April 23, 2014

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Sunday, January 24, 2010 - 9:06 PM

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...

Wednesday, January 20, 2010 - 2:57 AM

"It isn't fiscally irresponsible to raise the debt limit, I think it would be rather irresponsible not to raise the debt limit because we have already incurred the bill."

That quote, from Concord executive director Bob Bixby, is one of many from our new videos highlighting some of the key points driving fiscal discussions in Washington.

We recorded the videos because the Senate is set to begin debate on increasing the debt ceiling while all of Congress awaits the President's budget proposal, which will purportedly contain the Administration's ideas for how to reduce the country's budget deficits. 

The first shows a discussion about the basics behind increasing the debt limit and how there are a few key budget process reforms tied to fiscal responsibility that have become part of the debate as the Senate approaches a difficult vote. We talk about the possible Senate amendments...

Tuesday, January 19, 2010 - 6:52 PM

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...

Thursday, January 14, 2010 - 12:05 PM

The Concord Coalition is looking to hire a research assistant to help with the Washington Budget Report and other Concord policy work.

For the full position listing and application submission click here.

Tuesday, January 12, 2010 - 11:48 AM

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...

Friday, January 8, 2010 - 4:15 PM

When discussing health care reform, if we cannot even be clear that “advance care planning” is in no way, shape or form the same as a “death panel,” how will we ever be able to talk about the real (and factual) challenges facing the Medicare program and its long-term sustainability?

Ugh….

Let’s be clear: there are no “death panels” included in the health reform bills adopted by the House of Representatives and the Senate, although misinformation on this topic has been swirling for months. For example, last August during the Congressional recess I was quite distraught when my own Senator Charles Grassley stated in an Iowa town hall meeting that he was worried that efforts to increase the efficiency of Medicare or to create an Independent Medicare Advisory Commission would indeed mean that the federal government would be making decisions about when to “pull the plug on Grandma.” More recently, the clause in the House bill that allowed reimbursement to Medicare providers who hold “advanced care planning consultations” with their patients has been equated with a “death panel” deciding when a senior would die.  Nothing could be further from the truth.

Having studied end of life care in graduate school and...

Wednesday, January 6, 2010 - 10:57 AM

When we finished our issue brief on the health care reform "endgame" before the holidays, we had a difficult time trying to isolate the key 10-year costs and savings of different components of the legislation. Now that we have had a bit more time with the final House and Senate versions of the legislation and the CBO analyses, we wanted to present the following table:

 House BillSenate Bill
Insurance Coverage Expansion1052871
   
Minus Offsets  

Spending Cuts

352413
CLASS Act10272
Tax Increases570474
Penalties16843
Subtotal (offsets)1,1921,002
   
Deficit Reduction-138...
Wednesday, December 23, 2009 - 4:07 PM

With the House having passed its version of health care reform (H.R. 3962) and the Senate on the verge of passing its version (H.R. 3590), the outline of a final bill is beginning to take shape. In our new Issue Brief, we look ahead at the fiscal considerations that will likely be the subject of conference committee discussions and “end game” negotiations. These include the cost of expanding coverage, the methods used to prevent that cost from adding to the deficit, and the prospects for systemic reforms to reduce cost growth over time. 

This issue brief gives The Concord Coalition’s perspective on how the bills measure up, what the risks are and how these risks could be lessened. We conclude that:

•    Both bills establish...
Tuesday, December 22, 2009 - 11:46 AM

U.S. House Speaker Nancy Pelosi and other members of Congress got a lot of good advice recently when representatives of The Concord Coalition’s fiscal advisory councils visited Capitol Hill to present their recommendations.

The basic message: Elected officials must make some dramatic changes to put the country on a more responsible fiscal course, protect our economic future and avoid saddling our children and grandchildren with massive debt.

Advisory council members from across the country -- Atlanta, Iowa, Milwaukee, Northern California and Philadelphia -- met with members of Congress and their staffs as part of The Concord Coalition’s National Conference of Fiscal Stewardship this month in Washington. The Fiscal Advisory Council of Northern Virginia had already met with several members of Congress in the fall. Representatives from the University of Denver, where the Fiscal Stewardship Project featured a special student engagement initiative this year, also attended the conference and met with elected officials.

In the conference’s opening...

Thursday, December 17, 2009 - 1:48 PM

As mentioned in the last post, the Senate dramatically weakened the Independent Medicare Advisory Board in the health care legislation currently being debated.

Today, Concord released an issue brief discussing this and highlighting the fact that there is an amendment being proposed by Senator Rockefeller that would restore the board's potential for cost control and delivery system reform. 

The legislative process right now is quite a jumble and it is unknown whether any amendments still have a chance to be voted on or folded into the final "manager's amendment." Hopefully, Senators concerned about cost control will see the wisdom in still altering the bill to strengthen its provisions on that score. Ruth Marcus at the Washington Post had a good column about this in the paper yesterday.