Health Care

Obamacare as “Play or Pay”

June 28, 2012

I have a new post up at National Review Online on how today's Supreme Court decision raises some interesting questions about how Obamacare will operate in the real world:

The Congressional Budget Office (CBO) and others have suggested that the presumed mandatory obligation to buy health insurance would be a very powerful motivator for those who today choose to remain uninsured to purchase coverage, even though the “penalty” they must pay is generally far less than the premiums for even bare-bones health insurance. In other words, the CBO assumes these people will go along with the program because everyone else is going along with it and, well, it’s the “right thing to do.”

This was always a dubious assumption, as it presumes people will act against their own self interests. But it would seem even less plausible now because the Supreme Court, in its language today, has made it clear that the mandate cannot be viewed as a mandate at all; it’s just an optional tax that citizens can pay in lieu of securing health insurance.

You can read the rest of the article here.

posted by James C. Capretta | 7:28 pm
Tags: individual mandate
File As: Health Care

SCOTUS Post-Mortem

June 28, 2012 • I have a column up at e21 on what today's Supreme Court ruling means for the future of Obamacare, and what opponents of that plan need to do to repeal and replace it:

Still, there’s no question that today’s ruling provides a boost to the administration and to the long-term prospects of ObamaCare. The future of ObamaCare now rests in the political and legislative arena -- perhaps appropriately, as that is where the fate of most important policy matters should be settled. ObamaCare opponents should be optimistic, because the public remains firmly opposed to the law, but also determined, because it won’t be easy.

You can read the rest of the article here.

posted by James C. Capretta | 4:30 pm
Tags: Supreme Court, Obamacare
File As: Health Care

All the President’s Mandate Positions

June 27, 2012

I have a new column up at National Review Online on Obama’s history of flip-flops on the individual mandate:

Without the mandate, the Obama plan would not be considered a “universal coverage” plan in Democratic circles, as analysts, including those at the Congressional Budget Office, would expect large numbers of Americans to decline to sign up for coverage in a voluntary system. Party elites and activists would regard this as a major, perhaps even fatal, flaw. Nothing in the Democratic catechism is more sacred than the goal of “universal coverage” in health care.

So Senator Obama was taking a risk in not toeing the party line. But it was a calculated risk. He knew from polling data that, despite its popularity among party elites and left-leaning health-care analysts, the individual mandate was far less popular among Democratic primary voters. Here was a policy difference with Senator Clinton that he could exploit to his advantage in the primaries.

You can read the rest of the article here.

posted by James C. Capretta | 3:00 pm
Tags: individual mandate
File As: Health Care

Obamacare’s Failings Go Well Beyond the Individual Mandate and Medicaid

June 21, 2012

I have a new issue brief at the Heritage Foundation on four of the worst problems with Obamacare that are not under review by the Supreme Court. Here’s one:

Obamacare will exacerbate the nation’s already alarming entitlement spending and debt crises. Already, the dramatic rise in spending on Medicare and Medicaid is pushing the federal budget to the breaking point. Obamacare makes the problem much worse by creating two new additional entitlement programs in the form of a massive Medicaid expansion and a new premium credit entitlement for households with incomes between 138 percent and 400 percent of the federal poverty level. These two entitlement expansions are expected to add a minimum of 35 million Americans to the entitlement rolls when phased in, at an expense of more than $200 billion annually by the end of the decade.

You can read the rest of the article here.

posted by James C. Capretta | 12:45 pm
Tags: Obamacare, Supreme Court
File As: Health Care

The Case for Romney’s Health Care Plan in USA Today

June 15, 2012

I have an Op-Ed today in USA Today, offering an opposing viewpoint to their editorial:

This week, former Massachusetts governor Mitt Romney began to describe the kind of health care reform plan he would implement if he is elected president. It's the right vision, and it's very different from President Obama's.

The president's 2010 law is based on a government-centric approach to health care reform. The federal government, already heavily involved in regulating the health sector through Medicare and Medicaid, will have near-total control over all important decisions under the new law, including what's covered by insurance, where people go to access their coverage, and how doctors and hospitals should organize themselves.

Gov. Romney has a different focus....

You can read the rest of the piece here. (Note that their editors chose the title.)

posted by James C. Capretta | 12:25 pm
Tags: Obamacare, Mitt Romney
File As: Health Care

Supreme Suspense: Getting Ready for the Big Obamacare Decision

June 14, 2012 • I have a new column up at e21 on how conservatives should be prepared for whatever the Supreme Court decision on Obamacare turns out to be:’s possible to boil down the various scenarios to a handful that capture the most likely outcomes, and to examine the implications of those scenarios through both a policy and a political lens. Indeed, for those who have spent the past three years opposing ObamaCare, it’s critically important to be prepared for all eventualities because what the key players in this drama say and do in the days after the Court issues its decision could be just as important as the decision itself to the future of ObamaCare and American health care.

