Health Care

The Reform Vision of the GOP Budget

March 26, 2012

I have a new column up at CNN on the new GOP budget proposal:

The budget proposal introduced by House Republicans on Tuesday is much more than a series of numbers on a spreadsheet -- it's a vision for reforming the key pillars of the American social contract in the 21st century. In that regard, it's very different from the vision put forward by President Obama in his budget plan from a month ago, which emphasized preserving the status quo with another round of tax hikes.

The central economic problem of coming years is how to update the nation's largest entitlement programs so that they are sustainable and available to future generations of Americans.

The Congressional Budget Office projects that spending on Social Security, Medicare and Medicaid (plus the new 2010 health care law) will increase from about 10% of the nation's total economic output this year, as measured by gross domestic product (GDP), to nearly 16% in 2035. Historically, the government has collected about 18% of GDP in revenue. Thus, if the entitlement programs remain on autopilot, there will either be nothing left in the budget beyond transfer payments, or government taxes will have to soar.

The whole piece is available here.

posted by James C. Capretta | 1:09 pm
Tags: budget
File As: Health Care

How to Replace Obamacare

March 22, 2012

I have an article in the new issue of National Affairs on “How to Replace Obamacare”:

...repeal will not be enough, for a simple reason: Although Obamacare would worsen many of the problems with our system of health-care financing, that system clearly does call out for serious reform. Despite the widespread public antipathy toward the new health-care law, simply reverting to the pre-Obamacare status quo would be viewed by many Americans, perhaps even most, as unacceptable. After all, a repeal-only approach would leave many of the most grievous flaws in our system of financing health care unaddressed. Chief among them would be steadily rising health-care costs, driven by the same misguided government policies that so evidently demand reform.

If the problems that are today obvious to the public had been addressed by market-oriented policies over the past few decades, there would have been no political opening through which to ram Obamacare. Instead, these problems were allowed to fester; by 2009, they had become so acute that there was strong sentiment, even among some business-oriented conservatives, that "something had to be done." And as the 2010 congressional debate over Obamacare reached its climax, this sentiment — that some action, even an imperfect one, would be better than nothing — likely played a large role in enabling the health-care law to pass.

This history suggests that, now that Obamacare is with us, the law cannot be reversed without a credible proposal for what should take its place. Those reforms must account for both the strengths and the weaknesses of our health-care system, and must solve the problems that contributed to the demand for Obamacare in the first place. There is room for debate about the particulars of these reforms, and different components of our health-care system will call for different kinds of fixes. What any effective solution must involve, however, is the creation of a true market in health coverage — one that drives efficiency through competition, and places health-care decisions in the hands of consumers and taxpayers, where they belong.

The entire article is available online here.

posted by James C. Capretta | 12:49 pm
Tags: Obamacare, repeal and replace
File As: Health Care

A Federal-State Framework for Market-Based Reform

March 19, 2012

I’ve contributed the final chapter to the new book The Great Experiment: The States, the Feds, and Your Healthcare, available on Amazon and published by the Pioneer Institute. Here’s an excerpt:

Despite criticism from some quarters, the health care system in the United States has significant strengths. The hospitals and clinics through which most Americans get their care are staffed by some of the world's most highly trained and accomplished physicians and these institutions have the capacity to deliver the finest and most sophisticated medical care found anywhere in the world. Most Americans have ready access to this care through third-party insurance arrangements provided by their employers, or in the case of seniors, by Medicare. Finally, U.S. health care is open to medical innovation in ways that other systems around the world are not. The resulting rapid pace of innovation that has occurred in recent decades has, in the main, provided a tremendous boost to the quality of patient care.

There are also many problems with American health care. These problems are aggravated by the Patient Protection and Affordable Care Act (PPACA) but they will remain even if the PPACA is repealed. These problems have worsened in the past three decades, to the point where a large percentage of the electorate believes real change is needed.

These problems include:

  • Cost increases that exceed the levels that patients, taxpayers, or other payers are either able or willing to pay
  • Government spending on health care that is rising much more rapidly than the revenue base that pays for it, thus putting tremendous strain not just on governmental finances but also on U.S. economy and credit-worthiness
  • A substantial number of Americans with pre-existing conditions who either cannot afford or cannot find insurance options that provide secure and sufficient coverage for their conditions
  • A considerable number of working Americans who go without insurance for long periods or intermittently because they cannot afford it or it is not offered by their employers
  • A surprisingly low and unpredictable quality of care in many settings

What the American health care sector needs most is the discipline, balance, and accountability that come from a functioning marketplace....

You can read the rest of the chapter here, or in PDF here.

posted by James C. Capretta | 6:43 pm
File As: Health Care

Bunting on Contraception

March 19, 2012

I have a new post up at The Corner on the Obama administration’s latest announcement, release late Friday afternoon, about the HHS mandate, which they’re now proposing not to issue final regulations on until far after this year’s elections:

In the ANPRM, the administration said it is seeking input and comments on the so-called “accommodation” that the president announced on February 10. But the ANPRM also makes it clear that this process of getting input and issuing new rules will be very long and drawn out — so much so that the administration doesn’t expect to issue final regulations until August 1, 2013....

Still, despite the transparent stalling tactics, it is abundantly clear from the text of the ANPRM that this process is essentially a waste of time. The administration is seeking comment only on its dead-end “accommodation” proposal that doesn’t come close to satisfying legitimate religious-liberty interests, including those expressed yet again by the nation’s Catholic bishops this week in their latest statement on the matter.

