April 23, 2014

Posts on health care

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Wednesday, April 24, 2013 - 1:52 PM

Last Thursday, the Bipartisan Policy Center’s (BPC) Health Care Cost Containment Initiative released a comprehensive plan to increase efficiency and reduce costs while reorienting the nation’s health care system to become more patient-centered. That combination would ideally lead not only to a more sustainable fiscal future but to better health care as well.

The plan targets the largest health care levers that federal policymakers have: Medicare and the tax code -- specifically the exclusion of employer-provided health care from taxation. The plan, as scored by health policy experts, would reduce budget deficits over the next 10 years and then continue to lower the trajectory of the federal debt.

Medicare would be transformed into a system that rewards value and coordination instead of the quantity of services, and the tax code would no longer encourage overspending on health care. Furthermore, these changes at the federal level are meant to encourage and incent a more rational private health care system.

These lofty goals were heralded by BPC’s health care leaders: former Senators Tom Daschle, Bill Frist and Pete Domenici, along with Dr. Alice Rivlin. Their agreement after a year of...

Tuesday, March 26, 2013 - 11:22 AM

Most plans to put the federal budget on a more sustainable path make a crucial assumption: That today’s younger workers will pay more of their own retirement costs than previous generations have.

By setting aside more money for retirement, the thinking goes, these younger workers can enable the federal government to reduce the high projected growth of Social Security and Medicare. They should theoretically be able to do this because they have more time to save large amounts of money and to let those savings compound.

As The Concord Coalition has often noted, however, Washington already favors older generations in many ways. And younger Americans face a number of financial hurdles and future challenges that must be kept in mind.

Many of them have been hit hard by the last recession, struggling with a poor job market and – thanks to skyrocketing tuition costs -- large amounts of student debt. With companies cutting back on retirement and health care programs, many younger people who have jobs  do not receive the compensation or employee benefits that their parents did.

The large and growing federal debt, meanwhile, means that younger Americans can expect higher taxes and less assistance from the federal government...

Wednesday, February 27, 2013 - 4:15 PM

Among budget wonks who discuss the long-term fiscal challenge, there is something of a consensus -- the projected upward trajectory of our debt is caused primarily by the projected growth in federal health care programs.

For some, this consensus has developed into short-hand: The nation’s fiscal challenge is really “just a health care problem.” This leads to the conclusion that the nation’s unsustainable fiscal future can only be redirected by reforming the entire health care sector of the economy. Or perhaps by simply converting Medicare into a “premium support” program.

The latest CBO report, which takes into account three consecutive years of dramatically slower health care cost increases, should serve as a warning (and a reminder) that it is misleading to say the problem with the federal budget “is just a health care problem.”

If one only looks at the two CBO updates over the last six months, projected 10-year Medicare spending has been revised downward by $306 billion. Projected Medicaid spending has been revised downward by $273 billion (not counting revised estimates of lower Medicaid enrollment due to the Supreme Court’s ruling on Medicaid expansion in the Affordable...

Wednesday, October 31, 2012 - 9:32 AM

This is Part II of a two-part series of posts on the presidential candidates' fiscal policies. Part I examines Governor Romney's plans.

The first part of this blog post series looked at the unanswered questions in Governor Romney’s overall fiscal policy, tax reform plans and health care reform plans. This second part will look at President Obama’s budget plans in addition to some areas of uncertainty.

Simply by virtue of being the President, with the requirement to submit an annual budget, Obama has had to provide more details about his fiscal plans. Yet, what those details clearly show is an inadequate long-term fiscal goal. Over ten years, federal debt held by the public would only stabilize temporarily, and at a higher level than it is today.

To the President’s credit, he supports negotiating a long-term, bipartisan “grand bargain” on fiscal issues with both spending cuts and new revenues. Yet, such explicit support has come only after his initial tepid reaction to the Simpson-Bowles report when it was released. Nevertheless, if Obama is re-elected, the upcoming...

Wednesday, October 31, 2012 - 9:31 AM

This is Part I of a two-part series of posts on the presidential candidates' fiscal policies. Part II examines President Obama's plans.

As election day approaches, it is appropriate to look at what we know and what we don’t know about the two candidates’ fiscal policy proposals -- especially since it is unlikely we will get any more details prior to election day.

In many respects, the crucial differences between the two candidates are defined by their fiscal policies, and it is almost certain that the winning candidate’s fiscal policy choices will be as immediately consequential as any president’s in history.

In this blog post, I will review Governor Romney’s proposals and in Part II, I will cover the President’s proposals looking at three key areas: The overall budget goal, tax policy and health care.

It is difficult to overstate how little we know about where Governor Romney’s policies will lead. The basic problem is that he has...

