis. Either way, with more clarity about where the parties actually stand, Republicans can win the public fight.

At the heart of the spending problem, of course, is health care, and at the heart of the health-care cost problem is Medicare. The Obamacare “solution” is heavy-handed regulation and government-imposed cost controls. That approach never works, and only erodes the quality of the system. What’s needed is a functioning marketplace, with government oversight and cost-conscious consumers directing the allocation of resources. And that’s exactly what the Ryan plan would deliver.

The country faces serious and daunting challenges in the coming months and years. We need serious political leaders who are ready and capable of rising to the challenge. No one has demonstrated that capacity more than Paul Ryan.

[Cross-posted on the Corner.]

posted by James C. Capretta | 11:39 am
Tags: Ryan Plan, Paul Ryan, Medicare, Obamacare, debt
File As: Health Care

The Debt Commission, Health Care, and Obama’s Budgetary Game Plan

In another Web Memo for the Heritage Foundation this week, I wrote a bit more about the debt commission and the budgetary and political problems that Obamacare creates for the nation's finances. Here's an excerpt from the beginning:

Unfortunately, the timeline for the United States to take corrective action may have already been shortened in just the past few weeks. What began as a slow-motion crumble of Greece’s economic house of cards has now quite clearly become the triggering point for full-fledged examination of the risks posed by massive increases in governmental debt combined with aging populations around the developed world. No country is exempt from the scrutiny of the bond markets, including the U.S. Moreover, if Europe’s economy slides back again into a deep recession as the debt crisis spreads, no part of the global economy will be completely spared from the fallout, including the U.S. The new health care law will only worsen the nation’s fiscal situation, and despite President Obama’s claim that “everything is on the table,” it is clear that the Administration wants to lock in Obamacare and force the commission to look elsewhere.

You can read the entire memo here.

posted by James C. Capretta | 11:36 am
Tags: Debt Commission, Obamacare, debt
File As: Health Care

The Debt Commission and Obamacare

The president’s debt commission had its first meeting this week, and all of the talk was of getting serious about putting our fiscal house in order, with everything “on the table” for consideration.

There’s no arguing with the need to get serious. According to the Congressional Budget Office (CBO), if the Obama budget were adopted in full, just the interest on the national debt would exceed $900 billion in 2020 and consume one out of every five dollars in federal revenue. To put that in perspective, in 2007, before the financial crisis hit with full force, interest payments on debt stood at $237 billion, or just 9 percent of total tax collections. A sudden and steep rise in the percentage of governmental revenue dedicated to servicing past excess consumption is a clear warning sign to lenders and credit-rating agencies that a country’s finances are approaching the point of no return.

Unfortunately, the timeline for taking corrective action may have shortened even in the past few weeks and days. What began as a slow-motion crumble of Greece’s economic house of cards is now threatening to become a serious global crisis. The flight from sovereign debt risk is now spreading to other vulnerable, highly leveraged countries, including Portugal, Ireland, and Spain. The implications for European economic recovery are ominous. And, if Europe’s economy slides backward again into a deep recession, no part of the global economy will be completely spared from the fallout, including the United States.

So we are long past the point when national leaders should have been sitting down together to hammer out a budget framework to avert the crisis everyone could long see coming. Indeed, one might have thought it would be the first order of business for a newly elected president of the United States.

But it wasn’t. Instead, President Barack Obama decided to spend 2009 using unusually large Democratic majorities in the House and Senate to jam a partisan and highly polarizing health care bill through the Congress. No Republican supported the measure, in large part because it vastly expanded federal entitlement commitments at the very moment when it was abundantly clear that the existing entitlements are the problem.

With the health legislation signed into law over the objections of a united Republican party, the president now wants Republicans to help him finance the newly enlarged welfare state.

Of course, the commission itself is a transparent maneuver to pass the buck in an election year. Voters are beyond fed up with the massive spending spree taking place in Washington. To every hostile question Democratic candidates will get in coming months about the exploding national debt, they are therefore planning the following answer: we’re waiting for the commission to make its recommendations in December. Never mind that Democrats control the White House and Congress. If they wanted to cut the budget, they could certainly do so, starting right now. Instead, they will try to use the appointment of a non-binding commission to create the appearance of a proactive agenda.

