The Great Debate

Why Obama must prevail for a ‘grand bargain’

President Barack Obama and House Speaker John Boehner (R-Ohio) (R) in Washington, Mar. 19, 2013. REUTERS/Gary Cameron

It’s been a while since we’ve had good news about our economy, so the recent upbeat reports are welcome. The deficit picture for 2013 has brightened a bit, along with an upturn in the housing market. Yet those developments don’t tell the full story. Our economic horizon remains cloudy due to serious structural challenges.

In fact, this improving economic picture threatens to diminish our sense of urgency about striking the needed “grand bargain” to address our fiscal disease. That shouldn’t happen — and Washington policy makers should use the continuing talks about fiscal 2014 appropriations levels to nail down a framework for the deal we all need.

First, let’s look at the good news in context. Several weeks ago, the Congressional Budget Office reported that the federal budget deficit for fiscal 2013 will be $642 billion. That’s a substantial drop from 2012′s $1.1 trillion deficit. But several significant reasons for the decline are unusual events: large dividend payments from Fannie Mae and Freddie Mac; savings from the ill-conceived and unsustainable sequester; and accelerated tax revenues from wealthy individuals anticipating the fiscal cliff.

More good news came in recent weeks with signs of strength in the housing market — an upward trend in home sales and housing starts. Yet unemployment remains stubbornly high, at 7.6 percent, and investors are nervously wondering how much and how quickly the Federal Reserve Bank will pull back on its monetary stimulus program.

Can Obama fire up younger voters?


As national attention focuses on the devastation inflicted on Atlantic states by megastorm Sandy, polls show the same basic electoral reality that has prevailed throughout the presidential campaign: Without a strong turnout among young voters, President Barack Obama loses on Nov. 6.

So, Obama may need more than fiery “go vote!” entreaties to students to overcome his presidency’s disorganized, mixed record on youth issues.

New polls taken nationally and in key swing states (Ohio, Virginia, North Carolina, Colorado, Iowa, Florida, Nevada and Wisconsin) show how crucial young voters are to the president’s reelection. Obama leads Republican challenger Mitt Romney among 18- to 29-year-olds by landslide margins, more than offsetting the mildly pro-Romney sentiments of their elders.

Key fiscal questions nominees must answer


We can only hope the final presidential debate Monday provides less heat and more light than the previous two. Especially with regard to fiscal matters, the debates have so far not provided the substance and solutions that voters need and deserve to hear.

Our nation’s escalating deficits and debt represent the biggest threat to our national security, as I said in early 2007. Admiral Mike Mullen, former chairman of the Joint Chiefs of Staff, said much the same in 2010. So the topic of the third debate, foreign policy and national security, needs to include a frank discussion of fiscal issues.

For, as our economy weakens, so does our position in the world. It will eventually compromise both our national security and domestic tranquility if not effectively addressed. Both our allies and adversaries recognize this, and we need to take action.

Romney should be proud of Massachusetts health law

It’s been six years since Mitt Romney signed the Massachusetts healthcare reform law. That law was a framework for change, a values statement about what we believe in Massachusetts: that health is a public good and that everyone deserves access to affordable, high-quality healthcare.

Six years after its passage, our experiment in universal healthcare is working, expanding coverage while helping to control costs. Mitt Romney should be proud of the law he signed. As the one responsible for implementing it, I know I am. Here’s why.

More people have health insurance in Massachusetts than anywhere else in the country: 98.1 percent of our total population. Of our children, 99.8 percent are covered. While the number of people without health insurance in America grew from 2006 to 2010, more than 400,000 people in Massachusetts gained coverage.

Ryan’s budget frames 2012 election around Medicare

This week, House Budget Committee Chairman Paul Ryan released what amounts to the most substantive roadmap for fiscal policy that any Republican is likely to offer in 2012. Many political pundits and policy analysts, especially those on the left, are eager to dig into the details to alert the public about the potential (negative) impacts of a budget that slices off $5 trillion in total federal spending compared with the plan offered by President Obama in February.

Providing 100 pages of budget and policy detail in an election year is considered political suicide by many. Democrats fully intend to use the plan to campaign against Republicans in the fall, hoping to gain an advantage not only in select House or Senate races but also in the presidential contest.

Ryan, though, sees this as the only responsible path forward: So what if his plan won’t get enacted into law this year. Should Ryan’s House colleagues, or the candidates for president, avoid taking a detailed position on our country’s fiscal future? As Ryan explains: “If we simply operate based on political fear, nothing is ever going to get done.”

