Joe Antos Republicain Approche Bipartisane Membre Task Force Clinton Membre avec démocrate de Alliance for Health Reform (voir doc) Expert Health Policy à l’American Entreprise Institute (AEI) Passageà CBO (voir book : Joyce, 2012) http://www.academyhealth.org/Events/content.cfm?ItemNumber=5307&navItemNumber=2061 Joseph R. Antos, Ph.D.

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 an adjunct professor at the School of Public Health of the University of North Carolina at Chapel Hill.

Dr. Antos’ research focuses on the economics of health policy, including Medicare reform, health insurance regulation, and the uninsured. He is the editor with Alice Rivlin of Restoring Fiscal Sanity 2007: The Health Spending Challenge (Brookings Institution Press, 2007).

Before joining AEI, Dr. Antos was assistant director for health and human resources at the Congressional Budget Office, and he held senior positions in the U.S. Department of Health and Human Services, the Office of Management and Budget, and the President’s Council of Economic Advisers.

Dr. Antos received a B.A. in mathematics from Cornell University and an M.A. and Ph.D. in economics from the University of Rochester.

Carrière : • 2013–present : Adjunct Associate Professor, Emergency Medicine, George Washington

University,

• 2007–13 : Member, Panel of Health Advisers, Congressional Budget Office,

• 2004–12 : Commissioner, Maryland Health Services Cost Review Commission,

• 2001–03 : Adjunct Professor, Gillings School of Global Public Health, University of North Carolina at Chapel Hill,

• 1995–2001 : Assistant Director for Health and Human Resources, Congressional Budget Office,

• 1987–95 : Director, Office of Research and Demonstrations; Deputy Director of the Office of the Actuary; Acting Associate Administrator for Management, Health Care Financing Administration,

• 1987–93 and 1998 : Health Financing Consultant to the World Bank and to the Organisation for Economic Co-operation and Development, Bulgaria, Croatia, Czech Republic, Slovakia, and Taiwan,

• Senior Economic Adviser, Europe and New Independent States Bureau, US Agency for International Development, 1994–95Deputy Chief of Staff, Office of the Secretary; Principal Deputy Assistant Secretary for Management and Budget, US Department of Health and Human Services, 1986–87

• 1985–86 : Senior Staff Economist, Council of Economic Advisers,

• 1983–85 : Senior Economist, Office of Management and Budget,

1974–83Director of Economic Policy Analysis and Senior Economist, Office of Research and Evaluation, Bureau of Labor Statistics, US Department of Labor,

EDUCATION

Joseph R. Antos, Ph.D.

American Enterprise Institute 1150 Seventeenth Street, NW Washington, D.C. 20036 (202) 862-5938 (tel) (202) 862-7177 (fax) jantos@aei.org

- Ph.D. (Economics) University of Rochester, 1974

- M.A. (Economics) University of Rochester,

- B.A. (Mathematics)

- 1971 Cornell University, 1968

EMPLOYMENT HISTORY

2001 - present

American Enterprise Institute

Wilson H. Taylor Scholar in Health Care and Retirement Policy, 2003 - present Resident Scholar, 2001 - 2002

Conducts research on the interactions between health plans, insurers, providers, policy makers, and consumers of health care. Current interests include health system reform, Medicare reforms (including the introduction of a prescription drug benefit and broader reforms intended to maintain the program’s long-term viability), policies to help the uninsured, and regulation of health plans and providers.

Maryland Health Services Cost Review Commission 2004 – 2012

Commissioner

The Commission determines payment rates for hospitals in Maryland. Members are appointed by the Governor on an unpaid basis.

University of North Carolina, Chapel Hill 2001 – 2003

Adjunct Professor in the School of Public Health.

Congressional Budget Office 1995 - 2001

Assistant Director for Health and Human Resources Directed CBO’s analysis of policies related to health, retirement, welfare, labormarket, and education programs.

Studies examine the costs and economic effects of current programs and legislative proposals. The division provides technical advice to Congress on legislative initiatives and program reforms.

Health Care Financing Administration 1987 - 1995

(renamed the Centers for Medicare and Medicaid Services) Deputy Director, Office of the Actuary, 1993 - 1995

Provided managerial and professional direction for the Office of the Actuary. Senior adviser for economic studies of the costs, utilization, and efficiency of Medicare and Medicaid programs and policies that affect those programs.

Director, Office of Research and Demonstrations, 1987 - 1993

Directed the Health Care Financing Administration’s $75 million research and demonstration program. Major research initiatives encompassed a wide range of Medicare and Medicaid policies,

including: Payment systems for hospital, physician, and other Medicare services,

Access to and quality of care, Managed care, Long-term care, and State innovations in Medicaid.

Acting Associate Administrator for Management, 1988 - 1989

Directed HCFA bureaus that provide administrative, data processing, and actuarial support for the agency. Oversaw the formulation and implementation of HCFA’s $120 billion annual budget. Directed a major actuarial analysis of prescription drug costs under Medicare.

U.S. Department of Health and Human Services 1986 - 1987

Deputy Chief of Staff, 1986 - 1987

Provided direct technical support for the Secretary, Undersecretary, Chief of Staff, and other senior Department officials. Led development of the Secretary’s catastrophic illness proposal, managing resources and information from all parts of the Department in this year-long effort.

Principal Deputy Assistant Secretary for Management and Budget, 1986

Provided managerial and professional direction to the Department’s Office of Management and Budget. Activities included oversight of the Department’s budget process during the first Gramm-Rudman-Hollings sequester, and development of streamlining plans and reorganization of administrative functions within the Office of the Secretary.

Executive Office of the President 1983 - 1986

Senior Staff Economist, President’s Council of Economic Advisers, 1985 - 1986

Responsible for providing policy guidance in the areas of health, labor, and social policy. Led the Council’s participation in developing policies regarding managed care and Medicare physician payment. Co-authored a chapter on immigration for the annual Economic Report of the President.