For the commission itself, the elephant in the room is Obamacare. Former Senator Alan Simpson, the co-chair of the commission, says the president has agreed that even the health law is “on the table” for discussion.

That’s good, if he means it. Because it is not possible to write a durable, bipartisan budget framework with health spending written entirely according to one party’s formulation.

Health care remains the largest problem in the nation’s long-term budget outlook, even after enactment of the health bill. On paper, the bill makes massive cuts in Medicare. But all of the supposed savings would go toward standing up a new entitlement that costs even more than the savings. So, health entitlement spending expands under the legislation, not contracts.

Moreover, the Medicare savings are from arbitrary payment-rate reductions. OMB Director Peter Orszag continues to argue the health law lays the predicate for cost-control through painless efficiency improvement in the delivery of medical services. But that’s either a smokescreen or the most alarming kind of wishful thinking. The “delivery system reforms” in the legislation are at best small pilot projects that will amount to very little. Certainly CBO assumed no savings from them. Neither did the chief actuary of the Medicare program.

The real cuts in Medicare come from reductions in payment rates. The cuts apply to all providers, across-the-board. There’s no attempt to calibrate based on the quality of the patient care or performance. If the debt commission takes Obamacare as a given when looking for additional savings in health care, it will inevitably fall into the same trap. To find quick and “scoreable” savings (that is, savings that CBO will recognize), the easiest thing to do is to further ratchet down payment rates and pretend the cuts will solve the budget problem. Going down that road would be a disaster for the quality of American medicine and would not provide a lasting solution.

What’s needed in American health care is a dynamic marketplace that drives up the productivity of those delivering medical services. That’s the only way to cut costs without harming quality. That’s genuine delivery system reform. Building such a marketplace requires, first and foremost, cost-conscious consumers, which in turn requires fundamental reform of the health entitlement programs and the tax treatment of health insurance. Fortunately, Congressman Paul Ryan’s roadmap has already shown us the way.

Like it or not, the budget debate remains in large part a health-care debate. Obamacare settled nothing because it did not solve the health care cost problem. It papered it over with price controls.

posted by James C. Capretta | 5:20 pm
Tags: debt commission, debt, Alan Simpson, Greece, Peter Orszag, CBO, payment-rate reductions
File As: Health Care

The Obama Budget Plan: Taxes and Rationing

Suddenly, the Obama administration and Democratic congressional leaders seem to want health care news stories to fall off of the front page.

This week, House Energy and Commerce Chairman Henry Waxman abruptly cancelled a high-profile hearing he had called just days earlier to berate corporate CEOs who dared to tell their investors that the health-care bill would raise their costs. It seems to have dawned on Congressman Waxman and his staff that his transparent effort to intimidate anyone who tells the truth about the legislation could actually backfire on him and turn into a PR disaster.

The Democratic contention that the bill actually lowers costs for American business is not supported by any rigorous analysis that would justify use in auditable corporate accounting methods. The Business Roundtable study that many Obamacare advocates like to cite as proof of the bill’s savings provides no such proof at all. The prediction of cost savings in the study from the mostly minor provisions in the legislation aimed at “delivery system reform” are highly speculative at best. Indeed, the study itself notes the potential for much higher costs and cites many cost-cutting provisions that are not in the new health law.

What is certain is that the new health law reduced the value to America’s corporations of federal support for retiree drug-benefit coverage. That means it will cost these companies more to provide such coverage in the future. There’s no disputing that. Indeed, there’s no disputing that the companies had an obligation to acknowledge this cost in their financial statements. One way or another, some Americans will be forced to pay higher costs because of this provision, in the form of reduced prescription-drug benefits for retirees or reduced value for the shareholders of the firms in question.

Perhaps Congressman Waxman realized the tables might actually get turned on him this time. A hearing in which Democratic congressmen lectured private-sector CEOs — CEOs who employ tens of thousands of people — for following the law and telling the truth would only make an out-of-touch Democratic Congress look even more disconnected from reality.

