November 28, 2014

Posts on health care

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Thursday, July 30, 2009 - 10:18 AM

The Congressional Budget Office once again validates some intuition many of us had about health care reform: when you have health costs rising much faster than the economy is growing, a package that expands coverage but is unwilling to tax health benefits to pay for it is not likely to add up to a deficit-neutral plan over the longer term. The basic problem is that the cost of coverage expansion will continue to increase at the same rate as health care costs, but the tax increase offsets will only grow (at best) at the rate of economic growth. Then you have an additional problem that many of the offsets might be one-time cuts or cuts whose value does not even keep up with economic growth or inflation. 

Quoting from pages 12-13 of the report (a letter to Congressman Dave Camp (R-MI) on the House tri-committee proposal), emphasis added:

Looking ahead to the decade beyond 2019, CBO tries to evaluate the rate at which the budgetary impact of...

Tuesday, July 28, 2009 - 4:13 PM

Yesterday, experts from the Iowa Committee for Value in Healthcare -- a diverse group of Iowa health care providers, purchasers, payers, patient advocates, and policy analysts -- sent a letter to President Obama and Congressional leaders indicating the principles for value-based health care reform that should be considered in any health care legislation. 

This committee was established as part of The Concord Coalition's Fiscal Stewardship Project to suggest ways that health reform could be enhanced to create a more value-based system. As Congressional efforts toward health reform continue through the summer, value, cost and long-term savings have become more prominent aspects of the debate. Achieving value in the health care system is essential for the ...

Thursday, July 23, 2009 - 8:19 PM

While the President's press conference Wednesday night got a lot of attention and focused substantially on health care, he also did an interview with Washington Post editorial page editor Fred Hiatt earlier in the day. The wide-ranging interview touched on health care reform, but also on a lot of the other subjects Concord Coalition members are interested in -- like deficits, debt, Social Security reform and a BRAC-like fiscal commission. It is worth a read.

Wednesday, July 22, 2009 - 4:59 PM

In today’s Washington Post, Harold Meyerson complains that the centrist “Blue Dog” Democrats have a “can’t do” attitude when it comes to health care reform:

[O]ur government used to actually pave roads, build bridges and allow for secure retirements by levying taxes on those who could afford to pay them. To today’s centrist Democrats, this has become a distant memory, a history lesson they cannot grasp. The notion that actual individuals might have to pay to secure the national interest appalls them. In the House, the Blue Dogs doggedly oppose proposals to fund universal coverage by taxing the wealthiest 1 percent of the nation’s households…

Centrist Democrats’ opposition to health reform verges on the incoherent. A caucus (the Blue Dogs) formed ostensibly to promote balanced budgets now disapproves of the proposed taxes that would cover the expenses of the new programs. The congressional centrists say, commendably, that they want to squeeze more economies out of the system, but they oppose giving more power to an agency that would set the payment...

Friday, July 17, 2009 - 2:39 PM

From my previous post, it might be clear that there's finally some serious discussion on the Hill about cost control within the health care reform debate. 

Today, the Administration weighed in with an important proposal that might provide the best shot at making sure health care reform legislation has a lasting legacy of reducing costs. (See a summary of the proposal here).

As CBO director Orszag explains, they are looking to create an independent council which will be able to set payment rates and alter payment systems in Medicare, and these recommendations will be done regularly and will take effect unless the President and then Congress explicitly decide to ignore them.  

In this proposal, the body of experts would be called the Independent Medicare Advisory Council or IMAC. The idea for such...

Thursday, July 16, 2009 - 1:25 PM

Health Care reform is moving quite quickly on the Hill and it is almost impossible to keep up with all of the developments in Congress and all of the great reporting in the media on what is needed for fiscally responsible health care reform. So, over the next 90 days as health care dominates the political agenda, we are going to try to briefly highlight developments as they occur by linking to other sources and throwing in Concord material as it is published.

The links brought to you today cover the fundamental cost control issues being discussed (or unfortunately not discussed) as legislation makes its way through the House and Senate Committees.

