Health Policy: New America Events

Health Care Quality

Communications — Fri, 19 Sep 2008 05:00:00 -0400

A New America Event
09/19/2008 - 10:00am

Whether you are insured or uninsured, the serious quality problems in the American health care system affect you. There are many excellent health care providers in America, yet there are too many preventable mistakes and too few efforts to coordinate patient care. Our Emergency Departments are over-burdened and inefficient and many Americans experience unequal health care outcomes because of race, ethnicity, and income.

Fundamental changes are needed in health care delivery in the United States. Indeed, efforts to improve the quality of patient care are central to reforming our struggling health system.

At this New America Foundation event, the panelists below discussed the various opportunities to improve the quality of patient care in the U.S. An MP3 recording can be downloaded below, as can the presentation slides from this discussion.

Busting the Budget: Healthcare Costs or Entitlement Programs?

Communications — Mon, 15 Sep 2008 04:00:00 -0400

A New America Event
09/15/2008 - 12:00pm

On Monday, September 15th, six experts in fiscal policy and healthcare policy debated the nature of the nation’s pending fiscal crisis at the National Press Club. Moderated by TaxVox editor Howard Gleckman, the event featured Henry Aaron and Alice Rivlin of the Brookings Institution, Julie Barnes and Maya MacGuineas of the New America Foundation, Robert Greenstein of the Center for Budget and Policy Priorities, and Eugene Steuerle of the Peterson Foundation.

Henry Aaron warned that long-term deficit projections would be unsustainable, but argued that two questions must be answered: what causes these deficits and what should the solution be? Although the answers need not be the same, Aaron explained that healthcare cost growth is both the primary driver, and should be the primary solution. He offered 5 conclusions:

Projected deficits are large and unsustainable.
Spending cuts and Social Security reform can help reduce them a little bit, and should be undertaken.
Healthcare spending, and the taxes needed to pay for them, should continue to grow faster than GDP.
Healthcare cost growth can be slowed considerably, greatly reducing the projected deficit.
The problem of future deficits is not an entitlement problem, but a problem of large and growing costs in the overall healthcare system.

Maya MacGuineas agreed that continued deficits would be unsustainable because they would hamper economic growth, reduce intergenerational fairness, and inhibit budget flexibility. She pointed to areas of agreement between the panelists, explaining that they each believed the deficit is projected to grow to unsustainable levels, and healthcare is a key driver of that growth. At the same time, MacGuineas warned about focusing entirely on healthcare cost growth since there still doesn’t exist much knowledge of how to sufficiently reduce healthcare costs to close the fiscal gap, and where there does, there is little political will. Given this reality, MacGuineas suggested the next President focus on a budget deal for the short-term, a comprehensive fix to Social Security, and “round one of healthcare reform.” Since we will inevitably spend more on healthcare as society gets older and richer, she explained, the solution must focus on all areas of the budget.

Julie Barnes spoke next, explaining that healthcare costs are the major reason that the budget is unsustainable. She took issue with both the argument that we do not know how to reform healthcare costs and that healthcare reform is politically unviable. Barnes pointed to studies which have shown that roughly one third of healthcare spending adds little or no value, and reducing just 10% of that waste a year would offer tremendous savings. She pointed to payment reform and care coordination as proven tools to help deliver healthcare more efficiently and at a lower cost. She also explained that both Presidential candidates have plans to reduce healthcare costs considerably, that both houses have strong bi-partisan healthcare reform plans, and that many of the major stakeholders are now in agreement on much of what has to be done.

Alice Rivlin then suggested that the panelists were in fact debating the wrong question. Rather than arguing over whether closing the fiscal gap should focus on entitlements reform or healthcare reform or tax reform, they should recognize that all three are important. Rivlin explained the there are really two problems driving entitlement growth – demographics and healthcare cost growth. Because of demographics, Social Security costs will rise rapidly over the next two decades and then begin to level off. Medicare and Medicaid, on the other hand, will rise steadily indefinitely. This means that Social Security is important in the short-term, while healthcare entitlements drive the deficit further into the future. Rivlin suggested five main solutions to the looming fiscal crisis:

Encourage people to work longer by both reforming Social Security and changing rules and incentives in private pensions.
Encourage more efficient distribution of medical care, using Medicare and Medicaid to lead payment system reform.
Move toward universal healthcare coverage with spending controls.
Shift healthcare expenses to the private sector where possible.
Reform the tax code to make it more equitable and efficient so that it can bring in the needed revenue without being overly burdensome to the economy.

Bob Greenstein agreed with Rivlin that no either-or situation exists, and made four points of his own:

There is no general entitlement crisis, and in fact all entitlements besides Medicare, Medicaid, and Social Security are shrinking.
Tax entitlements for healthcare and retirement need to be addressed.
Revenue matters, as evident by the fact that renewing all the Bush tax cuts is three times as expensive as reforming Social Security.
Healthcare cost growth is the single most important factor driving the fiscal situation.
Greenstein suggested that reforms to Medicare – such as higher premiums for the wealthy and many of the payment reforms suggested by MedPac – could be adopted, but they would close only a small part of the nation’s long-term fiscal gap. Social Security, spending, and tax reform might also help, but will be woefully insufficient. Therefore, he explained, it is impossible to solve the nation’s fiscal problems without slowing the overall growth in healthcare costs.

