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The high costs of U.S. health care impose an ever-increasing burden on families and businesses and threaten the country's fiscal stability. At an AEI event Thursday afternoon, health policy experts joined Joseph Antos and Norman Ornstein of AEI to discuss proposals to bend the health cost curve.
Antos and Gail Wilensky, who oversaw Medicare and Medicaid in the George H.W. Bush administration, began with a discussion of their just-published paper "Bending the Cost Curve through Market-Based Incentives," which was co-authored by Mark Pauly. The paper proposes replacing the current defined-benefit approach to federal health subsidies with a defined contribution system for Medicare and employer-sponsored insurance, Wilensky explained. Antos clarified that unlike arbitrary federal limits on spending, a defined contribution approach fixes the underlying financial incentives that drive high health spending.
Paul Ginsburg of the Center for Studying Health System Change stressed the importance of using many approaches to cost containment at the same time. Yet, the polarization that dominates American politics, Ornstein explained, has made enacting such proposals a near political impossibility.
Health insurance costs are climbing to unaffordable levels and threatening the country’s fiscal stability. Health experts Joseph Antos, Mark Pauly and Gail Wilensky propose a competitive market approach that would correct the current health care system’s underlying financial incentives, which are driving up costs.
The current Affordable Care Act relies heavily on regulatory approaches and mandates to finance health coverage, and recent proposals offer alternatives — but they have not met the market test. Antos, Pauly and Wilensky’s proposal would allow consumers and providers — rather than Washington, D.C., policymakers — to make decisions about what coverage to purchase, what services to produce and how to optimize value.
Joseph Antos, AEI
Paul Ginsburg, Center for Studying Health System Change
Norman J. Ornstein, AEI
Gail Wilensky, Project HOPE
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Joseph Antos is the Wilson H. Taylor Scholar in Health Care and Retirement Policy at AEI. He is also a commissioner of the Maryland Health Services Cost Review Commission and a health adviser to the Congressional Budget Office. Before joining AEI, Antos was assistant director for health and human resources at the Congressional Budget Office. At AEI, 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. Antos is the co-author of the AEI paper "A Better Prescription: AEI Scholars on Realistic Health Reform." He is also a co-author of the recent New England Journal of Medicine paper “Bending the Cost Curve through Market-Based Incentives.”
Paul Ginsburg is the president of the Center for Studying Health System Change (HSC). A noted speaker and commentator on changes taking place in the health care system, Ginsburg's recent research topics have included cost trends and drivers, Medicare physician and hospital payment policy, Medicare governance, consumer-directed health care, the future of employer-based health insurance and competition in health care. Ginsburg has been named six times by Modern Healthcare as one of "The 100 Most Powerful People in Healthcare." He received the first annual Health Services Research Impact Award from AcademyHealth, the professional association for health policy researchers and analysts. He is a founding member of the National Academy of Social Insurance — a public trustee of the American Academy of Ophthalmology —and served two elected terms on the board of AcademyHealth. Before founding HSC, Ginsburg was the executive director of the Physician Payment Review Commission, created by the U.S. Congress to provide nonpartisan advice about Medicare and Medicaid payment issues. Ginsburg previously worked for the RAND Corporation and the Congressional Budget Office.
Norman J. Ornstein is a longtime observer of the U.S. Congress and politics. He writes a weekly column for Roll Call and is an election analyst for CBS News. He also serves as co-director of the AEI-Brookings Project on Redistricting and as a senior counselor to the Continuity of Government Commission. Ornstein led a working group of scholars and practitioners that helped shape the law known as McCain-Feingold, which reformed the campaign-financing system. He was elected as a fellow of the American Academy of Arts and Sciences in 2004. His many books include “The Permanent Campaign and Its Future” (AEI Press, 2000), “The Broken Branch: How Congress Is Failing America and How to Get It Back on Track” (Oxford University Press, 2006, with Thomas E. Mann), “Vital Statistics on Congress, 2008” (Brookings Institution Press, 2008, with Mann and Michael Malbin) and “It’s Even Worse Than It Looks: How the American Constitutional System Collided with the New Politics of Extremism” (Basic Books, 2012, with Mann).
Gail Wilensky is an economist and senior fellow at Project HOPE, an international health foundation. She directed the Medicare and Medicaid programs and was a senior adviser on health and welfare issues to President George H.W. Bush and was also the first chair of the Medicare Payment Advisory Commission. Her expertise is on strategies to reform health care, with emphasis on Medicare, comparative effectiveness research and military health care. Wilensky is a trustee of the Combined Benefits Fund of the United Mine Workers of America and the National Opinion Research Center and is on the board of regents of the Uniformed Services University of the Health Sciences, the visiting committee of the Harvard Medical School and the board of directors of the Geisinger Health System Foundation. She recently served as president of the Defense Health Board, a commissioner on the World Health Organization’s Commission on the Social Determinants of Health, co-chair of Department of Defense Task Force on the Future of Military Health Care and chair of the Physician Payment Review Commission. Wilensky is also a co-author — with Joseph Antos and Mark Pauly — of the New England Journal of Medicine paper “Bending the Cost Curve through Market-Based Incentives.”