Senior Economist, Office of Management and Budget, 1983 -1985

Responsible for policy analysis of income maintenance, labor, and other social programs. Managed and refined extensive data analyses conducted by HHS and the Bureau of the Census regarding poverty in America, in support of the OMB Director’s congressional testimonies.

U.S. Department of Labor 1974 - 1983

Director of Economic Policy Analysis, Office of the Assistant Secretary for Policy, 1982 – 1983

Directed a technical staff dedicated to analysis of labor market trends and the impacts of Department programs on employment, wage levels, and future job growth.

Senior Economist, Office of Research and Evaluation, U.S. Bureau of Labor Statistics, 1974 - 1981

Directed large-scale studies of the labor market, including analyses of the consequences of job-changing among young people, trade-offs between wage and non-wage compensation of employees, and the job creation effects of small employers. Led a year-long study of the two major BLS employment series, to reconcile apparent differences in trends displayed by these major labor market indicators.

I

nternational Experience

Senior Economic Adviser, Bureau for Europe and New Independent States, U.S. Agency for International Development (USAID), 1994 - 1995

Led technical assistance missions to the Czech Republic, the Slovak Republic, and Bulgaria. Major issues included establishing payment systems for hospital, physician, and clinic services; developing a data infrastructure for management and policy development; establishing more efficient methods of delivering care.

Moderator, “Insurance Reform: Establishing a New Health Insurance Agency,” for USAID conference on Realizing the Vision of Health Reform: Changes, Challenges, and Successes in Central and Eastern Europe, September 25 - 28, 1994, Prague.

Organized “Risk Management in Health Insurance Programs,” USAID training program for the Czech

Republic, October 3 - 12, 1994, Prague.

Health Financing Consultant, 1987 – present

Speaker and session moderator, CSIS-CNHDRC Roundtable on Healthcare Reforms in China and the United States, Beijing, 2011.

Health financing specialist, World Bank mission to Thailand on the fiscal sustainability of Thailand’s health reform, 2007.

Health financing specialist, World Bank mission to Egypt on health reform, 2002.

Health financing specialist, World Bank mission to Croatia on sector reform, 1998.

Course instructor, “Designing a National Insurance Program,” Ministry of Health, Republic of China (Taiwan), August 2-4, 1993.

Representative for the U.S. Department of Health and Human Services, study tour of the German health system funded by the German Bundestag, November 20 - December 4, 1993.

Conducted a USAID assessment mission to the Czech Republic to determine the level of assistance required for health reform measures, 1992.

Representative for the U.S. Department of Health and Human Services, Seminar on Health Financing and Health Insurance in Asia, December 10-14, 1990, Bali, Indonesia.

Representative for the Health Care Financing Administration, 23rd General Assembly of the International Social Security Administration, September 5-13, 1989, Vienna.

Representative for the U.S. Department of Health and Human Services, working party meetings, Organization for Economic Cooperation and Development (OECD), Paris. Meeting dates: September 8-12, 1989; September 23-25, 1992; December 7-9, 1992; November 29-30, 1993.

OTHER PROFESSIONAL EXPERIENCE

1150 Seventeenth Street, N.W., Washington, D.C. 20036 202.862.5800 Fax 202.862.7178 www.aei.org

Memberships: American Economic Association, National Academy of Social Insurance, AcademyHealth

Coalition for Health Services Research, board member 2005 – present, treasurer 2006 – 2007, chair 2007 – 2008, past chair, 2009 – 2010

AcademyHealth, board member 2008

Member, Panel of Health Advisers, Congressional Budget Office, 2007 - present

Member, Comeback America Initiative advisory council, 2011 – present

Member, Institute for Health Systems Solutions advisory board, 2012 – present

Member, Peterson Center on Healthcare advisory board, 2013 – present

Member, Committee on the Fiscal Future of the United States, The National Academies and the National Academy of Public Administration, 2008 – 2010

Member, National Advisory Committee, AmericaSpeaks: Our Budget, our Economy, 2010 Member, board of trustees, David A. Winston Health Policy Fellowship, 2008 – present Member, editorial board, American Health and Drug Benefits, 2008 – present Member, editorial board, Health Affairs, 2012 – present

Member, advisory board, Health Sector Assembly, 2008 – present

Member, advisory board, McKinsey Health Systems Institute and Center for U.S. Health System Reform, 2010 – present

Member, advisory board, Consumer Engagement in Health Care Survey, Employee Benefits Research Institute, 2005 – present

Member, advisory panel to the Critical Review of the U.S. Actuarial Profession, organized by the American Academy of Actuaries, 2006

Member, Fiscal Sustainability Task Force for the Federal Accounting Standards Advisory Board, 2007

Reviewer for Health Affairs, Congressional Budget Office, Medicare Payment Advisory Commission, Medicaid and CHIP Payment and Access Commission

Steering Committee for the National Health Policy Forum, 1996 - 2001

1150 Seventeenth Street, N.W., Washington, D.C. 20036 202.862.5800 Fax 202.862.7178 www.aei.org

Teaching experience: American University, Business School, 1979 St. John Fisher College, Economics Department, 1972 - 1974 University of Rochester, Economics Department, 1972

President’s Reorganization Project for the Federal Statistical System, Consultant, 1978 Educational Testing Service, Consultant, 1976

AWARDS

Management Leadership Award, Congressional Budget Office, 2000 Presidential Executive Rank Award for Meritorious Service, 1991 Senior Executive Service Performance Awards, 1986, 1988 - 1992 Secretary’s Citation, U.S. Department of Health and Human Services, 1987 Distinguished Service Award, U.S. Department of Labor, 1983 Distinguished Achievement Award for Research, U.S. Department of Labor, 1978

http://www.aei.org/files/2013/03/20/-antos-curriculum-vitae_171602290046.pdf

Bibliographie :

SELECTED PUBLICATIONS AND PRESENTATIONS

Congressional Testimony

Joseph Antos, “Medicare's fiscal crisis and options for reform,” report to Rep. Phil Gingrey, M.D. (at the request of himself and 15 health professionals who are members of Congress), April 30, 2012.