Gene Steuerle spoke last, arguing that “never before in history has so much been committed for so many people, so far into the future.” Ultimately, he suggested, allowing Medicare and Medicaid costs to grow automatically is a democratic issue – with previous generations taking decision-making away from current voters. Steuerle warned that we have considerable resources now pledged to “middle aged” retirees, since we have failed to redefine the elderly in light of increasing life expectancy. By continuing to retire in our early 60s, he suggested, we are not only driving healthcare costs upward, but also decreasing the number of tax payers (and amount of revenue), and slowing GDP growth. Turning to the healthcare system, Steuerle suggested perverse incentives encourage acute care over preventative care and more surgeons over more primary care doctors. He explained that he was not advocating less entitlement or healthcare spending, but rather arguing that we should make explicit decisions about how resources are allocated.

Howard Gleckman asked the panel what reform should be undertaken first. Rivlin suggested that policy makers should first use Medicare to “lead the way” toward more effective evidence-based care. Aaron agreed, but also believed that both candidates were proposing far too much in tax cuts, and should allow many of the Bush tax cuts to expire as scheduled in 2010. MacGuineas suggested that policy-makers should do whatever is most politically opportune at the time, but should push for as much change as possible since reforms tend to come in waves. Barnes suggested that politicians could build confidence from the voters and each other by first engaging in easy health reforms, such as the renewal of SCHIP, which would cost the federal government additional money. Greenstein believed that politicians should start by developing the infrastructure to make future healthcare reform possible (such as better Health IT), and cutting subsidies to Medicare Advantage. And Steuerle suggested the next President change the entire focus of government and point it toward long-term budgeting.

Gleckman then asked how much healthcare waste is really out there. Aaron explained that while there is some pure waste, most of what should be considered waste does have “some benefits for some people some of the time.” This makes it politically difficult to reduce waste – although we need to reduce high-cost low-benefit care. Barnes followed by explaining that one third of healthcare spending is on waste – roughly 5% of GDP. She pointed to payment reform and medical homes as a way to cut that waste. Steuerle suggested that the best way to reduce waste would be to put healthcare spending under some type of budget constraint. And MacGuineas warned that in an issue as complicated and personal as healthcare, it will be hard to identify waste – so we shouldn’t look at it as a free lunch.

The next questioner asked how the American people could be educated about the high cost of healthcare, and the “lousy results” we get in the United States. Aaron suggested that explaining these issues to the public would be difficult, and the focus should be on getting the elites to understand and push for solutions. Steuerle suggested that the smartest thing to do would be to change the defaults so that politicians could provide winners by increasing benefits and payments relative to what would happen automatically, rather than decreasing them.

Senator John Breaux next asked if comparative effectiveness research was worthwhile if it was only based on finding the highest quality care without concern for cost. Rivlin suggested that evaluating treatments on the basis of cost effectiveness was very important. Barnes agreed that cost and health outcomes both matter, but suggested that the latter was more important. Aaron warned that even with comparative effectiveness research in hand, it would be very difficult to ban ineffective or overly expensive care, but that we can use comparative effectiveness research to change incentives.

Howard Gleckman then asked whether there should be any types of caps on healthcare spending. Greenstein suggested that global healthcare caps would be impossible without single-payer healthcare, and a cap only on Medicare would be unsustainable as long as private healthcare costs continued to grow. MacGuineas argued that patient incentives need to give individuals a better idea of how things cost, with different amounts of cost sharing depending on the necessity of the treatment or procedure.

The final questioner suggested that entitlement growth represented a case of irresponsible spending. Steuerle agreed, arguing that the solution was not necessarily to cut public spending, but the budget for healthcare spending explicitly. MacGuineas agreed, suggesting that our baselines need to change to let politicians “spend more” rather than taking benefits away. She went further, expressing that the fundamental principle of governance should be that if you are going to spend more, you need to find ways to pay for it. Although this wouldn’t solve the problem, she suggested, it would stop things from getting worse. The bottom line, she explained, is that “if we are going to spend more on healthcare, we have to pay for it.”

-Marc Goldwein, Policy Analyst for the Fiscal Policy Program

America's Health Care Debacle

Communications — Wed, 30 Jul 2008 08:15:00 -0400

A New America Event
07/30/2008 - 4:15pm

Featured Speakers

The Hon. Tom Daschle
Former Senator (D-SD) and Senate Majority Leader
Special Policy Advisor, Alston+Bird

Leo Hindery
Economic Advisor, Obama for President
Managing Director, InterMedia Partners
Former CEO, AT&T Broadband and Yankee Entertainment & Sports Network

Moderator

Steve Clemons
Director, American Strategy Program New America Foundation
Publisher, www.TheWashingtonNote.com

For more information, please see the New America Foundation/Health Policy Program Report, Employer Health Costs in a Global Economy.

This program is sponsored by New America Foundation's Smart Globalization Initiative and the Health Policy Program.

Making Medicare Sustainable

Communications — Tue, 22 Jul 2008 19:15:00 -0400

A New America Event
07/23/2008 - 8:15am

Rising health care costs place increasing strain on state and local budgets and threaten the long-term stability of the Medicare program. In order to begin to control health care costs nationwide and make the Medicare program more sustainable, Medicare must become a more value-based purchaser of health care.

Medicare experts from across the country joined the New America Foundation on July 23rd in Washington, DC, to propose innovative ways to reform our Medicare program.

