1150 Seventeenth Street, N.W., Washington, D.C. 20036
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Email Event
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President Obama has tried to avoid the mistakes many say doomed the Clinton health reform effort. Clinton presented a detailed plan to Congress as a fait accompli; Obama has bided his time, allowing Congress to develop its own plan. While this might be a more effective political strategy, it
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has resulted in a public debate hampered by limited and conflicting information about how health reform might affect families, health care providers, insurers, employers, public programs, and the economy. What did we know in 1994 that we do not know now? What do we need to know to fairly judge the merits of alternative reform proposals emerging from Congress? Will the president’s game plan produce reform legislation he can sign into law?
A distinguished panel of experts who played key roles during the 1993-94 debates will discuss these issues. Robert Reischauer, president of the Urban Institute, directed the Congressional Budget Office during the Clinton reform era. Bill Gradison, member of the Public Company Accounting Oversight Board, was president of the Health Insurance Association of America in the 1990s. Len Nichols, director of health policy at the New America Foundation, served as senior adviser for health policy at the Office of Management and Budget. James Capretta, a fellow at the Ethics and Public Policy Center, was a senior staff member of the Senate Budget Committee during the 1990s and later became associate director of the Office of Management and Budget under President George W. Bush. Dean Rosen, a partner at Mehlman Vogel Castagnetti, was health policy coordinator for the Senate Committee on Labor and Human Resources during the 1990s and more recently was chief health care advisor to Senate Majority Leader Bill Frist. AEI's Joseph Antos will moderate and participate in the discussion.
| 9:00 a.m. | Registration | |
| 9:15 |
Presenters: | James Capretta, Ethics and Public Policy Center |
| Bill Gradison, Public Company Accounting Oversight Board | ||
| Len Nichols, New America Foundation | ||
| Robert Reischauer, Urban Institute | ||
| Dean Rosen, Mehlman Vogel Castagnetti | ||
| Moderator: | Joseph Antos, AEI |
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| 11:15 |
Adjournment |
American Enterprise Institute
1150 Seventeenth Street, N.W.
Washington, DC 20036
Phone: 202-862-6037
E-mail: elizabeth.dupre@aei.org
WASHINGTON, SEPTEMBER 11, 2009 -- Amid the heated debate about health reform on Capitol Hill and across the country, many still have questions about what the legislation will mean for them, for the quality of healthcare, and for the nation's economy. A panel of health experts, many of whom were key players in the Clinton reform attempt, assembled at AEI to address these questions and shed light on the current debate through a comparison of today's reform efforts with those of 1993-1994.
"We know some things about what's emerging but we don't know an awful lot and we don't know really what the bill looks like," said Joseph Antos, a resident scholar at AEI. He contrasted the extended and involved policy development process of the Clinton plan with the rapid and fragmented evolution of separate bills in the House and Senate, which, he argued, puts the country "at a great disadvantage in terms of public policymaking this year."
"It's very hard to talk in any kind of specificity about that for which we don't have the specifics," echoed Robert Reischauer, a former director of the Congressional Budget Office and the current president of the Urban Institute. Touching on economic, political, budgetary, and media contexts among others, Reischauer explained eight ways in which today's reform environment is different from that of 1993-1994. "Back in '93 we were pretty smug and we had no problem saying, ‘you know, we might pay more than everybody else and we might leave 10-12 percent of the population uninsured, but the health care in America is the best in the world for those who are getting it.'" Now, Reischauer said, a host of studies challenges that claim and shows that the United States is dropping in the rankings. However, some things remain the same: Reischauer noted the persisting difficulty of accurately estimating the impacts of large policy changes, and observed that "the American people and many of their leaders remain woefully confused and misinformed about health," adding, "It's very hard to change something, in a rational way, which people don't understand…I think a huge education task lies before us whether we are successful in this round or not."
Bill Gradison, a former Congressman from Ohio and president of a predecessor organization to America's Health Insurance Plans during the 1993-1994 reform years, drew the audience's attention to a number of significant but unanswered questions surrounding premium increases, the availability of adequate funding, the impact of health reform on competing priorities, and the long-term implications of the current health care debates for government involvement in other industries. "Where is the capital going to come from to finance coverage for tens of millions of additional people?" he asked. That's one thing, Gradison said, that was not sufficiently discussed in the 1993-1994 debates either. Highlighting a difference between the 1993-1994 reform effort and the situation today, Gradison noted that insurers now have a voice in the debate. He commented in jest that the insurance industry's "great reward for coming to the table is hearing that a public plan is needed to keep health insurance honest."
