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Alice Rivlin: A career spent making better public policy

"I was always interested in doing good policy analysis, and improving the policy process," says Alice M. Rivlin in this interview about her career in public policy and contributions to making the policy process better. She is a senior fellow in Economic Studies and the Center for Health Policy at Brookings, and one of the nation's, and this…

       




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The CARES Act Risks Becoming a Caste Act. Here’s How We Change That.

       




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Is the Health Care Mandate a Tax?

People who get health insurance through their employer under national health reform will lose over $6,000 in wages annually -- but that is actually a good thing. It means we can extend health insurance to many of the 50 million uninsured in the U.S. efficiently without killing jobs. The key is the "individual mandate" to…

       




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The Power to Tax Justifies the Power to Mandate Health Care Insurance, Which Can be More Economically Efficient

Today, the Supreme Court upheld the individual mandate, a central feature of the Affordable Care Act, under the federal government’s power to tax. I attended the Supreme Court oral arguments on the constitutionality of the individual mandate, and I noticed that the legal relationship between mandates and taxes relies very little on the economic relationship…

       




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The Future of U.S. Health Care Spending

For several decades health spending in the United States rose much faster than other spending. Forecasters predicted the health sector, already 17% of GDP, would soon exceed 20 to 25% of GDP, driving out other necessary public and private spending. However, in recent years health spending growth dropped dramatically and surprisingly, to a record slow pace for the…

       




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The Early Impact of the Affordable Care Act

SummaryThe number of Americans insured in the individual health insurance market through exchanges and directly through insurers was at least 13.2 million in the second quarter of 2014 – larger than reported by the government, which only includes the number insured through exchanges – and at least 4.2 million of them would not have been…

       




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We need more primary care physicians: Here’s why and how

A series of articles published this year in JAMA Internal Medicine has substantially added to the empirical literature showing that access to and use of primary care medicine in the US is associated with higher value care and better health outcomes than care that is more specialist-oriented. While these studies confirm our view that the…

       




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Health care priorities for a COVID-19 stimulus bill: Recommendations to the administration, congress, and other federal, state, and local leaders from public health, medical, policy, and legal experts

       




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Replacing the Affordable Care Act

THE ISSUE: As Congress considers the new House Republican-backed replacement for the Affordable Care Act (ACA), they must ensure that it accomplishes a set of specific goals that are crucial for providing broad, affordable coverage to U.S. citizens. https://youtu.be/xqe4kBcyQC4 The ability to evolve has to be a key part of the ACA replacement. THE THINGS YOU…

      




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Repealing the Affordable Care Act

THE ISSUE: If Congress rejects the new House Republican-backed replacement for the Affordable Care Act (ACA), the full repeal long advocated for by many Republicans could be their next option. https://youtu.be/4wpHccHawbg A straight ACA repeal would leave an estimated 20+ million people without health coverage. THE THINGS YOU NEED TO KNOW Republicans have long advocated…

      




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Caremongering in the time of coronavirus: Random acts of kindness and online enrichment

It is the middle of the night and I am cloistered in my apartment in downtown Washington, D.C. I am facing four screens, including my smartphone, a laptop, a Mac desktop and a large wall monitor. I am trying to make sense of the fast-changing data on the spread and deadliness of the virus around…

       




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Why care about Ukraine and the Budapest Memorandum

Since 2014, when Russia annexed Crimea from Ukraine, the United States has provided Ukraine with $3 billion in reform and military assistance and $3 billion in loan guarantees. U.S. troops in western Ukraine train their Ukrainian colleagues. Washington, in concert with the European Union, has taken steps to isolate Moscow politically and imposed a series of economic…

       




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Physician Social Networks and Geographic Variation in Medical Care

CSED Working Paper No. 33: Physician Social Networks and Geographic Variation in Medical Care

      
 
 




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Strengthening Medicare for 2030 - A working paper series


The addition of Medicare in 1965 completed a suite of federal programs designed to protect the wealth and health of people reaching older ages in the United States, starting with the Committee on Economic Security of 1934—known today as Social Security. While few would deny Medicare’s important role in improving older and disabled Americans’ financial security and health, many worry about sustaining and strengthening Medicare to finance high-quality, affordable health care for coming generations.

In 1965, average life expectancy for a 65-year-old man and woman was another 13 years and 16 years, respectively. Now, life expectancy for 65-year-olds is 18 years for men and 20 years for women—effectively a four- to five-year increase.