Dr. Lawrence Casalino from the University of Chicago kicked off the day-long conference by presenting his paper about value-based purchasing opportunities in traditional Medicare. Casalino discussed the merits of medical homes, accountable care systems (ACSs), pay for performance, and public reporting. (PowerPoint Presentation)

The next presenter, Timothy Jost of the Washington and Lee School of Law, addressed the legal and regulatory issues surrounding Casalino’s proposed solutions. He explained that in some cases accommodating value-based purchasing will require changes in HHS regulations. In other instances, he explained, the impediments to value purchasing are statutory, and Congress will have to act to remove them. (PowerPoint Presentation)

Dr. Charles Boult from the Johns Hopkins Bloomberg School of Public Health, examined what policies and processes work best for Medicare beneficiaries that are particularly vulnerable. He suggested that lawmakers consider interdisciplinary and supplemental primary care, transitional care between hospital and post-acute settings, and advance practice nurse-physician partnerships for caring for Medicare’s sickest enrollees. (PowerPoint Presentation)

To round out the morning session, New America’s Len Nichols, PhD, and Dr. Bob Berenson from the Urban Institute proposed a board-like entity to oversee the Medicare program and relieve some of the political pressure from lawmakers in Congress. (PowerPoint Presentation)

After listening to luncheon keynote speakers, Congressman Ron Kind (D-WI) and former Congresswoman Nancy Johnson (R-CT), attendees heard from two panels about the possibilities for Medicare reform. Panelists agreed that many of the general concepts presented at the event will play some roll in reforming the Medicare program. However, they reminded us that many of these reforms might require Congress to cede some of its decision-making power to other sources. Therefore, in order to implement these reforms, it will be important to allow Congress to relinquish some of its day to day decision-making while maintaining legislative ownership of the Medicare program.

For more information visit the New Health Dialogue blog.

**All papers presented at the conference were in DRAFT form. Final versions will be compiled and released in the fall.**

To watch a video of the event and for transcripts, please visit the Kaiser Family Foundation website.

Employer Health Costs in a Global Economy

Communications — Thu, 08 May 2008 22:00:00 -0400

A New America Event
05/09/2008 - 10:00am

Voters are sending a clear message: they are concerned about the economy and worried about being able to afford health care. To examine this important nexus of health care and the economy, the New America Foundation welcomed Senator Deborah Stabenow (D-MI), the Wall Street Journal’s Laurie McGinley, and representatives from the business, labor, and economic communities to discuss the impact of rising health care costs on U.S. competitiveness and American jobs. The Capitol Hill event was focused on the recent work by Len Nichols and Sarah Axeen entitled, “Employer Health Costs in a Global Economy: A Competitive Disadvantage for U.S. Firms.”

Senator Stabenow kicked off the event by thanking Len and New America for producing the data necessary bolster what she has believed for years: our nation’s health care crisis costs Americans jobs and hinders the ability of U.S. businesses to thrive in a global economy.

Len Nichols, Director of the Health Policy Program at New America, argued that while economic theory teaches us that it is workers—rather than employers—who pay for health care through lower wages, employers face a variety of constraints that may make it difficult for them to fully shift health costs in the short run. Therefore, health care costs are having a real effect on employers and workers.

Following Len’s presentation, Joe Antos from AEI spoke about the importance of focusing on the steps necessary to get our nation from its current health system to a reformed system. Charlie Kolb, President of the Committee for Economic Development, stressed the need to transition away from an employer based system, while Andrew Webber, President and CEO of the National Business Coalition on Health, argued that employers should demand the changes necessary to continue to offer health benefits and improve the system. Finally, Gerald Shea, Assistant to the Director of Government Affairs for AFL-CIO, stressed the need for substantive change through a public-private partnership. Shea emphasized that the status quo is unsustainable for workers and employers. Panelists were largely in agreement that rising health care costs represent a serious problem for employers.

Stay tuned as the Health Policy Program continues to examine the economic case for a quality health care system for all Americans.

The Presidential Candidates' Domestic Policy Plans

Communications — Sun, 27 Apr 2008 22:30:00 -0400

A New America Event
04/29/2008 - 8:30am

On Tuesday the 29th of April, the Committee for a Responsible Federal Budget, in association with the New America Foundation, American University and the Tax Foundation, hosted an event concerning the major domestic policy issues facing the nation before the upcoming presidential election. Focusing on the candidates’ policy proposals, the event featured four panels of policy experts. The first three—on climate change, health care, and tax reform—featured independent experts from across the political spectrum, expressing varied and often contradictory views on their issues of expertise. The final panel featured economic advisors from the campaigns themselves, who gave the audience a glimpse of the candidates’ views on these important policy issues.

The first panel, moderated by David Wessel of the Wall Street Journal, concerned climate change policy. The panelists, William Pizer of Resources for the Future, Nikki Roy of the Pew Center on Global Climate Change and Robert McNally of the Tudor Investment Corporation agreed that all three candidates had promising positions on the issue from the perspective of an environmentalist. At the same time, all three expressed skepticism about the candidates’ commitment to the issue. Pizer pointed out that there are four major components to a national environmental policy—cost, competitiveness, allocation and treatment of preexisting state-level climate policies—that will make climate legislation difficult to design and equally difficult to move through congress. Roy complained that none of the candidates were campaigning on the issue, despite supporting it on their websites. Without putting it out front in the campaign, he suggested, the candidates would not have the political capital to push legislation through once they are elected. McNally added that whatever legislation eventually passed would take years to do so, and that eventual success might have to be driven by a small energy crisis, such as widespread brown-outs in major cities. In the end, the panelists agreed that the scientific community had reached a strong consensus, but disagreed about whether the American public would continue to support climate change policy as it drives up energy bills.

