Health Care


Curing the Pre-Existing Conditions of Obamacare

September 10, 2012

Tom Miller and I have a column in AEI’s The American on why Obamacare is the wrong way to cover pre-existing conditions.

The starting point for addressing the problem of pre-existing conditions is a proper perspective on its size. The claim that tens of millions of Americans are at risk of losing coverage defies common sense. ObamaCare included $5 billion in new funding to subsidize insurance for the millions who were supposedly sick and without options. Far from the alleged 65 million people,only 77,877 had signed up for the subsidized Pre-Existing Condition Insurance Plan by June 30 of this year. The truth is that most Americans with health problems are protected by rules passed years ago by Congress and state legislatures that prohibit discrimination against them in job-based insurance. Not surprisingly, those employer plans pay for hundreds of billions of dollars of claims each year—from workers with “pre-existing” health conditions.

But don’t get us wrong. The problem of gaps in coverage for pre-existing conditions is real and needs to be addressed. It affects several million Americans, and that’s far too many.

The fundamental cause of gaps in coverage is a lack of portable health insurance, not the likelihood that almost everyone will eventually suffer from some spells of poor health. Health problems are an inevitable pre-existing condition of life, especially as we live longer. Lack of access to health insurance, however, is largely due to two particular public policies that unfairly penalize individuals and families seeking coverage on their own, rather than through their employer’s group coverage.

You can read the rest of the column here.

posted by James C. Capretta | 11:28 am
Tags: Obamacare, pre-existing conditions
File As: Health Care

The Medicare Distortions

September 10, 2012

I have a column up at National Review Online about the dishonest attacks over Medicare on the Romney-Ryan campaign by the Obama campaign and its apologists.  

To begin with, those attacking Ryan have resorted to silly name-calling (“VoucherCare,” “CouponCare”) in an attempt to discredit the idea of Medicare premium support. But premium support — which, by the way, has a long bipartisan history, including support from Democratic senator Ron Wyden — cannot be considered a “voucher” program any more than the prescription-drug benefit in Medicare is a voucher program. Under the drug benefit, the federal government accepts bids from private insurers wishing to offer coverage to the beneficiaries. The government’s contribution toward coverage is based on the weighted average of those bids. Every beneficiary in a given market area is entitled to the same level of governmental support. The government provides an organized format to assist the beneficiaries in their choice of plans. And once a beneficiary decides on a plan, the government’s contribution is sent directly to the insurer. No voucher is ever issued. That’s exactly how a Wyden-Ryan premium-support plan would work in the rest of Medicare.

You can read the rest of the article here.

posted by James C. Capretta | 11:25 am
Tags: 2012 election, Medicare
File As: Health Care

Ryan and His Panicky Critics

August 30, 2012

I have a column up at National Review Online responding to the criticisms of Paul Ryan’s nomination acceptance speech made by some of his liberal detractors.

Ryan’s critics are beside themselves that the Romney campaign has effectively pinned $716 billion in Medicare cuts on the Obama administration. Two arguments are made to defend the president. First, it is said that Ryan’s own budget cut Medicare by the same amount. But the Ryan budget not only repealed all of Obamacare’s spending, it also doesn’t specify the kinds of Medicare cuts Obamacare does: It calls for the same level of savings but doesn’t spend the money elsewhere and leaves room for Congress to pursue those savings in ways that don’t rely on price controls and the elimination of benefits. Moreover, both Romney and Ryan have said that they, in a Romney administration, would meet their budgetary goals without Obamacare’s Medicare cuts by trimming elsewhere in the budget. And it is certainly the case that Romney and Ryan will have much greater flexibility than Ryan did as House Budget Committee chairman to make cuts wherever they can find them.