Despite such lingering concerns, this time Congress will pass a bill, said Dean Rosen, who has held various health policy positions on Capitol Hill and is now a partner at Mehlman Vogel Castagnetti, Inc. Not doing so, he argued, would amount to "legislative malpractice" on the part of the large Democratic majority in Congress, since President Obama has so much at stake in this effort. What we do not know, however, is how these reforms will sit with the American people once they are passed, "whether this bill is going to be more like Medicare or whether it's going to be more like Medicare catastrophic."
Len Nichols, director of the health policy program at the New America Foundation and formerly the senior advisor for health policy at the Office of Management and Budget during the 1993-1994 effort, listed several realities that we know more about today than we did during those debates. He highlighted geographic disparities in the cost of care as one example, calling this observation "simultaneously stunning, scary, and also full of promise" because it showed that "some parts of our country…are actually doing this stuff right." But one thing he thinks has stayed the same is that "the president's job is impossible." Given the level of cooperation needed to develop and pass bills in several committees simultaneously and in such a short period of time, Nichols argued, "Congress did pretty well."
While recognizing the current approach to health reform—in which Congress, not the White House, has drafted reform legislation—as deliberate and a reflection of events in 1993-1994, James Capretta responded that Congress's decision to set such a short timeline for passing health reform was a "legislative tactic" designed to prevent substantial analysis of the proposals. Capretta, a fellow in the Economics and Ethics program of the Ethics and Public Policy Center, challenged three "highly questionable" claims made by President Obama during his health care address on September 9, 2009, namely that the bill would not add to the deficit, that costs would decrease for everyone, and that reform would be funded predominantly by cutting waste and inefficiency in Medicare and Medicaid. All of these claims, said Capretta, are either unsupported or directly contradicted by the analysis done to date on the bills under consideration.
Joseph Antos is the Wilson H. Taylor Scholar in Health Care and
Retirement Policy. He is also a commissioner of the Maryland Health
Services Cost Review Commission, a health adviser to the Congressional
Budget Office, and an adjunct professor at the Gillings School of
Global Public Health at the University of North Carolina at Chapel
Hill. Before joining AEI, Mr. Antos was Assistant Director for Health
and Human Resources at the Congressional Budget Office. At AEI, Mr.
Antos's research focuses on the economics of health policy, including
Medicare reform, health insurance regulation, and the uninsured. He has
written and spoken extensively on the Medicare drug benefit and has led
a team of experienced independent actuaries and cost estimators in a
study to evaluate various proposals to extend health coverage to the
uninsured. Mr. Antos also writes for AEI's Health Policy Outlook series.
James C. Capretta is a Fellow in the Economics and Ethics Program of the Ethics and Public Policy Center (EPPC). He is also a contributing editor to EPPC's journal The New Atlantis, and the author of the health care policy blog Diagnosis. From 2001 –2004, Mr. Capretta served as the Bush Administration's top budget official for health care, Social Security and pensions, education, and labor policy. He was the lead official in the Office of Management and Budget (OMB) for all aspects of Medicare and Medicaid reform policy development and implementation as well as for the development of the President's other important domestic policy initiatives in education and labor. From 2004 – 2006, Mr. Capretta was a managing director of Wexler and Walker Public Policy Associates, where he performed a wide range of consulting and advocacy services for clients. Prior to joining the White House in 2001, Mr. Capretta served for nearly a decade as a senior policy analyst on the Republican staff for the U.S. Senate Budget Committee under Senator Pete Domenici (R-NM), handling health care and Social Security issues, and as a professional staff member of the House Ways & Means Subcommittee on Health. Mr. Capretta is also a principal at Civic Enterprises, a public policy consulting firm, an adjunct fellow with the Global Aging Initiative of the Center for Strategic and International Studies, and an adjunct fellow with the Hudson Institute. Mr. Capretta served as a visiting lecturer at the Sanford Institute of Public Policy at Duke University in 2006 and was a visiting fellow in Economic Studies at the Brookings Institution in 2005-2006. Mr. Capretta began his career as a budget examiner at OMB from 1987 to 1990.