Democrats are also contemplating (though no decisions have been made) shelving consideration of the congressional budget resolution to avoid having to debate levels of taxation, federal spending, deficits, and debt before the midterm election. The budget resolution is the annual blueprint that sets parameters for considering budget-related legislation during the rest of a congressional session.

Their reticence is understandable. President Obama is presiding over the largest expansion of the federal government in a generation, even though the federal government is already rushing headlong toward a debt crisis. The government is expected to run a budget deficit in excess of $1 trillion in 2010, after running a deficit of $1.4 trillion in 2009. And that’s just the beginning of an endless sea of red ink. The Congressional Budget Office expects the Obama administration’s latest budget plan would push the nation’s debt to more than $20 trillion in 2020, up from $5.8 trillion in 2008. No wonder congressional Democrats want to change the subject.

But no one should be fooled into thinking the administration and its allies in Congress will never again revisit the budget and health care. They will — largely because the president will have no choice. He is presiding over a spending and borrowing binge unlike anything ever experienced in the nation’s post-war history. And it can’t go on much longer before it will precipitate an economic crisis of one sort or another.

So the president and his team will come back to the budget, just not before the midterm election. That’s the whole point of standing up the debt commission. To every question about runaway deficits and debt, they have a ready answer to divert the press.

But, as Charles Krauthammer noted recently, there are signs aplenty of what the administration will push for when they do come back to the budget gap, probably just after the midterm election. It’s no accident that the debt commission will make its recommendations known only after the November elections. That way Democratic candidates can run for office by suggesting the commission will solve our budget problems without ever having to specify any tax or spending cut.

When, however, the administration does make a push for closing the budget deficit, its plan will start with the mother of all tax increases, probably a value-added tax (VAT). When the problem is as big as it is today, Democrats will see no use in nickel-and-diming it. With a VAT, they would get a large new revenue stream, not collected directly from voters, and one that they could expand endlessly as they further enlarged the government.

But an Obama-style budget fix almost certainly wouldn’t end there. To get a tax increase, he and his advisors surely realize they will need to look like they are cutting some spending too. And, contrary to some perceptions, liberals are definitely willing to cut some entitlement spending; it’s just that they insist it be done in only one way: with price controls on payments to medical providers.

Look at the recently enacted health bill. It includes large cuts in Medicare’s payments to hospitals, nursing homes, and others. These cuts aren’t calibrated based on quality or efficiency. They are across-the-board cuts hitting every service provider. And the bill also stands up a new independent board that is charged with essentially enforcing a cap on overall Medicare spending beginning in 2015. But the only changes in Medicare the board can recommend to stay within the cap are more reductions in provider-payment rates. The board can’t touch the Medicare benefit, much less propose a Ryan-style move toward more choice and market competition. No, the only option is more and deeper price controls.

So, it is entirely predictable where Democrats will turn when they need show their willingness to cut entitlement spending. They will push to broaden the reach of Medicare’s price controls to parts of the health system currently beyond their reach, including prescription drugs and the federally-subsidized insurance arrangements enacted as part of the new health law. It will be one more step toward their ultimate goal, which is a fully government-run health system, with all that entails — including waiting lists and restricted access to care.

posted by James C. Capretta | 4:14 pm
Tags: Debt Commission, debt, deficit, Henry Waxman
File As: Health Care

Tax Collecting for Obama’s Welfare State

Now that the health-care bill has been signed into law, President Obama wants to “pivot” to other pressing issues. But, truth be told, the biggest issue the country now faces is still, in large part, about health care.

The federal government is running massive budget deficits and is expected to continue to do so indefinitely. The Congressional Budget Office (CBO) projects the Obama budget plan would produce $10 trillion in deficits over the period 2011 to 2020. At the end of the decade, the government’s debt would top $20 trillion, or 90 percent of the nation’s GDP. By comparison, from 1789 to 2008, the country accumulated only $5.8 trillion of public debt.

The economic risks associated with such massive amounts of governmental borrowing are very real and very high. At some point, current lenders to the U.S. government will have their fill of Treasury securities, which will mean the cost of financing expansive government is sure to increase over time. CBO expects the annual cost of servicing the interest on the nation’s debt will reach $0.9 trillion in 2020 under the Obama budget plan, up from about $0.2 trillion this year. But it could very well go much higher than that, as a recent white paper from analysts at the International Monetary Fund (IMF) demonstrates. According to that projection, U.S. debt could top 100 percent of the GDP by 2020 if, as the IMF analysts expect, the large run-up in governmental debt pushes interest rates up faster than either CBO or the administration now forecasts.