The second panel, also moderated by Wessel, featured a discussion on healthcare reform from John Sheils of the Lewin Group, Joe Antos of the American Enterprise Institute, and Len Nichols of the New America Foundation. Sheils spoke first, discussing the employer tax exclusion for health insurance and the problems associated with it. In addition to costing around $250 billion in forgone public revenue, he explained, the exclusion is regressive and leads to over-purchasing of health insurance. It could be improved, he suggested, by replacing the exclusion with a standard deduction or tax credit. Nichols and Antos spoke next, taking turns discussing the good and bad parts of the Presidential candidates’ proposals. Nichols spoke favorably of McCain’s willingness to propose supply-side delivery system reforms and his decision to use the existing employer tax exclusion funds to subsidize individuals through a tax credit, rather than a tax deduction. At the same time, Nichols expressed concerns that McCain’s proposal to allow insurance to be purchased across state lines would leave insurance inaccessible for some Americans, particularly the sick, and disappointment that McCain has not discussed covering all Americans as a goal. Antos liked that the Democrats focused on bringing down healthcare costs and included some elements of consumerism, and was also happy that neither was claiming universal coverage as a free lunch. At the same time, he felt their plans include promises which couldn’t be kept, such as universal coverage and insurance “as good as your Congressman’s,” while over-regulating, overspending, and providing a back-door to single-payer healthcare.

The third panel, on tax policy, was moderated by Rudy Penner of the Urban Institute. Penner gave opening remarks, and then handed the microphone over to Alex Brill of the American Enterprise Institute, Len Burman of the Tax Policy Center and Scott Hodge of the Tax Foundation. All three agreed that tax policy is reaching a crucial point, with the Bush tax cuts expiring, the AMT reaching millions of new taxpayers every year, and the costs of government rising. Both Brill and Hodge supported McCain’s proposal to lower the corporate rate, citing its positive effect on growth and American competitiveness. Burman had few kind words for the current slate of policies the candidates have proposed, reserving particular disapproval for McCain’s gas-tax-holiday proposal, which Clinton has since supported. Following their opening remarks on the candidates’ plans, the panelists discussed the potential for a value added tax (VAT) to help solve some of these problems. All three agreed that it could be a useful tool, with Burman suggesting that it might help pay for health care, and Hodge saying that it could cover some of the cost of lowering the corporate tax rate.

The final panel, also moderated by Penner, featured a discussion between the economic advisors of the remaining presidential candidates, including Brian Deese, Dan Tarullo, and Kevin Hassett of the Clinton, Obama, and McCain campaigns, respectively. All three representatives believed his candidate would be best for the economy, but set out different economic goals. According to Tarullo, Obama’s policies will aim to foster a stable environment for economic growth, relief for the middle class, improved productivity, and a sustainable international economic environment. McCain, according to Hassett, would lower tax rates and improve the tax code to encourage economic growth and international competitiveness, while ensuring that lower taxes are accompanied by smaller government. Deese, finally, explained Clinton’s goals of addressing the “middle-class squeeze,” increasing the international attractiveness, restoring fiscal responsibility, and ensuring proactive and pragmatic executive leadership to address economic problems as they come.

-Marc Goldwein and Paul McLaughlin, Program Associates for the Fiscal Policy Program

California Health Reform: Lessons for the Nation

Communications — Fri, 07 Mar 2008 12:00:00 -0500

A New America Event
03/07/2008 - 12:00pm

Efforts to reform California's health system hold many lessons for the nation. The bipartisan spirit displayed by Governor Schwarzenegger and Assembly Speaker Núñez proves that Republicans and Democrats can work together to address the most challenging health care problems facing our nation. In addition, the campaign to cover all Californians united an unprecedented coalition of advocates: hospitals, insurers, large and small employers, labor, and patients. Rarely have such disparate interest groups united in favor of a health reform proposal as in California.

The California experience also serves as a reminder that comprehensive health reform contains many complex elements that require carefully crafted and politically feasible policy solutions. Above all, the cost of providing comprehensive health coverage—to both households and governments—represents real challenges to reform efforts.

Following the release of New America’s analysis of the California reform effort —Lessons from California’s Health Reform Efforts for the National Debate —–key stakeholders from California joined New America policy experts to evaluate the California reform effort and consider what lessons it can teach the nation.

Almost across the board, panelists emphasized the importance of strong leadership and recognized that California’s unique budgetary rules were a real impediment to reform efforts. Speakers highlighted that concerns about affordability, the employer role, and financing all played an important role in the California debate.

To view a video and transcript of this event, please visit the Kaiser Family Foundation website.

Examining Veterans’ Health Care

Communications — Wed, 16 Jan 2008 10:00:00 -0500

A New America Event
01/16/2008 - 10:00am

Between 1994 and 1999, Kenneth W. Kizer, MD, MPH, led a dramatic turnaround of the Veterans health care system. Today, in study after study, the VA emerges as an exemplar of best practices in patient safety, disease management, evidence-based medicine, electronic medical records and customer service. Both Senators Clinton and Obama, as well as a number of jounalists and academics, have recently pointed to the VA health care system as a model for national healthcare reform, and a December 2007 Congressional Budget Office interim report suggests VA may offer lessons to other public sector, as well as private sector systems.

But there is a very real danger that the system could unravel due to a confluence of political and financial pressures in the not-distant future. With the enormous federal financial challenges predicted by GAO and CBO for the next decade, what is really needed to treat the hundreds of thousands of new wounded warriors coming to VA hospitals out of Iraq and Afghanistan, as well as the millions of Vietnam, World War II and other veterans who currently rely on VA healthcare?

