The AEI Plan on Health Reform

The Obama administration is making a full-court press for health care reform, employing campaign-style techniques that the president used in 2008. In recent weeks, AEI scholars have been mounting a campaign of their own--building on more than three decades of work at the Institute--to highlight the weaknesses of the main Senate and House bills and their future implications.

In a short, must-read primer, published this week on AEI's website, Joseph Antos looks at the principles that should guide reform and inform the choice that the nation must make between an approach that further centralizes power and decision-making in Washington and one that levels with the American people by telling them what really needs to be fixed, what it will cost, and how the hard decisions need to be made. While acknowledging that "a market-based health reform is no panacea and will not produce an instant cure for the many problems facing the health system," Antos argues that the regulatory approach favored by leading Democrats in Congress and the administration will do no better, and in fact worse. Instead, he writes:

We should strengthen effective competition that rewards initiative, a system that does not protect poor business decisions with unearned taxpayer dollars. We should provide help where it is most needed, and give consumers (and their doctors) the tools to make good decisions about their insurance and their medical care. We should lay the foundation for a new understanding of the rights and responsibilities of individuals, and we should take steps to ensure that the reforms enacted this year are sustainable over the long term.

Scott Gottlieb, M.D., whose frequent appearances on television have made him one of the key voices in the debate, has written a series of articles that raise concerns about the fine print of current proposals. His latest article looks at the advisory boards in the main Senate and House bills that will ultimately ration care. In a recent Health Policy Outlook, he argues for rigorous scientific standards for the "comparativeness effectiveness" agency envisioned by the Democrats' main health plans.

In a series of posts at The Enterprise Blog, Thomas P. Miller is evaluating the media coverage of the current debate. His latest offered five hard questions on health care for President Obama.

In his latest Health Policy Outlook, Robert B. Helms argues for capping the tax exclusion for employer-sponsored health insurance, a proposal that remains "on the table" despite President Obama's stated opposition to it. AEI scholars and authors have pushed for a cap on the tax deduction for decades, arguing that it distorts the market for coverage. (See here and here.)

In addition to these writings, AEI scholars have been furthering the debate through conferences. Antos, Gottlieb, Helms, Miller, John E. Calfee, and Bill Thomas all spoke at a recent event on "the five (not so) easy pieces of health reform." Representative Paul Ryan (R-Wisc.) was the keynote speaker. AEI scholars' sober and detailed analyses are taken seriously by policymakers of all stripes and are one reason why people are having second thoughts about creating a government-dominated health care system and why momentum for a big health care push may be slowing down.

A full array of books, short publications, conferences, and multimedia materials from AEI's Health Policy Studies Program is available at www.aei.org/health. Some of AEI scholars' best essays on health reform were recently compiled in a new book, Uncle Sam, M.D. Information about downloading or ordering a free copy of this volume is available at www.aei.org/book/100010.

People and Programs

The growing income gap between the well educated and the less educated is a major issue in public policy debates. But income is just one part of well-being. What if you factor in leisure time for working Americans? In The Increase in Leisure Inequality, 1965-2005 (AEI Press, June 2009), Mark Aguiar and Erik Hurst find that "less-educated individuals increased their leisure relative to more-educated individuals during a period when the related wages of the less-educated workers fell." In the last quarter-century, for example, men without a high school diploma have increased their leisure time by eight hours per week, but men who have graduated from college lost six hours of leisure time per week. Aguiar and Hurst's detailed study is sure to shake up the debate about the factors we consider when we measure inequality.

Bringing the twentieth annual Bradley Lecture Series to a close on June 8, Christopher DeMuth examined the effectiveness of policy interventions in markets and other private arrangements. "Unintended consequences" is a famous way of describing the problems of interference (for example, urban blight wrought by "urban renewal" programs in the 1960s). DeMuth proposed an alternative interpretation: "intended non-consequences," which come about as a result of the government's limited tools for intervention and the competing interests of private parties who lobby to modify the intervention, resulting in limitations on its effectiveness.

Energy Secretary Steven Chu said at a recent symposium that painting all roofs white and making pavements a neutral color would be the equivalent of "reducing carbon emissions due to cars by 11 years." It is "actually geoengineering," he added. In June, the National Academy of Sciences held a conference to explore geoengineering the environment. AEI scholars were ahead of the curve on this with the AEI Geoengineering Project. In an article in the Washington Post, Samuel Thernstrom says geoengineering could "protect us from the worst effects of warming for the many decades it will take for emissions reductions to become effective" and has urged a significant federal research program to study the idea and the science. On June 25, a panel at AEI moderated by Lee Lane explored who should set the rules about geoengineering, what those rules should permit or forbid, and how they should be enforced.

On June 23, the New York Times featured new research by Emily Glassberg Sands, a recent graduate of Princeton University who interned at AEI with Sally Satel in 2007. Sands studied the disparity between the number of plays written by men that get produced and the number by women. Among her conclusions: there are more male playwrights than female, and the men are more prolific; female artistic directors are the ones who tend to favor male playwrights; and women's shows that get produced on Broadway make more money but have shorter runs. AEI is proud of Sands and our other interns; the summer 2009 class includes forty-six talented young people selected from nearly one thousand applicants.

Hot Off the Enterprise Blog

"My suspicion is that the so-called 'beautiful game' is not so beautiful to American sensibilities. We like, as good small 'd' democrats, our underdogs for sure but we also still expect folks in the end to get their just desert. And, in sports, that means excellence should prevail. Of course, the fact that is often not the case when it comes to soccer may be precisely the reason the sport is so popular in the countries of Latin America and Europe." [Read the full post]

--GARY J. SCHMITT