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Following up on our press release about the President's Fiscal Year 2011 budget proposal, here are a few more thoughts:

Annual discretionary spending:

• A major element of the Obama administration’s 2015 deficit reduction goal is a three-year freeze on non-security discretionary spending (FY 2011-2013). While the portion of the budget covered by the freeze is less than 20 percent, it would still save an estimated $29 billion in 2015 alone, and $249 billion over 10 years.

• Clearly, more must be done and even doing this will prove difficult. Nevertheless, The Concord Coalition supports the proposed freeze and, given current economic circumstances, agrees that it is appropriate to begin implementation in 2011. Concord also agrees that the freeze should not be across-the-board. Some programs may merit an increase while others can be cut. An aggregate freeze, as proposed, would help to set priorities and reduce waste.

• War costs in the budget are likely underestimated. In keeping with last year’s budget, the administration has included annual placeholder sums of $50 billion for war costs beyond 2012. While it is...

As the White House and congressional leaders rethink health care reform after the Republican upset in the Massachusetts Senate race, there is a growing danger that Congress will jettison comprehensive health care reform altogether. Even worse, they might pass stripped-down measures that eliminate politically difficult cost-containment, while popular but costly provisions are kept.

President Obama has suggested narrowing the focus of national reform, advising that Congress should “try to move quickly to coalesce around those elements of the package that people agree on.” Some members of Congress have also expressed support for a limited bill.

However, most policy experts agree that a limited bill is nearly impossible to construct without running into some major issues with short and long-term costs. That is because the easier elements -- the ones that “people agree on” -- are interlocked with elements whose benefits are far less apparent to many voters.

The key reforms for the health insurance industry are popular -- for instance, prohibiting discrimination based on pre-existing conditions. Yet, just doing that would lead to an insurance "death spiral" where only the sick would get insurance when needed, driving up the cost of premiums. The only way around this spiral is to have an individual mandate to...

It’s a little amusing to see how badly the idea of a bipartisan fiscal commission has frightened some partisans at both ends of the political spectrum. That alone indicates the idea may have merit.

Some skeptics, of course, doubt that a special bipartisan panel would have any hope of success in steering the government onto a more responsible fiscal course. And there’s no question that this would be a very tough assignment.

But the strident opposition to a bipartisan commission from some critics on both the right and the left is rooted in fears that such a panel might actually succeed. They describe commission proposals in conspiratorial terms, as though serious bipartisan planning for the nation’s future would be merely a cover for shady plots to sneak reprehensible policies past Congress and the American public. Oh, the deceit of it all...

The Wall Street Journal, for example, recently ran an editorial conceding that “current federal commitments are unsustainable, starting with $37 trillion in unfunded Medicare liabilities.”

Yet the editorial ruled out a bipartisan commission that could tackle this...

In my previous post, I spent some time clarifying how “advance care planning” is in no way, shape or form the same as a “death panel,” and how palliative care does not equate to any "rationing of care." Rather, both these health care interventions are patient-centered and improve the value of the health care experience for severely, chronically, and terminally ill patients and their families.

As Congress resumes its work and health reform continues to dominate talks on Capitol Hill, I'd like to put these in context given the status of health reform today.

The philosophy behind advance care planning fits nicely with the promotion of an Independent Payment Advisory Board tasked to make recommendations to Congress on slowing future Medicare cost growth. Similarly to advance care planning, where potential treatment options and often difficult decisions are discussed prior to a health crisis, the Independent Payment Advisory Board (IPAB) is being asked to evaluate the tough choices facing the longevity and fiscal health of the Medicare program in advance of a federal budget crisis. The Advisory Board would be made up of health care experts, people who entered their professions because...