Scenario 1: The Court Upholds ObamaCare. What if the Court doesn’t strike down any provisions of ObamaCare? This is the scenario conservatives are loath to consider but ignore at their peril. It is certainly possible that the Court will find ObamaCare within the bounds of existing constitutional law, despite the many flaws in the administration’s legal defense that were exposed during oral arguments. If that happens, it will be seen as a severe blow to the ObamaCare opposition because so many conservatives have invested so much energy in the two-year-long legal case....

You can read the rest of the article here.

posted by James C. Capretta | 3:28 pm
Tags: Obamacare, Supreme Court
File As: Health Care

It’s Obama’s Economy

June 7, 2012

I have a new article at National Review Online showing why Paul Krugman is wrong to blame the Republicans for the state of the economy:

No doubt it would be impressive if the president managed to convince the electorate that three years’ worth of anemic job creation is all the GOP’s fault. And certainly one can’t blame Krugman for making the suggestion (desperate political times call for desperate political evasions). But the odds of this working for President Obama are near zero.

For starters, there’s the problem of who has actually been in charge of economic policy since 2009. The president came into office with commanding Democratic majorities in the House and Senate. He could have done anything he wanted during those years, without even consulting with Republicans. And, in fact, he did do pretty much anything he wanted in those years, in spite of GOP objections. Which is why, as Douglas Holtz-Eakin has already noted, we got the $800 billion stimulus spending plan, very substantial spending increases in the 2009 and 2010 appropriations processes, Dodd-Frank, the auto bailout, a state- and local-government bailout bill, Cash for Clunkers, and much else — not to mention the huge tax hikes, including tax hikes on labor, contained in Obamacare. This was the president’s activist economic agenda, and it’s all been implemented or is in the process of being implemented. The fact that it hasn’t worked to spur a robust economic recovery is no one’s fault but the president’s.

You can read the rest of the article here.

posted by James C. Capretta | 6:22 pm
Tags: President Obama, Paul Krugman
File As: Health Care

The Democrats’ Budget Blame Game

May 23, 2012

I have a new column up at National Review Online rebutting the Democratic Party’s recent efforts to cast themselves as the party of fiscal restraint:

The numbers speak for themselves. At the end of 2008, the federal government’s cumulative debt stood at $5.8 trillion. In 2009, the federal government ran its first-ever trillion-dollar deficit. And then did it again in 2010 and 2011. Over those three years, the government borrowed an additional $4.2 trillion. This year will be no better. The Congressional Budget Office expects another trillion-dollar deficit. During Obama’s four-year term, the federal government will have added nearly $5.5 trillion to the government’s cumulative debt total — nearly as much as was accumulated from 1789 to 2008!

You can read the rest of the article here.

posted by James C. Capretta | 2:08 pm
Tags: deficit, President Obama, Democratic party
File As: Health Care

Hewitt Lecture: "The Future of Medicare and Medicaid"

May 23, 2012

Last month I had the honor of participating in a discussion with former CMS administrator Dr. Donald Berwick as part of the Pioneer Institute’s annual Hewitt Lecture Program. The video of my remarks is below, and Dr. Berwick’s remarks and the discussion between us (moderated by former CMS administrator Tom Scully) are available on video here.

posted by James C. Capretta | 12:13 pm
Tags: Medicare, Medicaid
File As: Health Care

Delivery System Reform

May 18, 2012

On May 16, the Senate Health, Education, Labor and Pensions Committee convened a hearing on “Identifying Opportunities for Health Care Delivery System Reform: Lessons from the Front Line.” I was asked to participate on a panel with Dr. Al Kurose, President and CEO of Coastal Medical in Providence, RI and Marcia James, Director of Provider Engagement for Humana. Here is an excerpt of my prepared testimony:

American health care has many virtues. The system of job-based insurance for working-age people and Medicare for retirees provides ready access to care for most citizens (although access is more problematic for the poor through Medicaid). We have the most advanced network of clinics and inpatient facilities found anywhere in the world. And U.S. health care is also open to medical innovation in ways that other health systems around the world are not.

But there is no denying that health care in the United States is all too often highly inefficient. The system is characterized by extreme fragmentation. Physicians, hospitals, clinics, labs, and pharmacies are all autonomous units that are financially independent of one another. They bill separately from the others when they render services to patients; what’s worse, there’s very little coordination of care among them, which leads to a disastrous level of duplicative services and low-quality care in too many instances. The bureaucracy is maddening, the paperwork is burdensome and excessive, and there is very little regard for making the care experience convenient and pleasant for the patient.

At the heart of this dysfunction is Medicare — and more precisely, Medicare’s dominant FFS [fee-for-service] insurance structure.

You can read the rest of my testimony here, and the prepared testimony of Dr. Kurose and Ms. James here and here. You can also watch the the full hearing online.

posted by James C. Capretta | 3:51 pm
Tags: fee-for-service
File As: Health Care

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