In 2011, the first of 75-million-plus baby boomers became eligible for Medicare. And by 2029, when all of the baby boomers will be 65 or older, the U.S. Census Bureau predicts 20 percent of the U.S. population will be older than 65. Just by virtue of the sheer size of the aging population, Medicare spending growth will accelerate sharply in the coming years.


Estimated Medicare Spending, 2010-2030



Sources: Future Elderly Model (FEM), University of Southern California Leonard D. Schaeffer Center for Health Policy & Economics, U.S. Census Bureau projections, Medicare Current Beneficiary Survey and Centers for Medicare & Medicaid Services.

The Center for Health Policy at Brookings and the USC Leonard D. Schaeffer Center for Health Policy and Economics' half-day forum on the future of Medicare, looked ahead to the year 2030--a year when the youngest baby boomers will be Medicare-eligible-- to explore the changing demographics, health care needs, medical technology costs, and financial resources that will be available to beneficiaries. The working papers below address five critical components of Medicare reform, including: modernizing Medicare's infrastructure, benefit design, marketplace competition, and payment mechanisms.

DISCUSSION PAPERS

  • Health and Health Care of Beneficiaries in 2030, Étienne Gaudette, Bryan Tysinger, Alwyn Cassil and Dana Goldman: This chartbook, prepared by the USC Schaeffer Center, aims to help policymakers understand how Medicare spending and beneficiary demographics will likely change over the next 15 years to help strengthen and sustain the program.
  • Trends in the Well-Being of Aged and their Prospects through 2030, Gary Burtless: This paper offers a survey of trends in old-age poverty, income, inequality, labor market activity, insurance coverage, and health status, and provides a brief discussion of whether the favorable trends of the past half century can continue in the next few decades.
  • The Transformation of Medicare, 2015 to 2030, Henry J. Aaron and Robert Reischauer: This paper discusses how Medicare can be made a better program and how it should look in 2030s using the perspectives of beneficiaries, policymakers and administrators; and that of society at large.
  • Improving Provider Payment in Medicare, Paul Ginsburg and Gail Wilensky: This paper discusses the various alternative payment models currently being implemented in the private sector and elsewhere that can be employed in the Medicare program to preserve quality of care and also reduce costs.

Authors

Publication: The Brookings Institution and the USC Schaeffer Center
     
 
 




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Strengthening Medicare for 2030


Event Information

June 5, 2015
9:00 AM - 1:00 PM EDT

Falk Auditorium
Brookings Institution
1775 Massachusetts Avenue, N.W.
Washington, DC 20036

Register for the Event

In its 50th year, the Medicare program currently provides health insurance coverage for more than 49 million Americans and accounts for $600 billion in federal spending. With those numbers expected to rise as the baby boomer generation ages, many policy experts consider this impending expansion a major threat to the nation’s economic future and question how it might affect the quality and value of health care for Medicare beneficiaries.

On June 5, the Center for Health Policy at Brookings and the USC Leonard D. Schaeffer Center for Health Policy and Economics hosted a half-day forum on the future of Medicare. Instead of reflecting on historical accomplishments, the event looked ahead to 2030—a time when the youngest Baby Boomers will be Medicare-eligible—and explore the changing demographics, health care needs, medical technology costs, and financial resources available to beneficiaries. The panels focused on modernizing Medicare's infrastructure, benefit design, marketplace competition, and payment mechanisms. The event also included the release of five policy papers from featured panelists.

Please note that presentation slides from USC's Dana Goldman will not be available for download. For more information on findings from his presentation download the working paper available on this page or watch the event video.

Video

Audio

Transcript

Event Materials

     
 
 




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The stunning ignorance of Trump's health care plan


One cannot help feeling a bit silly taking seriously the policy proposals of a person who seems not to take policy seriously himself. Donald Trump's policy positions have evolved faster over the years than a teenager's moods. He was for a woman's right to choose; now he is against it. He was for a wealth tax to pay off the national debt before proposing a tax plan that would enrich the wealthy and balloon the national debt. He was for universal health care but opposed to any practical way to achieve it.

Based on his previous flexibility, Trump's here-today proposals may well be gone tomorrow. As a sometime-Democrat, sometime-Republican, sometime-independent, who is now the leading candidate for the Republican presidential nomination, Trump has just issued his latest pronouncements on health care policy. So, what the hell, let's give them more respect than he has given his own past policy statements.