Joseph Antos, “Premium Support Proposals for Medicare Reform,” House Committee on Ways and Means, Health Subcommittee, April 27, 2012.

Joseph R. Antos, “A Time for Solutions: Finding Consensus in the Medicare Reform Debate,” Senate Special Committee on Aging, October 12, 2011.

Joseph R. Antos, “Triggering a Policy Response to the Medicare Funding Warning,” House Committee on Oversight and Government Reform, July 12, 2011.

Joseph R. Antos, “The Implementation and Sustainability of the Community Living Assistance Services and Supports (CLASS) Program,” House Committee on Energy and Commerce, March 17, 2011.

Joseph R. Antos, “Financing Health Care Reform,” Senate Committee on Finance Roundtable, 1150 Seventeenth Street, N.W., Washington, D.C. 20036 202.862.5800 Fax 202.862.7178 www.aei.orgMay 12, 2009.

Joseph R. Antos, “Protecting the Medicaid Safety Net Act of 2008, “ House Committee on Energy and Commerce, Health Subcommittee, April 3, 2008.

Joseph R. Antos, “Living without Health Insurance: Why Every American Needs Coverage, “ House Committee on Energy and Commerce, Health Subcommittee, April 25, 2007.

Joseph R. Antos, “Market Initiatives to Improve Access to Health Insurance,” Senate Committee on Health, Education, Labor, and Pensions, January 10, 2007.

Joseph R. Antos, “Role of Health Services Research in Improving Our Nation’s Health,” Subcommittee on Labor, Health and Human Services, Education and Related Agencies, Committee on Appropriations, U.S. House of Representatives, March 29, 2006 (on behalf of the Coalition for Health Services Research).

Joseph R. Antos, “Medicare and the Prescription Drug Benefit: Increased Pressure for Reform,” Subcommittee on Federal Financial Management, Government Information, and International Security, Committee on Homeland Security and Governmental Affairs, U.S. Senate, September 2005.

Joseph R. Antos, “Can Medicare and Medicaid Promote More Efficient Health Care?” U.S. Federal Trade Commission and U.S. Department of Justice, September 2003.

Joseph R. Antos, “A Medicare Prescription Drug Safety Net: Creating a Targeted Benefit for Low-Income Seniors,” Subcommittee on Human Rights and Wellness, Committee on Government Reform, U.S. House of Representatives, September 2003.

Joseph R. Antos and Jagadeesh Gokhale, “The Cost of Adding a Prescription Drug Benefit to Medicare,” Subcommittee on Human Rights and Wellness, Committee on Government Reform, U.S. House of Representatives, July 2003.

Joseph R. Antos, “The Role of Market Competition in Strengthening Medicare,” Senate Special Committee on Aging, May 2003.

Joseph R. Antos, “Medicare Financing and Prescription Drugs,” Committee on the Budget, U.S. House of

Representatives, May 2002.

Joseph R. Antos, “Designing a Medicare Prescription Drug Benefit,” briefing for the Subcommittee on Health, Committee on Ways and Means, U.S. House of Representatives, March 2001.

Joseph R. Antos, “Premium Increases in the Federal Employees Health Benefits Program,” Subcommittee on Civil Service, Committee on Government Reform and Oversight, U.S. House of Representatives, October 1997.

Joseph R. Antos, “2010 and Beyond: Preparing Medicare for the Baby Boomers,” Special 1150 Seventeenth Street, N.W., Washington, D.C. 20036 202.862.5800 Fax 202.862.7178 www.aei.org

Committee on Aging, U.S. Senate, August 1997 (at Sioux City, Iowa).

Joseph R. Antos, “Medicare Payment Policies for Post-Acute Care,” Committee on Finance, U.S. Senate, April 1997.

Joseph R. Antos, “The Magnitude of the Financial Crisis in Medicare,” Subcommittee on Health Care, Committee on Finance, U.S. Senate, February 1997.

Joseph R. Antos, “Status of the Medicaid Program,” Committee on Commerce, Subcommittee on Health and Environment, U.S. House of Representatives, June 1995.

Primary author of testimonies by the CBO Director:

“Medicare Reform: Providing Prescription Drug Coverage for Seniors,” Subcommittee on Health, Committee on Energy and Commerce, U.S. House of Representatives, May 2001.

“Laying the Groundwork for a Medicare Prescription Drug Benefit,” Subcommittee on Health, Committee on Ways and Means, U.S. House of Representatives, March 2001.

“Prescription Drugs and Medicare Financing,” Committee on Finance, U.S. Senate, March 2001.

“A CBO Analysis of the Administration’s Prescription Drug Proposal,” Subcommittee on Health, Committee on Ways and Means, U.S. House of Representatives, May 2000.

“Medicare for Future Generations,” Subcommittee on Health, Committee on Ways and Means, U.S. House of Representatives, September 1999.

“The President’s Proposal for Medicare Reform,” Committee on Finance, U.S. Senate, July 1999.

“Health Care Costs and Insurance Coverage,” Subcommittee on Employer-Employee Relations, Committee on Education and the Workforce, U.S. House of Representatives, June1999.

“Medicare Reform,” Committee on Finance, U.S. Senate, May 1999.

“The Implications of Medicare Financing for the Federal Budget,” Committee on Finance, U.S. Senate, May 1999.

“The Financial Status of Medicare,” Committee on Finance, U.S. Senate, March 1999.

“The Financial Status of the Medicare Program,” Committee on Finance, U.S. Senate, May 1995.