The New America Foundation invites you to join a panel of policy experts as they participate in a thoughtful discussion of the health care needs of today’s veterans, and discuss concepts from an independent commission focused on bringing about major change in VA’s health care for the future. As questions of cost effectiveness and quality care play out for the next decade, these experts will inform the debate in the public sphere and policy arena.

CA Event: Overtreated

Communications — Mon, 17 Dec 2007 12:00:00 -0500

A New America Event
12/17/2007 - 12:00pm

In most markets, paying more buys better quality. When you pay $400 for a night in the Four Seasons, you expect to get a better room and better service than you would at Motel 6. But in health care, the normal rules of economics don't apply. The American health care system ranks in the bottom third of developed nations. American medicine kills 100,000 patients a year through medical error and our health statistics are on a par with the Czech Republic and Chile -- yet we spend twice as much per capita on average as any other developed country.

Shannon Brownlee, author of Overtreated: Why Too Much Medicine is Making Us Sicker and Poorer, argues that as much as a third of every health care dollar, about $700 billion a year, is wasted on care that patients don't need -- and would probably avoid if they knew how useless and dangerous it is. California spends more per capita on unnecessary care than any other state except New Jersey. If we want to control costs and improve the quality of care, the ongoing efforts to cover the uninsured in the state should include payment reforms aimed at reducing over treatment.

Shannon Brownlee is a writer whose stories, essays, and opinion pieces about medicine and health care have appeared in such publications as The Atlantic Monthly, The New York Times Magazine, The New Republic, Slate, Time, Discover, BusinessWeek, Washington Monthly, The Washington Post, the Los Angeles Times, and The Wilson Quarterly. As a Schwartz Senior Fellow at the New America Foundation, Ms. Brownlee’s work focuses on the U.S. health care system, and the cultural, economic, and political forces that result in poor quality and high cost. She has written extensively about the lack of scientific evidence for many medical practices, and the problem of unnecessary care, which accounts for as much as a third of the nation’s health care bill. Her new book, Overtreated: Why Too Much Medicine is Making Americans Sicker and Poorer, is published by Bloomsbury Press.

If you have questions, call or email Claudie Bustamante at (916) 448-5189 or bustamante@newamerica.net.

CA Event: Why Too Much Medicine Is Making Us Sicker and Poorer

Communications — Fri, 14 Dec 2007 15:00:00 -0500

A New America Event
12/14/2007 - 3:00pm

Shannon Brownlee, award-winning journalist and senior fellow at the New America Foundation, has written and spoken widely about health care, genetic testing and the insurance industry, problems in the assisted reproductive industry, and the need for national policies to regulate new human genetic technologies.

In Overtreated, Shannon argues that the U.S. health care system delivers huge amounts of unnecessary care that is not only expensive and wasteful but can actually imperil our health. She shows how the interests of politicians and the medical-industrial complex continually trump those of patients, seducing the wealthy with unnecessary procedures and leaving the poor with haphazard access to treatment. In her talk, Shannon will also address the coming era of personalized genomic medicine. She’ll ask whether it is more likely to remedy the lack of evidence in current medical practice, or to exacerbate the problems of cost and unnecessary care.

Join the Center for Genetics and Society and the New America Foundation for a comprehensive look at how the American health care system fails to deliver value for its high spending. Egg Nog and holiday refreshments will be served.

To RSVP for this event, please click this link and sign up: Registration Page with name, affiliation, and contact information.

CBO's Peter Orszag Releases Study on Rising Cost of Health Care

Communications — Tue, 13 Nov 2007 10:15:00 -0500

A New America Event
11/13/2007 - 10:15am

On Nov. 13, 2007, Maya MacGuineas, director of the Fiscal Policy Program at the New America Foundation and President of the Committee for a Responsible Federal Budget, hosted an event featuring Dr. Peter Orszag, director of the Congressional Budget Office. At the event, Orszag released a CBO paper entitled “The Long-Term Outlook for Health Care Spending.” This paper precedes the regular release of the long-term budget outlook, of which health care is a major component.

Introducing Orszag, MacGuineas praised the CBO for taking the lead in developing an understanding of the fiscal impact of the health care system, both in terms of short-term policy options and long-term projections. These efforts give fiscal experts, who recognize the importance of health care to the long term picture but are less certain of the options to address the problems, more substance with which to work. She also praised the CBO for its clear, concise reports, which make a variety of public policy issues accessible to policy analysts and the public.

Orszag began by explaining the new methods of health care cost projections. Health care costs are “the key” to understanding the long-term fiscal outlook. CBO’s projections begin with growth rates based on the past 30 years of cost growth, a window long enough to smooth out one-time shocks to growth and that begins sufficiently after the introduction of Medicare and Medicaid to avoid distortions associated with the ramping up of those programs.

Recognizing that simply projecting those 30-year average growth rates into the future could eventually push overall health care spending above 100 percent of GDP, the CBO next accounts for that fact that as total costs as a share of GDP rise, various private and state-level adjustments will curb growth rates even without a change in federal policy. These non-federal adjustments, in turn, are assumed to some have spillover effects on federal cost growth, through changes in practice norms and technology.

In prior long-term health care cost projections, the CBO had used a 2.5 percent growth rate and a 1.0 percent growth rate to illustrate a range of possible outcomes. The new estimate, taking the spillovers into account, lies between these two estimates. It tracks the Medicare Trustees’ long-term projections for the next couple decades but then winds up significantly higher. Despite the long-term differences between CBO and the Trustees, both projections make the same basic prediction: a continuous rise in health care spending under current law will consume ever-larger portions of the budget and GDP.