You can read the whole post here.

posted by James C. Capretta | 6:38 pm
Tags: religious exemption, Obamacare, contraception
File As: Health Care

The ĎAccommodationí That Isnít

March 8, 2012

I have a new column up at National Review Online on the latest negotiations between Catholic leaders and the White House about the contraception mandate, and on why last month’s “accommodation” is anything but:

Unfortunately, until it is widely understood that the president’s accommodation is actually no such thing, confusion will continue to reign. Therefore, it is critical for those trying to defend religious liberty against the administration’s aggressive moves to expose the accommodation as the deception that it is, as quickly as possible.

Here, it’s worth repeating some of the basic facts. On February 10, on the same day that the administration announced it wanted to craft the so-called accommodation, it finalized the rule that had been previously issued with no change. That rule includes the infamous four-part test by which HHS bureaucrats will determine which houses of worship are pure enough to warrant a full exemption from the mandatory coverage of abortion-inducing drugs, sterilization procedures, and contraception. It is also the same rule that provides no exemption from the mandate for religious employers that provide services to the general public. So, as matters stand today, the Obama administration has implemented rules that even it concedes infringe on the traditional rights of religious employers.

You can read the whole column here.

posted by James C. Capretta | 4:16 pm
Tags: religious exemption, Obamacare, contraception
File As: Health Care

Testimony to the Budget Committee on Making Health Care Sustainable

February 29, 2012

Today, Senate Budget Committee Chairman Kent Conrad convened a hearing on “Putting Health Care Spending on a Sustainable Path.” I was asked to participate on a panel with David Cutler, Professor of Economics at Harvard University, and Len Nichols, Director of the Center for Health Policy Research and Ethics at George Mason University.

My prepared testimony is available here. The prepared testimony of Dr. Cutler is available here. And Dr. Nichols’s prepared testimony is available here.

The full hearing can be watched here (my testimony begins around 59:20).

posted by James C. Capretta | 5:00 pm
Tags: Senate Budget Committee Chairman, health care
File As: Health Care

The Top Five Flawed Arguments Against Premium Support

February 22, 2012

I have a new paper published at the Heritage Foundation on the flawed arguments against a premium-support reform of the health-care system. Here’s the abstract:

The introduction of the bipartisan Wyden–Ryan premium support plan for Medicare ensures that reform of the government’s largest health entitlement program will continue to be a major topic of debate in 2012. With premium support, the federal government moves away from running a health plan and instead provides fixed levels of support for insurance plans selected by the beneficiaries themselves. Opponents have made a number of flawed arguments against the concept that do not stand up to careful scrutiny. Political momentum continues to build for premium support because of its potential to control health care costs through the power of consumer choice.

You can read the whole paper here (or in PDF here).

posted by James C. Capretta | 4:24 pm
Tags: premium support
File As: Health Care

The Presidentís Plan: Higher Taxes, Deep Defense Cuts, and the Entitlement Status Quo

February 14, 2012

I have a new column up at e21 on why the president’s new budget proposal is more of the same. Here’s a snippet:

For a brief moment, it seemed that the president wanted to take on this challenge and pursue just such an agenda. In 2010, he appointed the Bowles-Simpson commission to come up with a comprehensive budget plan to restore long-term solvency to the government. Not surprisingly, the plan approved by that commission called for serious tax and entitlement reforms as well as deep cuts in every corner of the federal budget.

But instead of embracing the Bowles-Simpson plan, the president changed course and chose to ignore entirely the recommendations of the panel he had initiated to great fanfare. The president then spent all of 2011 attacking the GOP’s version of long-term budget reform instead of offering a serious plan of his own, thus making it all but impossible for a bipartisan consensus to form in Congress. The president’s 2013 budget plan fits this pattern, providing stark contrasts with the GOP at the expense of real progress.

You can read the full article here.

posted by James C. Capretta | 4:19 pm
Tags: budget
File As: Health Care

On the Contraceptives Controversy

February 9, 2012

I spoke on a panel yesterday at the Catholic Information Center in Washington, D.C., about the controversy brewing over the Obama administration’s requirement that church employers cover contraception (among other services deemed preventive) in the health care plans they provide to their employees. The video of that event is available from C-SPAN here.

posted by James C. Capretta | 5:11 pm
Tags: religious exemption, Obamacare, contraception
File As: Health Care

Two (Relatively) Recent Public Events

February 2, 2012

On December 16, 2011, I participated in a public forum at the Brookings Institution entitled “Controlling Medicare Costs: Is Premium Support the Answer?” The event was kicked off by a presentation from former New Mexico Senator Pete Domenici (my old boss from the years I spent on the staff of the Senate Budget Committee) and former Clinton administration Budget Director Alice Rivlin, on the specific premium support plan they have proposed as part of the deficit reduction initiative of the Bipartisan Policy Center. I participated in a panel discussion that followed their presentation, which featured the views of both opponents and proponents of premium support in the Medicare context. My remarks were based in large part on the views I expressed in a companion paper, also commissioned by Brookings (available here). A full description of the event, and a full video recording of it are available here.

And this week, I had the pleasure of moderating a public forum, sponsored by e21, on Capitol Hill featuring introductory remarks from Wyoming Senator John Barrasso and a presentation from University of Minnesota Law Professor Daniel Schwarcz on why employers are likely to dump their unhealthy workers into the Patient Protection and Affordable Care Act’s state exchanges. Professor Schwarcz’s presentation drew on his findings from a law journal article he recently co-authored (available here). The full details regarding the event, as well as a full video recording of it, are available here.

posted by James C. Capretta | 11:48 am
Tags: premium support
File As: Health Care

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