Bill Gradison, a former Congressman from Ohio, was appointed by
the Securities and Exchange Commission as a founding member of the
Public Company Accounting Oversight Board (PCAOB), which was created by
the Sarbanes-Oxley Act of 2002. He was unanimously reappointed to a
full five-year term in August 2004, and was acting chairman from
December 2005 to July 2006. Before joining the PCAOB, Mr. Gradison was
senior public policy counselor with the Washington, D.C., law firm
Patton Boggs from 1999–2002, and also was president of the Health
Insurance Association of America for six years. Mr. Gradison began his
career in public service in 1953, as assistant to the Under Secretary
of the Treasury. Since that time, he has held elected offices for more
than 30 years, including eighteen years in Congress,and thirteen years
in the Cincinnati City Council as both vice mayor and mayor. As a
Congressman, Mr. Gradison was the ranking member of the House Budget
Committee and the Health Subcommittee of the Committee on Ways and
Means. His other accomplishments include a brief stint on the finance
faculty of the Harvard Business School, assistant to the Secretary of
Health, Education and Welfare, a general partner of a New York Stock
Exchange-listed firm, and chairman of the board of the Federal Home
Loan Bank of Cincinnati.
Len Nichols, a health care economist, directs the health policy program at the New America Foundation. Before his current position, Mr. Nichols was vice president of the Center for Studying Health System Change, a principal research associate at the Urban Institute, and the senior advisor for health policy at the Office of Management and Budget during the Clinton reform efforts of 1993-94. He has testified frequently before Congress and state legislators and has published widely in a variety of health related journals. Previously, Mr. Nichols was Chair of the Economics Department at Wellesley College, where he taught for 10 years. He has served as a member of the Competitive Pricing Advisory Commission (CPAC) and the 2001 Technical Review Panel for the Medicare Trustees Reports. He was on the advisory panel to the Robert Wood Johnson Foundation's Covering America project and has been a consultant to the World Bank, the InterAmerican Development Bank, and the Pan American Health Organization.
Robert D. Reischauer has been the president of the Urban Institute since 2000, having previously served there as a senior vice president from 1981–1986. He was a senior fellow of economic studies at the Brookings Institution from 1995–2000, and worked for the Congressional Budget Office (CBO) in several capacities between 1989–1995 and 1977–1981, including director, assistant director, and assistant director for human resources. Mr. Reischauer serves on the boards of several educational and nonprofit organizations. He is vice chair of the Medicare Payment Advisory Commission, frequently contributes to the opinion pages of major newspapers, comments on public policy developments on radio and television, and testifies before congressional committees.
Dean Rosen has played a leading role in developing and advancing
health policy for over 15 years in the nation’s capital. A partner at
Mehlman Vogel Castagnetti, Inc. (MVC), Mr. Rosen provides policy
counsel and strategic advice to policy makers, business leaders, trade
association executives, and non-profit organizations on a broad range
of health issues. Prior to joining MVC, Mr. Rosen was the chief health
care advisor to Senate Majority Leader William H. Frist, M.D.
(R-TN),served as staff director for the United States Senate
Subcommittee on Public Health and later as the Majority Leader’s health
policy director, and was majority counsel for the House Ways and Means
Health Subcommittee where he was involved in developing the Medicare
provisions of the Balanced Budget Act of 1997. Mr. Rosen has also
served as health policy coordinator and majority counsel to the Senate
Committee on Labor and Human Resources. Through his posts on Capitol
Hill, Mr. Rosen helped shepherd through Congress many pieces of
legislation, including: The Medicare Prescription Drug Improvement and
Modernization Act of 2003; The Project Bioshield Act of 2004; The
Patient Safety and Quality Improvement Act of 2005; The Health
Insurance Portability and Accountability Act of 1996 (HIPAA). In the
private sector, Mr. Rosen has been senior vice president of policy and
general counsel for the Health Insurance Association of America (HIAA),
and has practiced law at Dow, Lohnes and Albertson. Mr. Rosen also
holds several academic posts.
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