Whoever ends up controlling the White House next year – Barack Obama or Mitt Romney – will have to make compromises if they are to solve the nation’s current budget and health care crises.
Rivlin (Photo by New America Foundation via Flickr)
“I think we know what to do,” Alice Rivlin, a former director of the Office of Management and Budget, said Friday afternoon as part of a Brookings Institution panel about how the next president could curb spiraling health care costs.
Rivlin, now a senior fellow at Brookings, wrote in a paper published Friday that the “federal budget is on an unsustainable path” and Medicare reform is “essential” to addressing these dire fiscal straits. She gave the concept of “premium support” a nod, offering this approach as a means of moving toward debt reduction. Her primary example was the bipartisan Domenici-Rivlin plan, which she drafted with former Sen. Pete Domenici in 2010. She also mentioned the Ryan-Wyden Medicare plan, advanced by House Budget Committee Chairman Paul Ryan, R-Wis., and Sen. Ron Wyden, D-Ore.
Placing traditional Medicare in competition with private insurers is “not a risky, pernicious thing,” Rivlin said during the panel. While much of this year’s election will focus on contrasting views over premium support, tax revenue and other areas, Rivlin expects bipartisan progress early next year.
Panelist Thomas Mann, also a Brookings senior fellow, argued that bipartisan consensus is not possible – “it’s a pipe dream,” he said, underscoring comments from his own paper. Given the Republican party’s “ideological extremism and non-negotiable demands,” Mann wrote it would be better “to accept the reality of today’s intense and asymmetric polarization and challenge each party to make its best case in the election campaign.”
Speaking generally about premium support models for Medicare, Mann said, “it’s possible it could work,” but he first wants to see if health insurance exchanges will help empower consumers to make smart choices. He was not enthusiastic about the Ryan-Wyden plan.
If the health law is upheld by the Supreme Court, Rivlin wrote that the health law “should be fine-tuned but not repealed,” pointing to provisions – like the exchanges – that should go forward regardless of who controls the White House. In addition, the law’s Independent Advisory Board “should be strengthened,” she said. The board would help control costs, but has become a flashpoint for Republicans and an increasing number of Democrats.
Rivlin added that a “sensible tort reform provision” should be added to the law. This might include a push for medical practice guidelines or caps on payments. And if the individual mandate is struck down by the Supreme Court, “the president should work with Congress to find a constitutional way to ensure that almost everyone has health insurance and is in a risk pool.”
Ross Hammond, another Brookings fellow, responded to Rivlin, calling for “a renewed focus by the next president on obesity prevention.” Chronic disease costs could be brought down through investing in public health research and improving coordination among government agencies, Hammond wrote.
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50 million Americans are without health insurance and another 25 million are underinsured. That’s about 1/4th of the entire US population. When these people get sick, they simply go to the hospital emergency room. Who pays? The people with insurance pay. Until we get everyone covered under the same plan and until we have a single-payer system that can better identify the fraud and abuse, we will see these numbers grow rapidly worse. It’s only a matter of time before hospitals close their doors to charity care and stop accepting those that, for any number of reasons, will not pay. Socialized medicine is coming to America. It’s not a question of if, it’s only a question of when. Smart people realize this. The sad thing is, there aren’t too many smart people in the Congress or on the Supreme Court.
What does he mean? According to the article Mann said
“”Speaking generally about premium support models for Medicare, “it’s possible it could work,” but he first wants to see if health insurance exchanges will help empower consumers to make smart choices.”"
Every exchange proposal I’ve seen involves premium support. In Massachusetts, about 75% of the people on the Exchange get 100% premium support (free insurance) and another roughly 20% get highly subsidized premium support (a $500 a month policy for $100 on average). Only a few people pay full price after being empowered by the exchange. What goo goo nonsense.
And ironically, the goo goss want to take premium support away from us seniors while giving it to non-seniors. That makes a lot of sense.
The free market is working beautifully in healthcare. Claims are “losses” and paid premiums are “gains.”. Our current for-profit system pays shareholders by paying out as few claims as possible. Great for business, not so much for citizens of a country.
This system is unsustainable. Eventually the premiums will get so high that fewer and fewer individuals and small businesses will be able to afford it thereby adding even more to the number of uninsured.
Premium supports in ObamaCare are not “free insurance.” People have to pay their fair share according to their income and then they get “support” to make the premium. Or they have no insurance at all and end up in emergency rooms. They Cannnot pay those ER bills and those costs are shifted to the people paying premiums.
We can’t wait any longer. ObamaCare is a start to systemic change.
The reason Paul Ryan and Republicans in Congress don’t like Rivlin’s proposals Medicare and the Debt is simple. Rivlin is a women. Republicans don’t want women to have any ideas. Especially ideas that make guys like Ryan “and the boys” look like Neanderthals. When they recently held a House committee hearing on women’s health, not one women was invited to testify. Need I say more?
@ Dennis Byron.
You may want to google “premium support” before you start pontificating like you’re an expert. Premium support is a method of paying for Medicare and other programs. It does not refer to subsidies in general, as you seem to think.
Under premium support, seniors would be given a certain amount to buy coverage, rather than getting coverage paid for by traditional Medicare. This is different from subsidizing insurance payments on the exchanges, since coverage on the exchange is not entitlement.
@Sarah You do realize that the Ryan-Wyden premium support plan is nearly identical to Rivlin-Domenici? So Ryan clearly does like Rivlin’s proposal for Medicare (though debt is another story).
@sarah Woman (the singular noun) is spelled with an “a.”