Orszag then covered several steps that can be taken to bend the growth curve and get costs under control in the long run. Options included:

basing treatment decisions on reliable information. Comprehensive data from a team of researchers at Dartmouth shows that the variation between high- and low-cost markets arises less from variations in the costs of reliable treatments than the intensity of potentially questionable treatments in the higher-cost markets. It appears that many of these treatments could be scaled down with little if any adverse effect on outcomes;
reforming the fee-for-service system to discourage unnecessary or unproven treatments;
increasing cost-sharing by consumers to encourage more cost-consciousness. This final option would have little effect on heavily-insured catastrophic costs, which make up a majority of total health care costs, but could reduce non-catastrophic costs significantly.

He concluded his remarks by saying that the most auspicious approach to stemming cost growth involves generating information and aligning incentives to produce “higher value care, rather than just more care.”

MacGuineas opened the question-and-answer session by asking how important reforming health care is to fixing the overall fiscal picture as compared with reforming other entitlements or revenues. Orszag responded that he believed the ultimate solution to the overall fiscal problem would be a combination of reforms, but that solving every other problem without touching health care would not fix the overall situation. Health is far and away the most important component of the problem. “We are significantly overinvested in writing books about social security reform,” he asserted, “and significantly underinvested in writing books about bending the curve” of health care costs.

In response to the next three questions, Orszag discussed measures that have not been demonstrated to lower costs, and also addressed the CBO’s method of scoring. Increased longevity, first, does not necessarily lower overall costs, as end-of-life costs remain high. A longer average lifespan could, however, increase tax revenue as people work longer, making it easier to finance a given level of spending. In response to the next question, he asserted that some widely supported cost-saving measures (like preventative care and care coordination) often have little rigorous evidence suggesting that they generally succeed in lowering costs, which is why the CBO is often unable to score them as savings. To the third question, about how the breakdown of healthcare provision was predicted to change in CBO’s projections, Orszag replied that the CBO had assumed that the share of non-Medicare, non-Medicaid spending in the form of employer sponsored health care would remain constant at around 60% of total costs.

The next question concerned the extent of current research into best practices. Orszag replied that current efforts by some insurance companies and a small agency in the Department of Health and Human Services were important, but not nearly as extensive as is warranted or would be beneficial. Since best-practice findings are essentially a public good, insurance companies have little incentive to research them. Incentives are further decreased by customer turnover in the employer sponsored system which may prevent insurance companies from benefiting from best-practices that only pay off in the long term. Federal support may therefore be necessary to encourage such research. Once such research is completed, it would be more effectively applied if doctors were given incentives to choose the proven treatments more often.

MacGuineas asked the next two questions, inquiring whether Orszag had an ideal set of cost-lowering incentives, and whether he favored incentives on the consumer side of the provider side. Orszag replied that financial incentives affect both consumers and providers, and that we can use “both sides of the scissors” to cut costs. He then said that we do not yet have the information or infrastructure necessary to know exactly which incentives will work best.

New America Fellow Shannon Brownlee agreed with Orszag that more best-practice information is needed, but doubted that comparative effectiveness studies could reduce costs in the short-run, and whether they could ever address problems of over-supply. Orszag replied that he felt the problem lay in the payment system, of which the over-supply of medical care was a symptom rather than a cause. Moreover, the political economy of a “command and control” style of health care that statutorily limits care is difficult. The most auspicious course of action, he concluded, is to make the infrastructure and research investments that will put us in a position to reduce costs without reducing quality through evidence-based medicine.

The next question concerned the importance of Health Information Technology (HIT) in lowering costs. Orszag replied that the greatest benefit of HIT is that it provides data on which to base best-practice research. Simply installing an HIT system, however, without including an incentive structure to lower costs, would be unlikely to significantly reduce medical expenses.

The final question concerned how the CBO evaluated the potential for best-practice research to save money. Orszag said that they had brought in experts from Britain’s National Institute for Clinical Effectiveness to help them understand the process. He also pointed out the little noted fact that, while overall American health care costs are higher than those in most European countries, there are many American markets where costs are similar or even lower than in Europe. Following this answer, MacGuineas thanked Orszag, and the talk concluded.

Video of this event is available at right, while an MP3 audio recording, the CBO report and Orszag's presentation slides can be downloaded below.

-Paul McLaughlin, Research Associate for the Fiscal Policy Program

Health Insurance: What Should Everyone Be Covered For?

Communications — Thu, 01 Nov 2007 21:00:00 -0400

A New America Event
11/02/2007 - 10:00am

As our nation works to address our struggling health care system, no issue is more important or controversial than what should be included in a minimum, basic, or required benefit package. Following the release of her paper, “Balancing Act: Creating a Sustainable Health Care Benefits Package,” Marjorie Ginsburg joined Celia Wcislo of the Massachusetts Connector Board and SEIU, Cori Uccello of the American Academy of Actuaries, and the New America Foundation for a discussion about how and why the public can and must be involved in benefits design.

Ms. Ginsburg highlighted her work with the CHAT (Choosing Healthplans All Together) Program. CHAT is a computerized exercise through which ordinary people are asked to make important decisions about how best to allocate a community’s health care dollars. Results have shown that participants favor restricted provided networks over increased cost-sharing as a means of cost-containment, and that groups are more likely to embrace benefits that are widely utilized by the general public. CHAT provides policymakers with some insight into the priorities of health care consumers.