An unsung victory in healthcare

In 2008, 17 percent of office-based physicians and just 9 percent of hospitals had basic electronic health records (EHRs) and fewer than 10 percent used electronic prescriptions. This doesn’t mean most physicians were Luddites; rather, there were powerful disincentives to their adoption of health IT.

For example: Installing electronic health records required retraining physicians and staff, exacting months of significantly reduced productivity. Technology from different vendors typically did not communicate with each other, so the free flow of information — referral letters, hospital discharge summaries, lab results, X-rays and all the rest — that would make the investment worthwhile was not there. Then there was the network effect: Until a lot of doctors and hospitals were using electronic health records and a lot of vital information was available electronically — even if the various proprietary systems did communicate — it wasn’t worth it. And finally physicians feared that an expensive new EHR system would soon be obsolete, requiring another big capital investment.

On Feb. 17, 2009, President Obama signed the Recovery Act, which contained a number of healthcare provisions, including the Health Information Technology for Economic and Clinical Health Act (HITECH), which nullified these disincentives. HITECH did this by providing physicians payments of up to $44,000 from Medicare and $65,000 from Medicaid — and hospitals getting millions of dollars, with amounts varying based on how many Medicare and Medicaid patients they cared for — to help defray the cost of EHR adoption. Obviously, this is not free money. Physicians and hospitals receive the incentive payments if their EHRs are certified as capable of supporting “meaningful use.” This, in practical terms, means they can be used for e-prescribing, securely exchanging patients’ health information and electronically submitting data on the quality of care. The law also includes a penalty for physicians and hospitals that do not implement EHRs: Their Medicare payments will be reduced beginning in 2015. It also empowers the government to set technology standards regarding interoperability and the secure exchange of health information.

Wal-Mart will see you now

By Dave Chase
The views expressed are his own.

“We don’t have a debt problem. We have a healthcare problem.” Those are the words of Laura Tyson, one of the most respected economists in the world. In Bill Gates’ recent TED talk, he described healthcare as the factor that is devastating state budgets leading to education cuts. Clearly something must to be done now to address this crisis.

With the possible exception of the federal government, no organization is in a better position to reverse healthcare’s hyperinflation than Wal-Mart.

If that sounds crazy, let me explain. As Ezra Klein recently pointed out in a Washington Post graphic, it’s not the age or obesity of the population that is driving healthcare costs. Nor does it have much to do with alcohol or even malpractice costs. Rather, as the many cost comparisons in the presentation below show, we simply pay more for the same items when compared to other countries.

The government’s waning support of breast cancer?

By Sally Pipes
The opinions expressed are her own.

Breast Cancer Awareness month, which wound down last month, appeared to get plenty of government support.

Health and Human Services Secretary Kathleen Sebelius held a teleconference in recognition of national mammography day. She and Thomas Frieden, director of the Centers for Disease Control, touted a new program to promote awareness. The Vice President’s wife, Dr. Jill Biden, spoke about the importance of early detection, and Barack Obama himself, in a Presidential proclamation, said that “we reaffirm our commitment to supporting breast cancer research.”

It’s a sad irony, then, that at the same moment our leaders say they’re working to fight breast cancer — which kills some 40,000 American women a year — the Food and Drug Administration is on the verge of revoking approval of an important treatment.

Healthcare overhaul: The good news

Peter_Pitts– Peter J. Pitts is president of the Center for Medicine in the Public Interest and a former FDA Associate Commissioner. The views expressed are his own. –

After a feisty year of debate, Congress has passed healthcare reform legislation. Once enacted, it will increase the number of Americans with health insurance as well as both the size and scope of government.

And the numbers?  Staggering when you consider they are absurdly under-scored. According to Douglas Holtz-Eakin (director of the Congressional Budget Office from 2003 to 2005), if you strip out all the gimmicks and games and rework the calculus, a wholly different picture emerges: The health care reform legislation would raise, not lower, federal deficits, by $562 billion. Even with readjustment, it will make the Social Security trust fund look like Fort Knox.

Three ways the health reform package helps control costs

DavidKendall-photo-full size– David Kendall is senior fellow for health and fiscal policy at Third Way. The views expressed are his own. –

Among the many unfair accusations leveled at the health reform package just passed by the House is that it “does nothing” to control soaring health care costs.

In fact, nothing can be further from the truth.

At the same time that it will provide unprecedented stability in health care coverage to middle-class Americans, health reform will also bring about a quiet—but far-reaching–transformation of how our nation pays for health care. The result will be more efficient, better quality care, along with cost savings estimated by the non-partisan Congressional Budget Office of $138 billion over the next decade.