Perhaps unsurprisingly, those earlier pronouncements are notable for their detachment from fact and lack of internal logic. The one-time supporter of universal health care now joins other candidates in his newly-embraced party in calling for repeal of the only serious legislative attempt in American history to move toward universal coverage, the Affordable Care Act. Among his stated reasons for repeal, he alleges that the act has "resulted in runaway costs," promoted health care rationing, reduced competition and narrowed choice.

Each of these statements is clearly and demonstrably false. Health care spending per person has grown less rapidly in the six years since the Affordable Care Act was enacted than in any corresponding period in the last four decades. There is now less health care rationing than at any time in living memory, if the term rationing includes denial of care because it is unaffordable. Rationing because of unaffordability is certainly down for the more than 20 million people who are newly insured because of the Affordable Care Act. Hospital re-admissions, a standard indicator of low quality, are down, and the health care exchanges that Trump now says he would abolish, but that resemble the "health marts" he once espoused, have brought more choice to individual shoppers than private employers now offer or ever offered their workers.

Trump's proposed alternative to the Affordable Care Act is even worse than his criticism of it. He would retain the highly popular provision in the act that bars insurance companies from denying people coverage because of preexisting conditions, a practice all too common in the years before the health care law. But he would do away with two other provisions of the Affordable Care Act that are essential to make that reform sustainable: the mandate that people carry insurance and the financial assistance to make that requirement feasible for people of modest means.

Without those last two provisions, barring insurers from using preexisting conditions to jack up premiums or deny coverage would destroy the insurance market. Why? Because without the mandate and the financial aid, people would have powerful financial incentives to wait until they were seriously ill to buy insurance. They could safely do so, confident that some insurer would have to sell them coverage as soon as they became ill. Insurers that set affordable prices would go broke. If insurers set prices high enough to cover costs, few customers could afford them.

In simple terms, Trump's promise to bar insurers from using preexisting conditions to screen customers but simultaneously to scrap the companion provisions that make the bar feasible is either the fraudulent offer of a huckster who takes voters for fools, or clear evidence of stunning ignorance about how insurance works. Take your pick.

Unfortunately, none of the other Republican candidates offers a plan demonstrably superior to Trump's. All begin by calling for repeal and replacement of the Affordable Care Act. But none has yet advanced a well-crafted replacement.

It is not that the Affordable Care Act is perfect legislation. It isn't. But, as the old saying goes, you can't beat something with nothing. And so far as health care reform is concerned, nothing is what the Republican candidates now have on offer.


Editor's note: This piece originally appeared in U.S. News and World Report.

Authors

Publication: U.S. News and World Report
Image Source: © Lucy Nicholson / Reuters
      
 
 




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Careful or careless? Perspectives on the CARES Act

The Coronavirus Aid, Relief, and Economic Security (CARES) Act, passed by the Senate on March 25 and expected to be rapidly approved by the House and President, is the largest aid package in history. The bipartisan deal allocates $2 trillion in an effort to mitigate the mounting fallout from the COVID-19 pandemic, including $1.5 trillion…

       




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Should "Progressives" Boycott Whole Foods Over CEO's Statements on Health Care?

I am constantly amazed at the level of political discourse in the US. So a debate about health care degenerates into scares about "death panels" and boycotts of Whole Foods because their CEO is against it. It is all a bit much, and a complete mystery




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Food for Thought: Do The Health Care Views of Whole Food's CEO Keep You Away?

I went to Whole Foods in Oakland on Saturday, like I do most weekends, but I missed the dance/theater/protest against the grocery chain's co-founder and CEO John Mackey, he of the now infamous quote: "A careful reading of both the Declaration of




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Climate Care Heads Down Under

Australians may be world leaders in terms of greenhouse gas emissions, but with their new government signing Kyoto as one of its first acts in power, it seems change may well be in the air. So, is Australia about to go green in a big way? UK-based




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Trulia study finds Americans say they care about the environment but aren't willing to pay for it

The extremely dated "It ain't easy being green" title of this Trulia survey actually misinterprets the data; judging by the questions they asked, it is perfectly easy being green; it just ain't cheap.




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Kodak Files For Bankruptcy Protection; Nobody Notices Or Cares

It was pretty much inevitable; the company just couldn't capitalize on the digital revolution.