“The Financial Status of the Medicare Program,” Committee on the Budget, U.S. Senate, May 1995.

“The Financial Status of the Medicare Program,” Committee on Ways and Means, U.S. House of Representatives, May 1995.

“Growth in Medicaid Spending,” Committee on the Budget, U.S. House of Representatives, April 1995.

Books

Joseph Antos, Saving Medicare: A Market Cure for an Ailing Program. American Enterprise Institute, 2012. 78 pp.

Joseph Antos and Thomas P. Miller, A Better Prescription. American Enterprise Institute, 2010. 27 pp.

1150 Seventeenth Street, N.W., Washington, D.C. 20036 202.862.5800 Fax 202.862.7178 www.aei.org

Co-author, Choosing the Nation's Fiscal Future. The National Academies Press, 2010. 338 pp. Alice M. Rivlin and Joseph R. Antos (eds.), Restoring Fiscal Sanity 2007: The Health Spending

Challenge. Brookings Institution Press, 2007. 233 pp. Joseph Antos and Ximena Pinell, Private Discounts, Public Subsidies: How the Medicare

Prescription Drug Discount Card Really Works. Washington: The AEI Press, 2004. 37 pp. Joseph Antos et al., Issues in Designing a Prescription Drug Benefit in Medicare. Washington: Congressional Budget Office, October 2002. 52 pp.

Joseph R. Antos and Wesley Mellow, The Youth Labor Market: A Dynamic Overview. Washington: Government Printing Office, 1979. 189 pp.

Book Chapters

Joseph Antos, “Federal Health Spending: What Path Is Implied Under U.S. Budget Deficit Control?” in Sustainable Health Spending and the U.S. Federal Budget, Symposium Monograph, Altarum Center for Sustainable Health Spending, November 13, 2012, 4-10.

Joseph R. Antos and Alice M. Rivlin, “Slowing the Growth of Health Spending: We Need Mixed Strategies and We Need to Start Now” in Opportunity 08: Independent Ideas for America’s Next President, Michael O’Hanlon (ed.), Brookings Institution Press, 2007, 303-320.

Joseph R. Antos et al., “Expanding the Scope of Federal Retirement, Health, and Education Activities” in Budget Options, Washington: Congressional Budget Office, March 2001, 27-58.

Joseph R. Antos et al., “Options to Expand Federal Health, Retirement, and Education Activities” in Budget Options, Washington: Congressional Budget Office, March 2000, 11-40.

Joseph R. Antos and Linda Bilheimer, “The Bumpy Road to Medicare Reform” in Medicare in the 21st Century: Seeking Fair and Efficient Reform, R. Helms (ed.). Washington: American Enterprise Institute, 1999, 23-40.

Joseph R. Antos, “Financing Medicare: Preparing for the Retirement of the Baby Boomers,” in Medicare: Preparing for the Challenges of the 21st Century, R. Reischauer, S. Butler, and J. Lave (eds.). Washington: National Academy of Social Insurance, 1998, 43-51.

Joseph R. Antos and Linda Bilheimer, “Medicare and Medicaid: Deficit Reduction and Program Restructuring” in Reducing the Deficit: Spending and Revenue Options. Washington: Congressional Budget Office, March 1997, 295-326.

Joseph R. Antos and Linda Bilheimer, “Medicare and Medicaid: Deficit Reduction and Program Restructuring” in Reducing the Deficit: Spending and Revenue Options. Washington: Congressional Budget Office, August 1996, 415-446.

1150 Seventeenth Street, N.W., Washington, D.C. 20036 202.862.5800 Fax 202.862.7178 www.aei.org

Joseph R. Antos, “Research Perspectives on HMOs and the Elderly,” in HMOs and the Elderly, Hal Luft (ed.). San Francisco: Health Administration Press, 1994.

Joseph R. Antos, “Health Care Costs, Access to Care, and Prospects for Reform,” in Health Care Financing: Issues for Insurers. Schaumburg, IL: Society of Actuaries, 1991.

Joseph R. Antos, “The Policy Context of Physician Payment,” in Regulating Doctors’ Fees, H.E. Frech III (ed.). Washington: American Enterprise Institute, 1991, 35-51.

Joseph R. Antos, “Analysis of Labor Cost: Data Concepts and Sources,” in The Measurement of Labor Cost, Jack E. Triplett (ed.). Chicago: University of Chicago Press, 1983.

Articles, Reports, and Opinion

Joseph Antos, “Health Care for the Poor, Or Poor Health Care?” Real Clear Markets, March 6,

2013.

Joseph Antos, “The Medicaid Expansion is Not Such a Good Deal for States or the Poor,”

Journal of Health Politics, Policy, and Law, February 2013.

Joseph Antos, “Getting Back to Reality: The Election, the Fiscal Cliff, and the ACA,” American

Health & Drug Benefits, November/December 2012.

Joseph Antos, “Medicare Silver Bullets,” Kaiser Health News, December 12, 2012.

Joseph Antos, “After the Fall (Off the Fiscal Cliff),” Health Affairs Blog, November 15, 2012.

Joseph Antos, “Health Care Reform After SCOTUS: Hard Decisions Needed to Avoid Health

Sector Meltdown,” American Health & Drug Benefits, July/August 2012.

Joseph Antos, “Ryan's Plan Is Our Best Hope for Increasing Medicare Efficiency,” U.S. News

Debate Club, August 17, 2012.

Joseph Antos, “Medicare 2035: Older, sicker, poorer,” Daily Caller, August 16, 2012.

Joseph Antos, Mark Pauly, and Gail Wilensky, “Bending the Cost Curve through Market-Based

Incentives,” New England Journal of Medicine, August 1, 2012.

Joseph Antos and Michael Strain, “If You Don’t Buy Insurance, Will You Really Pay the Tax?”

The American, July 17, 2012.