Ryan’s critics also take exception to the implication that the Medicare “cuts” will do any harm to the health care provided to seniors, arguing that the savings come from “targeted cuts to providers,” not seniors. This is utter nonsense. Among the cuts in Obamacare is a deep and permanent reduction in payments to Medicare Advantage plans. According to the Medicare trustees, that cut will force 4 million seniors out of their Medicare Advantage plans. There is no question that these seniors will lose thousands of dollars per year in health benefits because of these cuts. Moreover, the chief actuary for the Medicare program has projected that, by the end of this decade, 15 percent of facilities will have to stop taking Medicare patients because of Obamacare’s cuts. That will directly impair access to care for millions of seniors, and the percentage of hospitals and nursing homes dropping out of Medicare will grow to 25 percent by 2030.

You can read the rest of the column here.

posted by James C. Capretta | 4:57 pm
Tags: Paul Ryan, mediscare
File As: Health Care

What to Say about Health Care

August 30, 2012

I have a column in the latest issue of National Review (payment required to view online) on how the Romney-Ryan campaign can offer Americans a compelling alternative to Obama’s health care plan.

It has also helped the Romney campaign tremendously that Ryan is carrying much of the load. He knows these issues cold, because he is a prominent budget expert, and health care in general, and Medicare specifically, are central to the nation’s long-term budgetary troubles. Ryan’s adeptness in debating the topic was on full display at the February 2010 White House “summit” on health care, during which Ryan dismantled the phony deficit-reduction claims the president and congressional Democrats were making about Obamacare.

The challenge for the Romney-Ryan ticket is to channel the political momentum generated by this early Medicare counterattack into a larger conversation about broad visions for health care. Although Obamacare remains unpopular, it will be difficult to uproot it without articulating a compelling replacement strategy that can solve the problems in the health-care sector without Obamacare’s massive expense and heavy-handed government coercion. Here again, Ryan will be indispensable, because he has become one of the party’s most articulate and persuasive advocates of a patient-driven health-care system.

You can find the rest of the article here.

posted by James C. Capretta | 2:02 pm
Tags: 2012 election
File As: Health Care

Paul Ryan's Medicare Plan Harnesses Consumer Power in Healthcare

August 22, 2012

Last Friday I contributed to a debate on the Ryan Medicare plan at the U.S. News & World Report “Debate Club.”

There are two basic choices for slowing the pace of rising costs in Medicare. The first option—the one embraced by the Obama administration—is to rely on the federal government to impose price controls and otherwise try to micromanage how healthcare is delivered to patients. This approach has been tried for the past four decades in Medicare, and hasn't worked.

The alternative is to harness the power of consumer choice in Medicare. The proposal would be phased in gradually. Current beneficiaries and those age 55 and older would see no changes in the way the program works for them. Future entrants, however, would be entitled to a premium support payment which they would direct to the plan of their choice.

You can read the rest of my post here.

posted by James C. Capretta | 3:27 pm
Tags: Ryan plan, Medicare
File As: Health Care

President Obama’s $700 Billion Medicare Problem

August 15, 2012

I have a new article at National Review Online on how the Romney campaign can and should go on the offensive against Obama for his cuts to Medicare.

The selection of Ryan has also been a revealing moment for the mainstream media. In these first days after the announcement, the media have largely played along with the Democratic story line that the selection of Ryan will put the Republicans on the defensive over Medicare in the run-up to November. They have told this story by repeating over and over completely inaccurate descriptions of the policy positions of the candidates.

A fair reading of the facts shows that the Romney-Ryan campaign has every reason to believe that they can put the Obama-Biden ticket on the defensive over Medicare. The most salient fact is that, to pass Obamacare, the president cut Medicare by more than $700 billion over the coming decade, according to the Congressional Budget Office (CBO). And these cuts are of the worst kind. They are arbitrary and across the board. They reduce reimbursement rates for all who provide services to Medicare patients, regardless of how well or badly they treat their patients. Among the cuts is a $156 billion reduction in payments to Medicare Advantage plans over ten years. These cuts will force seniors to pay $3,700 more for their health care by 2017, according to a study I co-authored with Robert Book (for those who might be interested, the cuts are distributed by congressional district here). The Medicare trustees project that the cuts will drive some 4 million seniors out of Medicare Advantage plans between 2012 and 2018.

