Health Care

A Clash of Conscience

January 30, 2012

I have a new column up at National Review Online on the Obama administration’s recent refusal to grant a religious exemption for institutions that wish not to be required to pay for contraception and abortifacients:

The central purpose of Obamacare — and the reason it was and is so strenuously opposed by so many Americans — is to transfer all of the critical decisions about how American health care operates to the federal government. Despite what the president contends, it is a federal takeover. The federal bureaucracy is now in the driver’s seat.

And, with the federal government now calling all of the shots, it is a foregone conclusion that a decidedly secularist and utilitarian point of view will be pervasive in everything that is done. It is simply beyond the capacity of the modern federal government to even consider arguments questioning the wisdom of governmental policies promoting free and abundant contraception. Indeed, it is an article of faith in the modern bureaucratic context that pushing such “prevention” measures onto the American public is one more step on the long march to a more just and humane society.

This is the environment in which we live. The hard truth is that the federal government cannot be trusted today with these kinds of decisions, and there’s no prospect of that changing anytime soon. That’s a big reason why Obamacare should never have been allowed to pass in the first place. Just the sight of Catholic leaders’ being forced to go begging before federal officials ought to be enough to convince most Americans that handing over so much power over such sensitive matters to the federal government was a terrible, terrible mistake.

Read more here.

posted by James C. Capretta | 11:24 am
Tags: religious exemption, Obamacare
File As: Health Care

On the State of the Union Speech

January 25, 2012

Over at National Review Online, I have a brief take on last night’s State of the Union speech. And at economics21, a lengthier response:

It was no real surprise that during last night’s state of the union address the president hit on the same populist themes he has been pounding since Labor Day, which essentially come down to this: the nation’s economic troubles — anemic job growth today, massive federal borrowing and debt accumulation, and stagnant wage growth for the middle class — can all be traced to public policies which deliver excessive economic gains to the rich at the expense of everyone else. In other words, if only the Republicans were willing to tax the rich, all would be well....

But what President Obama didn’t explain last evening — indeed, has never really explained — is how a tax hike on higher income households will help the struggling middle class. Because it’s not at all obvious it would.

You can read the whole column here.

posted by James C. Capretta | 2:19 pm
Tags: State of the Union
File As: Health Care

Inside the Obamacare Spin Zone

January 23, 2012

Over at National Review Online, I have a new column up looking inside the Obama administration’s claims about progress at the state level implementing the “health exchanges” meant to form much of the new health care system:

According to the administration’s spin, some 28 states are “on their way” toward establishing the exchanges, so everything is apparently well under control. In other words, nothing to worry about here. Full speed ahead! 

But is that really what’s going on here?

Because, even if one were to accept the White House’s accounting (which one shouldn’t), that would mean that 22 states — roughly 40 percent of the country — are not “on their way” toward erecting the Obamacare exchanges. Isn’t that a problem? Further, upon closer inspection, it’s clear that many of the 28 states that are supposedly “on their way” really aren’t “on their way.”

You can read the full column here.

posted by James C. Capretta | 6:43 pm
Tags: Obamacare, health exchanges
File As: Health Care

Yes, NPR, Repealing Obamacare is Possible

January 17, 2012 • NPR this morning ran a segment on the supposed difficulties that might be involved in repealing Obamacare. Folks who are interested in this question might want to check out a piece I wrote for NRO back in October 2011 laying out the steps involved in using a reconciliation bill in 2013 to repeal Obamacare (assuming Republicans keep control of the House, pick up a majority in the Senate, and take the White House). As the NPR reporter noted, some parts of Obamacare have already gone into effect, and repealers would have to decide which of those to keep intact. But the most significant and expensive components of the legislation certainly could and should be repealed in 2013.

posted by James C. Capretta | 5:53 pm
Tags: repeal, replace, reconciliation
File As: Health Care

More on Premium Support

January 5, 2012

I have a new column up at National Review Online on premium support and controlling health care costs:

There are many reasons to be grateful for the introduction of the Medicare “premium support” plan by Democratic senator Ron Wyden and Republican House Budget Committee chairman Paul Ryan.

In some respects, it represents an improvement over the design of previous versions of premium support. Whereas the original Ryan plan offered seniors a subsidy based on a predetermined formula, the Wyden-Ryan plan relies on competitive bidding for setting the government’s contribution rate. Competitive bidding has the potential to cut costs even more than a predetermined index, because an index tends to lock in today’s wasteful spending. Of course, Wyden-Ryan also very usefully shook up the political debate over premium support, making it much more difficult for Democrats to demonize the concept.

But perhaps the most useful byproduct of the Wyden-Ryan plan has been the clarifying effect it has had on the debate over how to slow the rise of health-care costs.

