About the Author

James C. Capretta

James C. Capretta

New Atlantis Contributing Editor James C. Capretta is an expert on health care and entitlement policy, with years of experience in both the executive and legislative branches of government. E-mail: jcapretta@aei.org.


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James C. Capretta’s Latest New Atlantis Articles

 Health Care with a Conscience” (Fall 2008) 

 Health Care 2008: A Political Primer” (Spring 2008) 

 The Clipboard of the Future” (Winter 2008)

 

 More on James C. Capretta

Text Patterns - by Alan JacobsFuturisms - Critiquing the project to reengineer humanity

Tuesday, January 27, 2009

The “Stimulus” Bill and Health Care Rationing 

The House is racing toward passage of an $815 billion economic “stimulus” bill this week (the full text is available at ReadTheStimulus.org). The Congressional Budget Office issued a cost estimate for the measure yesterday.

There are many features of the bill that are troubling. The federal government will need to borrow hundreds of billions of dollars for the spending, but much of it will do nothing to jump-start the economy. So the federal budget deficit will increase—dramatically and without a commensurate economic payoff.

What is just as disturbing is that the bill includes a large number of far-reaching policy changes that have gotten little scrutiny because of the crisis atmosphere and rush to passage.

For instance, in health care, the Democratic majority is laying the foundation for government rationing of health care—and the public has heard virtually nothing about it.

The bill provides $1 billion for a new program of comparative effectiveness research. The idea is to study more carefully medical practice patterns, new products, and new technology to determine what is cost-effective. In the United Kingdom, a similar program run by the National Institute for Clinical Evidence is used to deny payment by the government for certain drugs and procedures that are said to be “cost-ineffective.”

Democratic lawmakers will deny that rationing is their intent, but that is not credible. Why create a government program to study what’s cost-effective if not to use the data to inform payment decisions in public programs? The problem is that this kind of research inevitably includes value judgments best left to the market (for instance, how much is an extra year of life worth?) and the data can often be interpreted in more than one way.

It is probably inevitable that President Obama and his allies in Congress will succeed in passing a large portion of their agenda in the early days of 2009. The public voted for change in November 2008—and change they will get.

But that does not mean the Democratic majority should be given a pass when they tuck away sweeping and ill-conceived policy changes in otherwise unrelated legislation.

President Obama has said that he hopes to secure strong bipartisan support for his health care reform agenda later this year, but his allies in Congress are pulling together the stimulus bill in a way that makes bipartisan cooperation less, not more, likely as the year progresses.

[UPDATE: Some More specifics on the money and the politics of the stimulus bill.]

posted by James C. Capretta | 6:45 pm
File As: Health Care