You can read the rest of the article here.

posted by James C. Capretta | 10:19 am
Tags: Medicare cuts
File As: Health Care

More Mediscare

August 14, 2012

My colleague Yuval Levin and I have a column in The Weekly Standard about how a recent study of Medicare reform in the Journal of American Medical Association distorts its own findings in an attempt to discredit premium support proposals like the Wyden-Ryan plan:

For starters, the Wyden-Ryan plan would apply only to entrants into the program after 2023. No current senior, and no one under 55 today, would be affected by it. So there is no way for the reform to increase the premiums of any current beneficiaries.

Moreover, even the Harvard scholars’ own analysis shows that no senior would necessarily pay any more for Medicare coverage under the proposed reform. The point of premium support is to bring more efficiency into the program. If competition introduced new ways of providing and structuring coverage and care that significantly reduced costs, presumably the fee-for-service Medicare plan (which would remain an option under Ryan’s proposal) would learn from some of these and reduce its own costs too. If it didn’t, it would lose customers, and it would deserve to.

You can read the rest of the article here.

posted by James C. Capretta | 10:57 am
Tags: Yuval Levin, premium support
File As: Health Care

Talking About Replacing Obamacare

August 1, 2012

Last month, I was very pleased to be invited to appear on Brian Lehrer’s radio show (public radio in NYC) to talk about an alternative vision for health care reform, one that is very different from the vision embodied in Obamacare. The invitation to appear on the show was prompted by the piece Bob Moffit and I wrote for National Affairs magazine, entitled “How to Replace Obamacare.” The discussion focused on the reforms that are necessary to build a functioning marketplace for health care in the United States.

In addition, the American Enterprise Institute (where I am a visiting fellow) recently asked me to record a series of brief video remarks outlining the major features of a replacement plan for Obamacare. Those remarks closely follow the points I made with Bob in our National Affairs piece. AEI has posted the recorded videos on its YouTube channel.

For those who might be interested, the radio show is available here, and the AEI videos are available here.

posted by James C. Capretta | 0:00 am
Tags: AEI, health care reform
File As: Health Care

Health Care Costs and Obamacare

July 31, 2012

I have a new column at e21 rebutting Christine Romer’s latest defense of Obamacare’s cost control mechanisms:

Romer is right that rapidly rising health costs is the most serious threat to the nation’s long-term prosperity. Already, the rapid run-up in federal health entitlement spending is putting tremendous pressure on the federal budget. Between 1972 and 2011, federal spending on Medicare and Medicaid rose from 1.1 percent of GDP to 5.5 percent, according to the Congressional Budget Office (CBO). CBO’s latest projections indicate that spending on these programs, plus ObamaCare’s new entitlement spending, will push total health entitlement spending up to at least 8.4 percent of GDP by 2030. That’s a jump in spending of nearly 3 percentage points of GDP compared to today’s level — or the equivalent of another $500 billion in budget outlays.

But although Romer is right about the severity of the problem, she is dead wrong about ObamaCare’s role in addressing it. ObamaCare did not lay the foundation for sensible cost control, and did not partially ease budgetary pressures, as she asserts. Quite the contrary, ObamaCare will pour an ocean of gasoline on the health entitlement fire, and the supposed cost-control mechanisms are a mirage.

The rest of the column is here.

posted by James C. Capretta | 10:57 am
Tags: Obamacare, cost control
File As: Health Care

The Mandate After the Court

July 17, 2012

My colleague Yuval Levin and I have co-authored a new article for National Review Online about how the Roberts decision will affect Obamacare:

In the wake of the Roberts decision, participation in Obamacare’s insurance scheme is optional. Rather than a requirement to buy coverage backed with a penalty for violators, the law now offers Americans two equally lawful and legitimate options: buy expensive insurance (which Obamacare will make all the more expensive), or pay a modest (and still largely unenforceable) tax and just buy insurance for the same price later if you need it. Presented as a choice, not a command, this provision will invite a straightforward comparison, and for many Americans the choice it would pose would be a very easy one. 

You can read the rest of the article here

posted by James C. Capretta | 12:03 pm
Tags: Supreme Court, Yuval Levin
File As: Health Care

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