Further, this rise in federal borrowing will be occurring just as the baby boomers are entering their retirement years. Between 2010 and 2030, the population age 65 and older is expected to increase from 41 million to 71 million people. As these boomers sign up for Social Security and Medicare, costs for the programs will soar. Now is the time to get our fiscal house in order, before the entitlement tidal wave hits full force.

So what’s the president’s plan for heading off the wrenching debt crisis he has made more probable with his the expensive new spending programs he has forced through Congress? Instead of addressing it himself, the president has handed the problem off to a “bipartisan” commission.

Conveniently, the debt commission — headed by former Clinton White House chief of staff Erskine Bowles and former Republican Senator Alan Simpson — will make its recommendations after the November congressional elections.

The chutzpah here is something to behold. Having passed the largest entitlement expansion in half a century, in the most partisan manner imaginable, the president now wants Republicans to provide political cover to Democrats as they search for ways to finance the welfare state of their dreams.

Moreover, it is clear that Democrats have no intention of actually tackling the core problem in the federal budget, which is rapidly rising entitlement costs, especially for health care. They say their health-care bill has already addressed the problem. In the words of House Speaker Nancy Pelosi, “health reform is entitlement reform.”

In theory, it’s possible that Democrats could have passed a health bill that actually made durable reforms in the health entitlement programs that would have improved the medium and long-term budget outlook. But that’s not what they passed. No, new law makes the health entitlement much worse by adding tens of millions of people to Medicaid and a new insurance-subsidy program offered to persons getting insurance in the so-called “exchanges.” CBO expects the cost of these entitlement expansions to reach $216 billion in 2019. Further, the cost would escalate every year thereafter at a very rapid rate, just as Medicare and Medicaid have for more than four decades.

The Democrats respond by saying they also slowed the cost growth in Medicare. But, for starters, their cuts in Medicare do not cover the full cost of their entitlement expansions. That’s why they also raised taxes — by more than a half trillion dollars over ten years. Under the legislation President Obama just signed, federal health entitlement spending goes up, not down. Moreover, the cuts they do impose in Medicare do not in any way constitute “reform” of the program. For the most part, the big savings comes from paying less to hospitals, clinics, nursing homes, and others for the services they provide. In other words, it’s a price-control system.

These kinds of cuts have been passed by Congress many times before. They have never worked to permanently slow the pace of rising costs because they don’t do anything to make the delivery of health services any more efficient than it is today. Over time, arbitrary price controls imposed by the government always drive out willing suppliers of services and lead to access problems. That’s not entitlement reform. It’s government-enforced rationing of care.

To slow the pace of rising costs without harming the quality of American medicine will require restructuring the tax code and entitlement programs to promote a vibrant marketplace in the health sector, with strong price competition and consumer choice. That’s the vision Congressman Paul Ryan has laid out. And it’s both genuine health reform and entitlement reform too.

If the president and his allies were truly open to revisiting their “historic” health bill and replacing what has passed with a market-based reform program, that would be one thing. But does anyone really believe that’s a serious possibility at this point? The Democrats think they have scored a strategic victory by writing health-care legislation entirely according to their partisan vision. It is inconceivable they would backtrack willingly now.

But partisanship on health care has consequences too. It means bipartisanship on the budget will be all but impossible. The president has succeeded in enlarging the welfare state. Unless he is willing to roll it back now, it will be entirely his responsibility to collect the taxes to pay for it.

posted by James C. Capretta | 9:13 pm
Tags: CBO, entitlements, debt, deficit, debt commission
File As: Health Care

Discussing Deficits and the Debt

Yesterday I sat down with Kathleen Shannon of WLBZ2 in Maine to discuss the health care bill, entitlements more generally, and the deficit and debt.

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posted by James C. Capretta | 4:14 pm
Tags: interview, Obamacare, debt, deficits
File As: Health Care

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