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.


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

Wednesday, May 23, 2012

The Democrats’ Budget Blame Game 

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

Wednesday, May 23, 2012

Hewitt Lecture: "The Future of Medicare and Medicaid" 

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

Friday, May 18, 2012

Delivery System Reform 

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

Friday, May 11, 2012

Catholic Social Teaching and the Ryan Budget 

The Reverend Thomas V. Berg and I have an article up at The Public Discourse, where we defend the Ryan Budget against the criticism from some Catholic bishops that it violates the principles of Catholic social teaching.

To his credit, Chairman Ryan — a Catholic himself — didn’t simply ignore the criticism and move on. Instead, he chose to engage his critics in a conversation by offering, in a speech delivered at Georgetown University, a detailed defense of his budget based on his understanding of what Catholic social teaching calls him to do as an elected leader in the United States Congress.

And so, for the first time in recent memory, Catholics and the broader public have an actual and potentially useful debate under way addressing what the sound and widely shared principles of Catholic social teaching have to say about the federal budget, our out-of-control national deficit, and programs for the poor.

You can find the rest of the article here.

posted by James C. Capretta | 4:10 pm
Tags: Catholicism, social justice, Paul Ryan
File As: Health Care

Thursday, May 10, 2012

Obamacare Hurts Seniors 

I have an article up at National Review Online debunking the claim, based on a report released by Fidelity Investments, that Obamacare will reduce health care costs for seniors:

For starters, as the Fidelity announcement indicates, the analysis conducted by the company is based only on seniors enrolled in the traditional fee-for-service Medicare program. That means it excludes seniors enrolled in the private-plan option available in Medicare, known as Medicare Advantage. Today, about 25 percent of Medicare beneficiaries are enrolled in Medicare Advantage plans. Excluding them from the analysis significantly distorts the findings.

In a report I prepared with Robert Book for the Heritage Foundation, we found that Obamacare will cut Medicare Advantage payment rates by an average of $3,700 per beneficiary in 2017, or 27 percent below the payment rates that would have been made without Obamacare. These cuts will translate directly into higher health-care costs for seniors. Seniors who remain in Medicare Advantage will face higher costs, because the cuts will force the plans to cut back on the benefits they offer and to charge higher cost-sharing for the services they do cover. Further, seniors who will be pushed out of Medicare Advantage and back into the traditional program will lose entirely the added benefits provided by most Medicare Advantage plans. None of this is captured in Fidelity’s analysis.

You can read the rest of the article here, and find the Fidelity study online here.

posted by James C. Capretta | 11:00 am
Tags: Obamacare, Medicare Advantage
File As: Health Care

Wednesday, May 2, 2012

Exposing the Medicare Double Count 

Charles Blahous and I have a new column in the Wall Street Journal on how Obamacare tries to double-count certain revenue to twist its budget figures:

One of the enduring mysteries of President Obama's health law is how its spending constraints and payroll tax hikes on high earners can be used to shore up Medicare finances and at the same time pay for a massive new entitlement program. Isn't this double counting?

The short answer is: Yes, it is. You can't spend the same money twice. And so, thanks to the new health law, federal deficits and debt will be hundreds of billions of dollars higher in the next decade alone....

You can read the rest of our explanation of the Obama administration’s fiscal obfuscation here.

posted by James C. Capretta | 3:05 pm
Tags: Obamacare, Medicare, double-count
File As: Health Care

Tuesday, May 1, 2012

The 2009–2010 Slowdown in Health Spending 

I have a new post up at The Corner on new estimates showing that 2009 and 2010 had the slowest growth rates in health spending in five decades. The obvious cause is the recession. But:

it would appear that these economic factors alone don’t fully explain the drop in spending growth, so the search is on for additional causes.

Here’s one thing we can rule out: Obamacare.

Some of the law’s advocates are trying to take credit for the slowdown in spending, claiming that the debate over Obamacare and the prospect of its “cost control” efforts becoming law were enough to force anticipatory actions that have rooted out waste and inefficiency.

This is nonsense.

Details here.

posted by James C. Capretta | 1:26 pm
Tags: Obamacare, health spending
File As: Health Care

Friday, April 27, 2012

The Medicare Trustees’ Report and the $8.1 Trillion Double Count 

I have a new post up at the Weekly Standard blog on the recently released 2012 Medicare and Social Security trustees’ reports:

The other important story with respect to Medicare’s finances isn’t covered at all in the trustees’ report.... That’s the double counting of Medicare tax hikes and spending cuts in the Obamacare legislation.

Earlier this month, Chuck Blahous, one of two public trustees for the Medicare program, brought renewed attention to this subject when he released a paper documenting the double count and quantifying its impact on the federal budget. According to Blahous, when cost estimates are adjusted to remove the effects of double counted Medicare “savings” provisions, Obamacare increases the deficit by as much as $530 billion over ten years....

You can read the rest of post here, and see the trustees’ reports here and here.

posted by James C. Capretta | 11:15 am
Tags: Medicare, double-count, Medicare Trustees
File As: Health Care

Thursday, April 26, 2012

The President’s Incoherent Economic ‘Philosophy’ 

I have a new article up at National Review Online on how President Obama has abandoned his original stimulus-based approach to the economy, but failed to replace it with anything resembling a coherent, positive economic philosophy:

...the president has chosen to define his “plan” (if it can be called that) mainly by saying what it isn’t: He wants it known that his approach to the economy most definitely bears no resemblance to the plan he claims his GOP adversaries favor. Indeed, the primary purpose of these speeches has quite clearly been to tear down the straw man of a plan the president says the GOP supports in the hopes that the public will look more favorably on the president’s miserable economic record.

And so we hear from the president that the GOP favors creating a “you’re-on-your-own economy,” wants to “end Medicare as we know it,” seeks to revert to “social Darwinism,” and plans to eviscerate the social safety net to pay for a tax cut for the rich. None of this is true. No matter. The president has decided that the only path to electoral victory is to become attack-dog-in-chief.

But what about the actual substance? Is there anything at all to what the president is saying?

All is answered here.

posted by James C. Capretta | 1:12 pm
Tags: President Obama, stimulus, economic philosophy
File As: Health Care

Thursday, April 26, 2012

Obamacare’s Creation of Instability in Insurance Subsidies 

I have a new column up at e21 on the recent CBO study that shows the strange inequalities that will result in the health insurance options for certain families:

CBO’s analysis confirms a crucial point about ObamaCare which remains poorly understood, which is that the law creates a massive inequity in insurance subsidies for working families with low wages.... The problem is that the subsidies inside the exchanges will far exceed the tax subsidy for employer-paid premiums at the lower end of the wage scale.


CBO believes that other preexisting labor laws will make it very difficult for employers to selectively dump their workers into the exchanges.... But what if CBO is wrong and employers are able to find ways around the existing rules to create a two-pronged approach to coverage, with high-wage workers staying in tax-preferred employer plans and low-wage workers migrating to the exchanges?

You can read the rest of the article here.

posted by James C. Capretta | 10:40 am
Tags: Obamacare, health exchanges, CBO
File As: Health Care

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