Joseph Antos, “After the Supreme Court, Higher Cost and Unrealistic Timeline Will Force

Major Changes,” Health Affairs Blog, July 2, 2012.

Joseph Antos, “The mandate survived. Will the market?” AEIdeas, June 28, 2012.

1150 Seventeenth Street, N.W., Washington, D.C. 20036 202.862.5800 Fax 202.862.7178 www.aei.org

Joseph Antos, “Medicare's fiscal crisis and options for reform,” report to Rep. Phil Gingrey,

April 30, 2012.

Joseph Antos, “A bad day for the White House—and for taxpayers,” The Enterprise Blog, April

24, 2012.

Joseph Antos, “No, Obamacare really doesn’t add up,” The Enterprise Blog, April 11, 2012.

Joseph Antos, “The individual mandate won't save Obamacare,” Real Clear Markets, April 10,

2012.

Joseph Antos, “Fact checking the fact checker on Paul Ryan’s Medicare reform plan,” The

Enterprise Blog, April 6, 2012.

Joseph Antos, “The Ryan plan: the Cliff's Notes version of Republican health reform,” Health

Affairs Blog, March 21, 2012.

Joseph Antos, “No, Paul Ryan’s new budget does not end Medicare,” The Enterprise Blog,

March 20, 2012.

Joseph Antos, “IPAB is no Fed, will fail,” National Journal, March 5, 2012.

Joseph Antos, “Medicare Reform Faces Reality,” The American, February 17, 2012.

Joseph Antos, “Competitive bidding: A market cure for Medicare’s crisis,” The Enterprise Blog,

February 16, 2012.

Joseph Antos, “President Obama's Medicare cuts don't cut it,” The Hill, February 13, 2012.

Joseph Antos, “The Wyden–Ryan Proposal—A Foundation for Realistic Medicare Reform,” New

England Journal of Medicine, January 25, 2012.

Joseph Antos, “One step closer to a Medicare reform that can work,” The Enterprise Blog,

December 15, 2011.

Joseph Antos, “Obama plan to force 'rebates' into Medicare drug benefit will drive up costs for thousands of seniors,” New York Daily News, November 13, 2011.

Joseph Antos, “Medicare's failed physician payment policy,” RealClearMarkets, November 10, 2011.

Joseph Antos, “Designed to Fail,” National Journal, September 19, 2011. Joseph Antos, “How the Debt Deal Will Really Work,” The Enterprise Blog, August 18, 2011. Joseph Antos, “The American People Deserve Action,” The American Square, August 16, 2011.

1150 Seventeenth Street, N.W., Washington, D.C. 20036 202.862.5800 Fax 202.862.7178 www.aei.org

Joseph Antos, “The Debt Deal Will Undo Obamacare,” The American, August 4, 2011.

Joseph Antos, “The Debt Ceiling Deal: Kicking the Can Down the Road,” Health Affairs Blog, August 2, 2011.

Joseph Antos, “Waxman-Rockefeller Tax Is a Bad Deal for Senior Citizens,” Forbes.com, July 26, 2011.

Joseph Antos, “Top-down Controls Not the Solution: Response to Marmor, Oberlander, and White,” Journal of Policy Analysis and Management, July 15, 2011.

Joseph Antos, “Medicare Reform and Fiscal Reality,” Journal of Policy Analysis and Management, July 15, 2011.

Joseph Antos, “Will the McConnell Debt Deal Work?” The American Square, July 14, 2011. Joseph Antos, “Living in a Fiscal Fantasy World,” The American Square, July 12, 2011.

Joseph Antos and Guy King, “Tampering with Part D Will Not Solve Our Debt Crisis,”AEI Online, June 29, 2011.

Joseph Antos, “What Does Medicare Part D Say About the Ryan Plan?” RealClearMarkets.com, June 15, 2011.

Joseph Antos, “There's No Limit on Irresponsibility,” The American Square, June 6, 2011.

Joseph Antos, Andrew Biggs, Alex Brill, and Alan Viard, “Fiscal Solutions: A Balanced Plan for Fiscal Stability and Economic Growth,” Solutions Initiative by Peter G. Peterson Foundation, May 25, 2011.

Joseph Antos, “Mr. Speaker, Medicare IS Social Engineering,” The Enterprise Blog, May 16, 2011.

Joseph Antos, Andrew Biggs, Alex Brill, and Alan Viard, “How We Would Cut America's Debt,” Washington Post, May 23, 2011.

Joseph Antos, “The Choice Matters,” The American Square, April 22, 2011.

Joseph Antos, “Premium Support Can Save Medicare, But Only If Congress Can Just Say No,” The American Square, April 19, 2011.

Joseph Antos, “Just How Is Medicare Spending Our Money?” The Enterprise Blog, April 8, 2011.

Joseph Antos, “When Is a Rebate Not a Rebate?” The Enterprise Blog,

July 8, 2011.

Joseph Antos, “Congress Should Not Ignore Medicare’s Fiscal Crisis,” The Fiscal Times, April 1, 2011.

Joseph Antos, “Who’s Next, After Don Berwick?” The Enterprise Blog, March 9, 2011.

Joseph Antos, “Scorekeeping Doesn't Work if Policymakers Aren't Serious,” The Fiscal Times, January 31, 2011.

Joseph Antos, “State of the Union: A Taste of Budgets to Come,” Health Affairs Blog, January 26, 2011.

Douglas Holtz-Eakin, Joseph Antos, James Capretta, “Health Care Repeal Won't Add to the Deficit,” Wall Street Journal, January 19, 2011.

Joseph Antos, “Nonprofits Lobby, Too,” The Enterprise Blog, January 18, 2011.

Joseph Antos, “Without the Individual Mandate, What Will Happen to Obamacare?” Medical Progress Today Second Opinion, December 16, 2010. Joseph Antos, “Long May She Waive,” The American, December 15, 2010.