Saturday, August 11, 2012 - 4:30 PM

Here are links to some previously published material by The Concord Coalition on proposals by House Budget Chairman Paul Ryan, who was named Saturday as Republican presidential candidate Mitt Romney's running mate.

Politico Op-Ed by Robert L. Bixby (April 17, 2012)

Concord Coalition Analysis of Ryan Budget Plan (March 20, 2012)

Blog Post by Robert L. Bixby on Wyden-Ryan Medicare Plan (Dec. 20, 2011)

Blog Post by Robert L. Bixby on Medicare Proposals (May 31, 2011)

Blog Post by Robert L. Bixby Comparing Obama and Ryan Budget Proposals (April 12, 2011)

 

 

Saturday, August 11, 2012 - 3:46 PM

 

This commentary originally appeared on The Concord Square May 31, 2011

As a matter of controlling Medicare costs, I find myself liking a bit of Rep. Paul Ryan’s approach and a bit of President Obama’s. Too bad the political climate is such that Democrats and Republicans don’t seem willing to acknowledge that the other might just have a good idea.

In Ryan’s favor, I think the premium support model holds out the best hope for reining in cost growth. It would allow us to set a Medicare “budget” and create incentives for a more efficient system. Without a budget, I worry that efficiencies found in the pilot programs and demonstration projects enacted last year will not be translated into real savings. Of course for premium support to work, the level of support and growth rate have to be realistic. In this regard, I’m with those who think that Ryan’s plan misses the mark. However, the concept should not be rejected just because the details are flawed.

Even if we move toward premium support, we should have a back-up mechanism to ensure that targets are met and that quality of care is improving. President Obama’s suggestion to strengthen the Independent Payment Advisory Board (IPAB) would fill this role. It’s pretty clear that politicians are not the best at cutting health care costs. If...

Tuesday, July 24, 2012 - 4:14 PM

The Congressional Budget Office (CBO) today estimated that repealing the 2010 Affordable Care Act (ACA) would increase federal budget deficits between next year and 2022 by around $109 billion, only a small change from previous estimates. The CBO suggests that this can also be considered a rough estimate for how much the ACA reduces the deficit over the same time period.

The CBO cautions, however, that its estimates are uncertain because the projected effects of the law are themselves “highly uncertain.” The law contains some provisions that are projected to cost the government money, but others that would save money or provide additional revenue.

Also updated were CBO’s estimates of the budgetary effects of just the ACA’s health insurance coverage provisions in light of last month’s Supreme Court decision, which allows states to choose whether or not to expand eligibility for coverage under their Medicaid programs.

The budget office now estimates that these coverage provisions would have a net cost of $1,168 billion from 2012 to 2022, a net reduction of about $84 billion from estimates last March. This slightly reduced spending would come about because even with some states opting out of the relatively cheap Medicaid expansion and pushing some...

Wednesday, June 13, 2012 - 3:36 PM

The Medicare actuaries have just updated their projections for National Health Expenditures (NHE) and the overall picture they illustrate is a welcome one, but likely reflects temporary factors and cannot serve as an excuse for politicans to rest on their laurels.

On the plus side, health care cost inflation has slowed pretty dramatically over the last three years (2009-2011) and is also projected to be slower than normal for 2012 and 2013 -- with those costs staying nearly constant as a percent of GDP throughout the entire time period (around 17.9 percent). Furthermore, while spending is projected to jump in 2014, as the major health insurance provisions of the Affordable Care Act (ACA) extend coverage to approximately 22 million people, over the period 2011-2021 spending is projected to grow at an annual average of 0.9 percent above GDP growth. This is good news because most budget experts consider health care cost growth of 1 percent over GDP the "gold standard" for a tough, but theoretically obtainable, spending target. (Historically, health care costs have risen 2 percentage points faster than GDP.)

The actuaries suggest most of the recent slowdown in health care spending can be attributed to the recession and...

Tuesday, May 22, 2012 - 12:01 PM

In late April, the Medicare Trustees released an annual report on the financial status of the program. In their report, the trustees are required to analyze where Medicare costs are heading based on a strict reading of current law. However, there are numerous reasons to believe that these numbers do not give the full picture. As noted by the trustees, “Medicare’s actual future costs are highly uncertain and are likely to exceed those shown by the current-law projections in this report.”

To illustrate the cost picture more fully, the Medicare actuaries just released their updated 2012 “Illustrated Alternative Scenarios” which examine some of the shortcomings of the official Medicare projections.

 Medicare Cost Projection Percent of GDP 
  2030 2080
2009 (PRE-ACA) Trustees' Official Projection 6.26% 10.69%
2012 TRUSTEES' Official...