  • The big news today, as reported in The Washington Post, CNN and elsewhere, is that CBO director Elmendorf testified in front of the Senate Budget Committee and proclaimed that the legislative developments he has seen (the House bill and the Senate's HELP committee bill) seem to "significantly expand the...
Tuesday, June 30, 2009 - 11:15 AM

It has almost become axiomatic that growing health care costs, rather than population aging, is the overwhelming cause of a projected spike in federal spending. That notion was dispelled in CBO’s Long-Term Budget Outlook published last week. As explained in the report:

“Federal spending on Medicare, Medicaid, and Social Security will grow relative to the economy both because health care spending per beneficiary is projected to increase and because the population is aging. Spending on Medicare and Medicaid will be driven by both factors, while Social Security spending will rise because of the population’s aging. Between now and 2035, aging is projected to make the larger contribution to the growth of spending for those three programs as a share of GDP. After 2035, continued increases in health care spending per beneficiary are projected to dominate the growth in spending for the three programs.”

 

Later in the report, CBO quantifies the relative effects of aging and health care growth on projected...

Thursday, May 21, 2009 - 1:28 PM

Steven Pearlstein has a column in Wednesday, May 20's Washington Post called “Budget Scolds Shouldn’t Drown Out the Chorus Calling for Health Reform.” We assume that The Concord Coalition is among his targets given his definition:

"In the political menagerie that is Washington, there exists a species known as the budget scold — analysts, advocates, editorial writers and politicians who possess a fierce determination to bring the federal budget into better balance.

Budget scolds have a wonkish demeanor and a skeptical outlook. They possess an undue fascination with rules and processes, and speak in the arcane language of baselines, sunsets and pay-fors."

Although we don't define ourselves by the fact that we occasionally "scold," the rest of his characterization isn't that far off -- just ask those who run into us at parties. But the point of his article is that Pearlstein is concerned that worries about the budget deficit are going to scuttle health care reform. He writes:

"There have been times when the budget scolds have saved the country from short-...

Friday, May 15, 2009 - 2:26 PM

Today, the Concord Coalition released the first issue in our new Series on Health Care and Medicare entitled: "The Nation’s Health Care Conundrum: Where Do We Go From Here?"

This series is designed to illuminate how intertwined the health care challenge is with the nation's long-term fiscal challenge. As Congress and the President prepare to create legislation addressing health care reform, it is essential that this linkage is recognized in any reform package. The legislation must address health care cost control and Medicare cost control in a way that can work quickly to get the nation on a more sustainable fiscal path, especially since demographic changes by themselves will severely strain entitlement programs and the broader federal budget.

The multi-issue series was written by David Koitz, a former analyst for The Congressional Research Service and the Congressional Budget Office. It will be released over the next two months and will also be accompanied on our web site by video briefs highlighting the issues discussed in the series.

Late...

Monday, May 4, 2009 - 2:36 PM

Now that the Congressional Budget Resolution has passed, there has been a lot of talk about how the reconciliation instructions included in the resolution will make it easier for a health care reform effort to pass.  Particularly since the mechanics of reconciliation provide for a simple majority vote for approval -- instead of the 60 votes that might be needed to overcome a filibusterer in the Senate.

Ironically, considering political motivations, it might be easier to round up 60 votes for a fiscally irresponsible health care reform bill, than to attain the 51 votes for a fiscally responsible bill -- which would be needed to utilize the reconciliation fast track procedure. 

Let me explain. When the modern budget process was established, the idea behind including a lower procedural bar under reconciliation was to facilitate legislation that contained difficult choices resulting in deficit reduction. Only in recent years have legislators deviated from this intention, most notably by the usage of reconciliation to pass large, deficit-increasing tax cuts.

The guidelines put in place by the budget resolution for reconciliation -- in a sense -- navigate this budget procedure closer to its original purpose. Specifically, for Congress to consider any health care reform bill, it must contain...