Joseph Antos, “Reforming Health Care Reform in the 112th Congress,” The New England Journal of Medicine, December 8, 2010.

Joseph Antos, “Confessions of a Price Controller,” The American, October 30, 2010. Joseph Antos, “Ronald McDonald Keeps His Insurance,” The Enterprise Blog, October 8, 2010.

Joseph Antos, John Bertko, Michael Chernew, et al., “Bending the Curve Through Health Reform Implementation,” Engelberg Center for Health Care Reform at Brookings, October 2010.

Joseph Antos, “I’ll Have a Big Mac, Hold the Health Insurance,” The Enterprise Blog, September 30, 2010.

Joseph Antos, “Still No Good News for ObamaCare,” The American, September 23, 2010. Joseph Antos, “Krugman and the Cost Curve: Reality Check,” The Enterprise Blog, August 9,

2010. Joseph Antos, “A Mistaken Prognosis for Medicare,” The American, August 5, 2010.

Joseph Antos, “How I Learned to Stop Worrying and Love ObamaCare,” The Enterprise Blog, March 26, 2010.

Joseph Antos, “Arena Digest: Reform Essentials,” Politico, February 25, 2010. Joseph Antos, “Showdown at Blair House,” National Review Online, February 23, 2010.

1150 Seventeenth Street, N.W., Washington, D.C. 20036 202.862.5800 Fax 202.862.7178 www.aei.org

Joseph Antos and Thomas P. Miller, “A Better Prescription,” American Enterprise Institute and AEI Online, February 23, 2010.

Joseph Antos, “Unhealthy Spending, Unhealthy Economy,” ChoosingOurFiscalFuture.org, February 16, 2010.

Joseph Antos, “Commission Not a Serious Solution,” FiscalTimes.org, February 11, 2010.

Joseph Antos, “This Is How the Health Care Overhaul Ends,” The American, February 9, 2010.

Joseph Antos, “Rethinking Health Reform,” HealthAffairs.org, January 29, 2010.

Joseph Antos, “The Uninsured,” The American, January 19, 2010.

Joseph Antos, “Let’s Give Stupidity Its Due,” The Enterprise Blog, January 5, 2010.

Joseph Antos, “Troublesome Direction of Health Reform,” NationalJournal.com, November 16, 2009.

Joseph Antos, “Increase Consumer Choice,” New York Times Room for Debate, November 10, 2009.

Joseph Antos, “Health Reform: A Fiscal Fantasy Land,” Forbes.com, October 15, 2009.

Joseph Antos, John Bertko, Michael Chernew, et al., “Bending the Curve: Effective Steps to Address Long-Term Healthcare Spending Growth,” American Journal of Managed Care, 15 (October 2009): 676-680.

Joseph Antos, “The Politics and Principles of Health Care Reform,” AEI Health Policy Outlook, no. 11, September 2009.

Grace-Marie Turner and Joseph Antos, “Medicare Is No Model for Health Reform,” Wall Street Journal, September 11, 2009.

Joseph Antos and Jeet Guram, “Here's Why the Public Plan Won't Work,” The American, August 27, 2009.

Joseph Antos and others, “Bending the Curve,” The Brookings Institution, August 15, 2009.

Joseph Antos, “Taking the Politics Out of Health Reform? Hardly,” The Enterprise Blog, July 27, 2009.

Joseph Antos, “A Look at Health Care Reform by the Numbers,” Washington Examiner, July 15, 2009.

Joseph Antos, “What Can a Texas Town Teach Us About Healthcare?” The Enterprise Blog, June 1, 2009.

Joseph Antos, “The Case for Real Health Care Reform,” AEI Online, June 2009.

Joseph Antos, “Obama Targets Wrong Tax for Health Reform,” Detroit News, May 30, 2009.

Joseph Antos and Grace-Marie Turner, “The GOP’s Health-Care Alternative,” Wall Street Journal, May 20, 2009.

Joseph Antos, “Rangel Says ‘No New Taxes’,” The Enterprise Blog, May 11, 2009.

Joseph Antos, “Spending Our Way to Health Care Reform,” San Diego Union-Tribune, May 5, 2009.

Joseph Antos, “Stimulus Bails Out States, Puts off Health Care Reform,” Atlanta Journal- Constitution, February 22, 2009.

Joseph Antos, “Stimulus Package Punts on Health Care Reform,” Detroit News, February 6, 2009. Joseph Antos, “Health Policy in the New Administration,” American Health & Drug Benefits,

February 2009. Joseph Antos, “Stakeholder Perspective: Health Reform and the Next President,” American

Health & Drug Benefits, October 2008. Joseph Antos, “Obama's $2,500 Promise,” National Review Online, October 10, 2008.

Joseph Antos, “Symptomatic Relief, but No Cure—The Obama Health Care Reform,” New England Journal of Medicine, October 16, 2008.

Joseph Antos, Gail Wilensky, and Hanns Kuttner, “The Obama Plan: More Regulation, Unsustainable Spending,” Health Affairs (Web Exclusive), September 16, 2008.

Emily J. Holubowich and Joseph R. Antos, “Treading Water: The No-Growth Investment in Health Services Research,” American Health & Drug Benefits, July/August 2008.

Joseph Antos, “Have Health Reformers Forgotten Medicare?” AEI Health Policy Outlook, no. 5, July 2008.

Meena Seshamani, Jeanne M. Lambrew, and Joseph Antos, “Financing the U.S. Health System: Issues and Options for Change,” The Leaders’ Project on the State of American Health Care, Bipartisan Policy Center, June 2008.

Joseph Antos, “Lessons from the Clinton Plan: Incremental Market Reform, Not Sweeping Government Control,” Health Affairs May/June 2008.

Joseph Antos, “Health Reform and the Presidential Candidates,” Endocrine Practice May/June 2008.