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Care to Air Design Challenge by Levi's

Air-drying clothing is definitely the cheapest, and especially the most eco-friendly way of drying your clothes; no energy or machinery is needed. However, if you live in a small space, a rainy country or simply are a busy (or forgetful) person,




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New clothing care label wants you to stop overwashing

The Care Label Project will add a label to thousands of clothes in hopes that people will adopt laundry habits that are better for both fabric and the Earth.




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How to read laundry care labels

Help your clothes last longer by learning how to decode the mysterious hieroglyphics of care labels.




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Grateful Dog is Sacramento's First Green Dog Day Care

The name may give you visions of dogs mellowed out, but the Grateful Dog wants to make sure your dog is both happy and healthy throughout their entire stay. You can leave your dog for the day or the week, knowing that




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Everything you need to know about natural skin care

It turns out beauty is more than skin deep, but make sure you're taking good care of that beauty because chemicals are all over the skin care industry




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Driver in car hits 14 year old with right of way in crosswalk, and all they care about is the iPhone

It's almost like there is a concerted campaign to turn distracted walking into a serious problem.




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Province of Ontario introduces new penalties for careless drivers causing death

Drivers used to get away with murder; new legislation is much stronger.




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Would you send your child to daycare in the forest?

With daycare costs rising, perhaps ditching the building is not such a crazy idea.




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Thanks to the election, universal healthcare may be around the corner

A number of states are edging out insurance companies. This could be huge for the environment.




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If More of Us Love Nature, The Environment Will Take Care of Itself

Like the word 'sustainability', 'environmentalism' has become a hollow word, a word divorced from meaning, a word lacking in soul, separated from its essence.




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Surprising Agreement On The Connection Between Obesity and Healthcare Costs

Michael Pollan writes in the New York Times about the connection between the American diet and the cost of health care; Surprisingly, conservative writers like Marie-Josée Kravis are saying much the same thing,




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The troubling link between self-care and capitalism

The covering-yourself-with-blankets movement isn't nearly as cuddly as it seems.




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If we care about sustainability, should we still be building super-tall skyscrapers?

Studies show that taller buildings are simply less efficient, and don't even give you any more useable area. Why bother?




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You look scared. Are you scared?

Despite progress on many fronts, climate commentators and activists are increasingly owning up to their fears.




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The Hub, a Shared Work Space for People Who Care. In a City near You!

Working in shared office spaces is an attractive solution for creative start-ups, and has become more and more sought-after in many of the bigger cities. Green Spaces in Manhattan has turned into a well-working




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Who cares about BPA? Canned beer is more popular than ever

Nobody should be drinking canned beer. Period. But it is particularly bad for young women.




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Parents, don't be so scared of the world!

Letting kids venture out alone could be the best thing you do for them.




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Going to the office? Be Careful, It Is A Chemical Soup

Not much point in having a healthy house if you spend all day in an unhealthy office.




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Don’t Judge Argentina’s Care for Sustainable Living by its Inappropriate Air Conditioning Ads

Two misfortunate advertising campaigns from Argentina use polar bears and tackiness to promote air conditioning.




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It's "Sleepy Monday" – Be careful out there

Even a full day later, a one-hour shift in the clock is hard to adjust to.




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Arbor Day reminded us to care for trees year-round

Whether they are growing to be thousands of years old, making life-long friendships or confounding us with their resilience, trees provide to us invaluable material resources.




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Care and feeding of a healthy microbiome

The secret to a diet that makes the microbes in your gut healthy, for fighting obesity and disease




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Childcare center bans glitter. Parents and fish rejoice.

Whether for parental sanity or oceanic health, this is a powerful step toward a much better world.




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8 of the easiest houseplants to care for

Looking for indoor plants that are hard to kill? These green troopers are resilient and don't demand too much from their keepers.




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How to care for houseplants during the winter

Colder weather provides some unique challenges for indoor plants; here's how to how to help them get through it.




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Women's personal care the green way

Personal care is a big subject, but we'll focus on caring for our general appearance: Cleansing and cosmetics, hair care, skin care, makeup, hair removal and, of course, that time of the month most women deal




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Sharing Saves You Money. But Who Cares?

With all the talk of the "sharing economy", are we in danger of losing sight of the bigger picture? Sharing is caring after all.




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Honeybee pheromones scare away elephants

A new scientific study could save a whole lot of elephants.