Ms. Wcislo described her experience working in a “high-stakes CHAT game” as a member of the Massachusetts Connector Board and suggested that all stakeholders should be involved in discussions about insurance design. Finally, Ms. Uccello emphasized that our nation must not only address benefits design, but also the rising cost of health care and the role of health insurance in everyday life.

Overtreated (Postponed)

Communications — Thu, 18 Oct 2007 08:00:00 -0400

A New America Event
10/18/2007 - 9:00am

**THIS EVENT HAS BEEN POSTPONED UNTIL FURTHER NOTICE. WE APOLOGIZE FOR ANY INCONVENIENCE.**

American health care is reaching a tipping point. Costs are rising at an unsustainable rate while the number of uninsured Americans persists, and the quality of care remains astonishingly poor. Health care now tops the domestic political agenda, and there are several proposals for reforming the system so that we can simultaneously cover the entire population, improve quality and bring down costs. Improving quality will mean increasing the evidence base of health care. To bring down costs, we have to find ways to reduce the huge volume of unnecessary care that’s delivered to American patients.

In Overtreated, Shannon Brownlee argues that less is more with health care. She notes that Americans spend between one-fifth and one-third of health-care dollars on unnecessary treatments, medications, devices and tests. What's worse, there are an estimated 30,000 deaths per year caused by this unnecessary care. Multi-pronged solutions are needed, according to Brownlee, including ramping up federally funded clinical research, and a reimbursement system that rewards providers for the quality of care they deliver, not the quantity. Several models for excellent care already exist: group practices, like the Mayo Clinic, and other coordinated systems, like the Veterans Health Administration, which outperform the rest of the health care system on multiple measures of quality.

Join the New America Foundation for a comprehensive look at the American health care system with an array of experts: Shannon Brownlee is a Schwartz Senior Fellow at the New America Foundation, Elliott S. Fisher is a noted authority on the causes and consequences of regional variations in medical practice and spending, Gregg Bloche has written extensively about the policy issues surrounding medical evidence, and Len Nichols is Director of Health Policy at the New America Foundation. Following the presentation will be a robust Q&A session.

Obesity and Child Well Being

Communications — Thu, 04 Oct 2007 00:45:00 -0400

A New America Event
10/04/2007 - 10:45am

There is no greater problem facing America’s children than the epidemic of overweight and obesity. The Foundation for Child Development’s Child Well Being Index has concluded that the increase is obesity and overweight among children since 1975 has decreased the overall well being of children by more than 30%.

Researchers at the Center for Human Nutrition at the Johns Hopkins Bloomberg School of Public Health released a study this summer predicting that unless behaviors change, by 2015, 75% of adults and nearly 24% of children and adolescents in the United States will be overweight or obese. This could result in serious health, family and fiscal consequences for our nation.

What is causing this epidemic? What are its implications? What should America do about it?

This New America event, held in conjunction with the Foundation for Child Development and the offices of Senator Tom Harkin (D-IA) and Senator Lisa Murkowski (R-AK), featured a discussion of obesity and child well-being, and the communities that are most impacted. Panelists discussed the role of government and explored innovative programs at the state and local levels that are making a difference.

Video of the event is available at right, while an MP3 audio recording can be downloaded below.

Making the Social Contract Citizen-Based

Communications — Thu, 19 Jul 2007 22:30:00 -0400

A New America Event
07/20/2007 - 9:30am

America's social contract -- the complex, largely unwritten deal between workers, employers, and government that gives individuals the security they need to navigate a dynamic economy -- is eroding. The arrangements of our existing social contract no longer make sense in an economy characterized by global labor markets, shortened job tenure, heightened capital mobility, rapid technological change, and increased pressure for short-term profits. Ensuring that every American can access the goods and services necessary to enjoy a productive and enterprising life should not depend on where you work, where you live, or what you believe. The American social contract should be citizen-based.

One of the most glaring shortcomings of the current social contract is the link between health care and employment status. Creating a citizen-based social contract will require remaking our health care system so it becomes sustainable and accessible, one where health care benefits are portable and tied to the individual, rather than to his or her place of employment. Such a system can be built upon the essential pillars of personal responsibility and shared responsibility. Mandates to buy insurance and subsidies to help people afford to do so will be balanced with the creation of an insurance marketplace that is affordable and a delivery system that works in terms of both cost and quality.

At this event, the New America Foundation released two papers from The Next Social Contract Initiative. The first explores why the next social contract should be citizen-based and the second offers a detailed proposal to do so by starting with reforming our health care system.

The Next Social Contract Initiative aims to reinvent American social policy for the twenty-first century. Through a program of research and public education, the initiative will explore the origins of our modern social contract, articulate the guiding principles for constructing a new contract, and advance a set of promising policy reforms.

California Event: Ensuring Seamless Insurance Coverage For All

Communications — Wed, 04 Jul 2007 19:28:00 -0400

A New America Event
07/09/2007 - 3:30pm

The Legislature, Governor Schwarzenegger and key health care stakeholders are deep in discussions on how to reform California’s broken health care system, including how to reduce the number of uninsured Californians. At this event, New America Foundation Health Policy Program Director Len Nichols and Peter Harbage discussed how to use the principles of seamless coverage and shared responsibility to create a process to ensure all Californians have health coverage, including what we can learn from recent successful experiments in enforcing the individual requirement to purchase auto insurance.

Smarter Tax Treatment of Health Insurance

Communications — Mon, 02 Jul 2007 23:06:00 -0400

A New America Event
07/13/2007 - 10:00am

In August of 1994, with the prospects of health reform all but vanishing, Sen. Robert Bennett (R-UT) stood on the Senate floor and asked three fair questions: Why have we talked so much about insurance and health care instead of better health? Why have we not adequately explored what role markets can and cannot play in health care reform? And why do we fail to recognize that when employers or governments spend money on health care it is not their money, but our money?