Joseph Antos and Mark Pauly, “Saving Medicare,” Forbes.com, May 9, 2008

Joseph Antos, “Medicare’s Bad News: Is Anyone Listening?” AEI Health Policy Outlook, no. 3, April 2008.

Joseph Antos et al., “Taking Back Our Fiscal Future,” April 2008, www.brookings.edu/papers/2008/04_fiscal_future.aspx.

Joseph Antos, “The Uninsured and Affordability,” Letter to the Editor, Health Affairs March/April 2008; 27(2): 587-588.

Joseph Antos, “Balancing the Budget on the Backs of Cancer Patients?” www.american.com, June 12, 2007.

Joseph Antos, “Saving Medicare from a Fiscal Breakdown,” RealClearPolitics.com, April 10, 2007.

Joseph Antos and Alice Rivlin, “Slowing the Rising Costs of Health Care Possible,” Albany Times-Union, April 1, 2007.

Joseph R. Antos, “Good Medicine for the Tax Code,” www.american.com, January 25, 2007. Joseph R. Antos, “Q&A: Everything You Wanted to Know About Medicare But Were Too

Confused to Ask,” The American, March/April 2007. Joseph Antos and Roland (Guy) King, “Competition and Bundled Pricing in Medicare’s Part B

Drug Market,” December 2006. Joseph Antos, “Is There a Right Way to Promote Health Insurance Through the Tax System?”National Tax Journal, LIX no.3 (September 2006):477-490.

Joseph Antos, “Crisis du Jour or the Real Thing?” AEI Health Policy Outlook, no. 7, 2006.

Joseph Antos, “Will Competition Return to Medicare?,” AEI Online, February 2006.

Joseph Antos, “Commissioning a Medicare Crisis,” Medical Progress Today, February 6, 2006.

Joseph Antos, “Ensuring Access to Affordable Drug Coverage in Medicare,” Health Care Financing Review, Winter 2005-06, 103-112.

Joseph Antos, “Cutting through Confusion in Part D,” AEI Health Policy Outlook, no. 2, 2006. Tracy L. Foertsch and Joseph R. Antos, “Paying for Medicare: An Economic Look at the

Program's Unfunded Liabilities,” The Heritage Foundation WebMemo, no. 880, October 11, 2005. 1150 Seventeenth Street, N.W., Washington, D.C. 20036 202.862.5800 Fax 202.862.7178 www.aei.org

Tracy L. Foertsch and Joseph R. Antos, “The Economic and Fiscal Effects of Financing Medicare's Unfunded Liabilities,” The Heritage Foundation Center for Data Analysis Report, no. 05-06, October 11, 2005.

Joseph Antos, “Medicare: Yesterday and Tomorrow,” The Commonwealth Fund, July 2005; reprinted in AEI On The Issues, August 2005.

Joseph Antos and Thomas Wildsmith, “Inflated Claims about Drug Prices,” AEI Health Policy Outlook, July-August 2005.

Joseph Antos, “Health Policy on a Budget,” AEI Health Policy Outlook, March-April 2005. Joseph Antos and Jagadeesh Gokhale, “Medicare Prescription Drugs: Medical Necessity Meets

Fiscal Insanity,” Cato Institute Briefing Papers, no. 91, February 9, 2005.

Joseph Antos, Roland (Guy) King, Donald Muse, Tom Wildsmith, and Judy Xanthopoulos, Analyzing the Kerry and Bush Health Proposals: Estimates of Cost and Impact, American Enterprise Institute, September 13, 2004.

Joseph Antos, “Kerry, Bush, and the Uninsured,” AEI Health Policy Outlook, September-October 2004.

Grace-Marie Turner and Joseph Antos, “The Medicare Drug Discount Card: First Phase of a Market Revolution?”

The Heritage Foundation Heritage Lecture, no. 846, July 30, 2004.

Joseph Antos and Grace-Marie Turner, “New Drug Plan: There’s More For the Poor,” Wall Street Journal, May 6, 2004.

Joseph Antos, “Fixing the New Medicare Law, #2: How to Promote Real Medicare Cost Containment,” The Heritage Foundation Backgrounder, no. 1751, April 26, 2004.

Grace-Marie Turner and Joseph Antos, “Fixing the New Medicare Law, #3: How to Build on the Drug Discount Card,” The Heritage Foundation Backgrounder, no. 1752, April 26, 2004.

Joseph Antos, “Don’t Ask, Don’t Tell,” AEI Health Policy Outlook, March-April 2004. Joseph Antos and Jack E. Calfee, “Of Sausage-Making and Medicare,” AEI Health Policy Outlook,January-February 2004.

Joseph Antos and Guy King, Comparing Medicare and Private Sector Spending Growth: Recent Study Does Not Account for Important Private Sector Changes, Pharmaceutical Research and Manufacturers of America, Winter 2003.

Joseph Antos, “How to Overcome Four Key Obstacles to a Medicare Drug Benefit,” AEI Health Policy Outlook, September 2003.

1150 Seventeenth Street, N.W., Washington, D.C. 20036 202.862.5800 Fax 202.862.7178 www.aei.org

Joseph Antos and Jagadeesh Gokhale, “The Medicare Prescription Drug Benefit Is Bad for America’s Health,” AEI On The Issues, July 2003.

Joseph Antos and Jagadeesh Gokhale, “A Benefit That Is Bad For America’s Health,” Financial Times, June 20, 2003.

Joseph R. Antos, “Reforming Health Insurance: Realistic Options and Hard Choices,” Health Affairs (Web Exclusive), April 23, 2003.

Joseph R. Antos with Alfredo Goyburo, “Comparing Medicare and Private Health Insurance Spending,” The Heritage Foundation Web Memo, no. 250, April 8, 2003.