The full article is available here.

posted by James C. Capretta | 12:45 pm
Tags: Medicare reform, premium support
File As: Health Care

A Look Back at 2011: Congress and White House Edition

December 22, 2011

I have a new column up at e21, looking back at the major policy struggles of the last year:

2011 began with great uncertainty and anticipation. How would the new House majority, propelled into office with the energy from the emergent Tea Party movement, share power with a Democratic White House and Senate? And what would it all mean for economic and fiscal policy?

Now that 2011 is nearing an end, it’s safe to say that this particular political marriage — arranged to some extent by the voters who pulled the lever both for Barack Obama in 2008 and then for conservative Republican congressional candidates in 2010 — has been a rocky one, to put it mildly. Over the course of the past year, the news has been dominated by a series of high-level budget negotiations that were initiated by both sides with great fanfare and much hope for historic and game-changing breakthroughs, and that ended instead as spectacular, headline-grabbing failures....

You can read the whole column here.

posted by James C. Capretta | 1:11 pm
File As: Health Care

Premium Support in the new Medicare proposal

December 16, 2011

I have an article up at National Review Online on the new Medicare proposal:

The release of the Medicare-reform proposal cosponsored by Democratic senator Ron Wyden and GOP House Budget Committee Chairman Paul Ryan is a milestone event in the long-running struggle for sensible entitlement reform....

The Wyden-Ryan proposal has ... brought to the surface an important issue of how “premium support” is designed. The version that Ryan released in April 2011, and which passed the House as part of the GOP’s budget plan, would have given seniors a subsidy each year based on a predetermined government formula. The new version would instead set the government contribution based on bids from the competing plans, including the “public option” of traditional “fee for service” Medicare. Setting aside the public option for a moment, moving toward competitive bidding is actually an improvement over the previous version. Most analysts agree that the potential for cost-cutting in Medicare is immense. With a government-set formula for payments, there is a danger that excessive costs get locked into the payment stream. With competitive bidding, there is much greater potential for deep cost-cutting, as plans that find new ways to deliver more for less can attract enrollment with low premiums.

You can read the whole piece here.

posted by James C. Capretta | 4:26 pm
Tags: Medicare reform, premium support
File As: Health Care

Out and About

December 13, 2011

Last month, I had the opportunity to speak at several meetings on the subject of the relationship of health care to the nation’s medium and long-term fiscal challenge. Two of those sessions were video recorded and are available for viewing on the Internet for those who might be interested.

The first of the recorded sessions, at the Paul Merage School of Business at the University of California at Irvine on November 4, can be viewed here. The slides I used for my presentation are available here.

The second recorded session, at a meeting of the Association of Washington Business (the Chamber of Commerce for Washington State), in Seattle on November 15, can be viewed here. The slides I used for this session in Seattle (very similar to the ones used at UCI) are available here.

posted by James C. Capretta | 1:27 pm
File As: Health Care

The Case for Reforming Medicare with Premium Support

December 8, 2011

Over at economics21, I have a new paper on how Medicare can be reformed with a concept known as “premium support”:

To see the value of premium support as a reform concept, it is necessary to understand how Medicare works today, and especially the role that Medicare plays in today’s inefficient arrangements for delivering health care services.... The primary problem is that health care in this country is highly fragmented and uncoordinated. In the main, physicians, hospitals, clinics, labs, and pharmacies are autonomous, financially independent units. They bill separately for the services they render to patients, with very little need to coordinate with anyone else in the system. The result is an incredible level of duplication and waste, overemphasis on procedure-based medicine, as well as burdensome paperwork, excessive bureaucracy, and a lack of accountability for the all-too-frequent cases of low quality care....

Premium support provides a ... vision for how to bring about “delivery system reform.” Instead of relying on the government’s capacity to re-engineer how doctors and hospitals are organized and provide care, premium support relies on a decentralized process of consumer choice and vigorous price and quality competition among the plans providing coverage as well as among those providing services directly to patients. The idea is to give the program’s participants strong financial incentives to gravitate toward arrangements that can deliver high quality care at the lowest possible premium.

You can read the full paper here.

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

Letting the Super Committee Fail?

November 2, 2011

I have a new columm up at e21 on the prospects for success of the Joint Select Committee on Deficit Reduction:

The problem is not that the two sides can’t put on the table broad budget parameters that look good on paper (although Republicans will never agree to the kind of tax hike the Democrats are now calling for). The problem is that everything breaks down when the negotiations go from broad and general to the specific....

By all accounts, the super committee has made no progress in conquering these large obstacles to a “grand bargain” on the budget.

That being the case, some in Congress are pushing for a smaller, more incremental deal from the committee, to demonstrate to the markets and the ratings agencies that the American political system isn’t entirely broken. Fine, if it can be done. But under no circumstances should a deal which merely tinkers around the edges and does not fundamentally reform the tax code and entitlement programs be billed as anything but a temporary Band-Aid.

In truth, what is really holding back the super committee is that it does not have a mandate from voters to do what needs to be done. That’s going to take another election, in 2012.... 

You can read the full column here.

posted by James C. Capretta | 3:20 pm
Tags: super committee, budget
File As: Health Care

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