The Healthy Americans Act is the first legislative proposal to answer these questions. Now, almost 13 years later, Sens. Wyden and Bennett have introduced the first bipartisan, comprehensive health care reform proposal since the Clinton-era reforms. The core of their proposal not only restructures the tax system to end the current regressive treatment of health insurance, but also provides revenue to help insure all Americans. By putting more money in the hands of the consumer, rather than the employer, these tax code changes would increase efficiency, portability, and access within the health care system.

At this New America event, cosponsored with the Heritage Foundation, Sens. Wyden and Bennett discussed the Healthy Americans Act and their commitment to utilizing private sector forces while covering all Americans. Sen. Bennett discussed how the current health care system distorts market forces. He emphasized that severing the link between employers and health care will realign market incentives as employees, rather than employers, will be empowered to act as the consumer and choose a health plan tailored to their individual needs. Sen. Wyden highlighted the need to cover absolutely everyone, as people who are uninsured shift their costs to people who are insured.

The current health care income tax exclusion subsidizes the top two-thirds of the income scale; the Healthy Americans Act would reverse that regressive subsidy by subsidizing the bottom two-thirds. New America Health Policy Director, Len Nichols discussed tax reform as the key to affordable health system reform -- it allows us to capture money within the existing system and redirect it towards subsidies for low income individuals. The Healthy Americans Act takes this concept a step further by creating a marketplace that would work for everyone, and requiring (with subsidies for the low-income) everyone to obtain health insurance. Stuart Butler, Vice President, of Domestic and Economic Policy Studies at the Heritage Foundation, applauded Sens. Wyden and Bennett for their bipartisan effort, and emphasized that correcting the perverse incentives created by the current tax code should be the central focus in the health care reform debate.

Best Care Anywhere

Communications — Fri, 04 May 2007 09:00:00 -0400

A New America Event
05/04/2007 - 10:00am

Recent headlines about Walter Reed Army Medical Center have brought the military health care system under scrutiny. Yet despite problems with access, The Department of Veteran Affairs’ system of care, (which doesn’t run Walter Reed) turns out, in study after study, to outperform the rest of the American health care system by virtually all measures. These include patient satisfaction, patient safety, prevention, disease management, use of evidence-based medicine, information technology, and cost effectiveness.

What lessons does the VA’s performance offer for addressing America’s health care crisis? Should access to VA health care be expanded to more veterans, many of whom are denied previously promised benefits, and perhaps to their families as well? How feasible would it be to replicate the VA model of care for the general population, including the uninsured?

This event, which was carried on C-SPAN, produced a lively debate, featuring Phil Longman, author of Best Care Anywhere: Why VA Health Care is Better than Yours (PoliPointPress, 2007) and Dr. Kenneth Kizer, former Undersecretary for Health in the U.S. Department of Veterans Affairs, on this timely and provocative topic.

Video of this event is available at right, while an MP3 audio recording can be downloaded below. To learn more about Longman's new book, Best Care Anywhere, please click here.

Beyond Bioethics

Communications — Sat, 03 Mar 2007 18:00:00 -0500

A New America Event
03/02/2007 - 11:45am

Beyond Bioethics, a new report by Dr. Francis Fukuyama and Dr. Franco Furger, provides the most comprehensive examination to date of legislative and/or regulatory answers to the challenges raised by human biotechnologies in the United States. The report's premise is that reaping the benefits of medical progress offered by biotechnology while preventing possible abuses requires that we create a new regulatory agency. Dr. Fukuyama and Dr. Furger discussed legislative developments at the national and international level and explore public attitudes towards controversial reproductive technologies.

Following their presentation, Richard Hayes of the Center for Genetics and Society, William Galston of The Brookings Institution, and Shannon Brownlee of New America Foundation discussed possible policy implications for biotechnology. Steven Clemons moderated a question and answer session.

Video of the event is available at right, while an MP3 audio recording can be downloaded below. To download a copy of the report, please click here.

This event was co-sponsored with Johns Hopkins University School of Advanced International Studies.

Ten Big Ideas for a New America

Communications — Fri, 02 Feb 2007 02:00:00 -0500

A New America Event
01/31/2007 - 11:00am

The recent turnover in Congress, combined with a wide open presidential election cycle, creates a rare opportunity to bring new ideas into the political process. The spirit of this new era will be captured by those -- from either party or no party -- who embrace innovative yet pragmatic solutions to the foremost challenges facing our nation.

At this event, the New America Foundation released a major new report outlining Ten Big Ideas for a New America, and offered brief presentations on nine of the 10 ideas. (Senior Fellow Jacob Hacker, author of the Universal Risk Insurance proposal, was testifying on Capitol Hill and was unable to attend.)

In addition, Sens. Hillary Rodham Clinton (D-NY) and Lindsey Graham (R-SC) offered kenote addresses that explored their respective takes on the need for big ideas in American politics.

Video of the complete event is available at right, while MP3 audio recordings can be dowloaded at the bottom of this page. To jump directly to video of a particular keynote address or Big Idea presentation, please use the links below.

Every Baby a Trust Fund Baby

Closing the $700 Billion Tax Loophole

Instant Runoff Voting

Mandatory, Affordable Health Insurance

Tax Consumption, Not Work

A College Access Contract

A Capital Budget for Public Investment

A Universal 401(k) Plan

An Energy Efficiency Trading System