Joseph R. Antos and Grace-Marie Turner, “Congress and Prescription Drugs: It’s Time to Get Involved,” The World and I, March 2003.

Joseph R. Antos and Grace-Marie Turner, “What Congress Should Do about Prescription Drugs for Seniors,” AEI On The Issues, September 2002.

Grace-Marie Turner and Joseph R. Antos, “Outside View: The Senate on Drugs,” United Press International, August 1, 2002.

Grace-Marie Turner and Joseph R. Antos, “Congressional Pill: A Medicare Bill That Can Pass?” National Review Online, July 30, 2002.

Joseph R. Antos, Grace-Marie Turner, and Robert E. Moffit, “Time for a Sensible Medicare Drug Benefit,” The Heritage Foundation, Backgrounder, no. 1573, July 23, 2002.

Joseph R. Antos and Grace-Marie Turner, “Some Bad Options for Drug Coverage,” San Diego Union-Tribune, July 19, 2002.

Joseph R. Antos, “Medicare+Choice: Where Did the Scorekeepers Go Wrong?,” Health Affairs (Web Exclusive), November 28, 2001, W83-W85.

Joseph R. Antos and Linda Bilheimer, “Medicare Reform: Obstacles and Options,” American Economic Review, May 1999, 217-221.

Joseph R. Antos, Katherine Rarick, Bruce Vavrichek, and Judith Wagner, The Proposed Tobacco Settlement: Issues From a Federal Perspective, Congressional Budget Office, April 1998.

Joseph R. Antos and Richard Foster, “Now That the Dust Has Settled: What Was in Those Medicare Proposals?,” Contingencies, January/February 1997, 18-25.

Joseph R. Antos, Linda Bilheimer, and W. Pete Welch, Medicare Spending on Post-Acute Care Services: A Preliminary Analysis, Congressional Budget Office, January 1997.

Joseph R. Antos, Commentary on “The Long Term Prospects for Medicare and the Delivery of Retiree Health Benefits,” in Providing Health Care Benefits in Retirement, Judith Mazo, Anna Rappaport, and Sylvester Schieber (eds.). Philadelphia: University of Pennsylvania, 1994, 153- 159.

Joseph R. Antos, “Waivers, Research, and Health System Reform,” Health Affairs, Spring 1993, 178-183.

Joseph R. Antos, “Union Effects on White Collar Compensation,” Industrial and Labor Relations Review, April 1983, 461-479.

Joseph R. Antos, Mark Chandler, and Wesley Mellow, “Sex Differences in Union Membership,” Industrial and Labor Relations Review, January 1980, 162-169.

Joseph R. Antos, Wesley Mellow, and Jack E. Triplett “What is a Current Equivalent to Unemployment Rates of the Past?,” Monthly Labor Review, March 1979, 36-46.

Joseph R. Antos and Sherwin Rosen, “Discrimination in the Market for Public School Teachers,” Journal of

Econometrics, May 1975, 123-150. (Reprinted in Sherwin Rosen, Markets and Diversity. Cambridge: Harvard University Press, 2004. 56-90.)

Multimedia

Joseph Antos, “Policy Implications of the Affordable Care Act,” Washington Journal, C-SPAN, July 1, 2012, available at http://www.c-span.org/Events/Washington-Journal--Sunday-July-1- 2012/10737432045/.

Joseph Antos, “Health Care Costs: The Role of Technology,” Alliance for Health Reform, May 29, 2012, available at http://www.allhealth.org/briefing_detail.asp?bi=238.

Interview: “Antos on Why 'President Romney' Might Keep Parts of ACA,” Medscape One-on- One, May 29, 2012, available at http://www.medscape.com/viewarticle/763919?src=ptalk.

Joseph Antos, “Inside Deficit Reduction: What It Means for Medicare,” Alliance for Health Reform, October 11, 2011, video available at http://allhealth.org/briefing_detail.asp?bi=222.

Joseph Antos, “Will Health Reform Reduce the Federal Deficit?” Alliance for Health Reform, 2011, video

available at http://www.youtube.com/watch?v=IKWTwPmmmKw.

Joseph Antos, “Boomers Come of Age: Covering Early Retirees and Other 50-64 Year-Olds,” Alliance for Health Reform, January 24, 2011, available at http://allhealth.org/briefing_detail.asp?bi=204.

Interview: “U.S. Policymaker Testimonials,” Center for Medicine in the Public Interest, September 2008, available at http://www.biggovhealth.org/testimonials/policymakers/joseph-antos/.

Interview: Robert Henry, “Medicare Coverage Policies for Biologics: The Broad Gray Line,” American Health and Drug Benefits, April 2008.

Interview: Robert Henry, “Medicare Coverage Strategies: Impact of the MMA and PBMs,” American Health & Drug Benefits, February 2008.

Online debate: “President's Vision for Health Care,” debate between Joseph Antos and Gerald Shea, Washington Post, February 2, 2006, available at

http://www.washingtonpost.com/wp- dyn/content/discussion/2006/01/30/DI2006013000673.html.

Online debate: “Can Consumer Choice Cure the Nation's Health-Care Ills?,” debate between Joseph Antos, John Goodman, and Robert Reischauer, Wall Street Journal, print edition, January 9, 2006.

http://www.aei-ideas.org/2009/07/taking-the-politics-out-of-health-reform-hardly/

A.E.I. Ideas

Taking the Politics Out of Health Reform? Hardly

Joseph Antos | July 27, 2009, 9:13 am

Democrats call it “MedPAC on steroids.”Their idea:a new independent agency that will limit spending in Medicare, something Congress and the president have not been able to do for the past four decades.We already have a Medicare Payment Advisory Commission (MedPAC) that makes recommendations to Congress on ways to improve the program and reduce unnecessary spending, but it only gives advice.Congress is under no obligation to take it.

The Obama administration wants an agency with real authority.Called the Independent Medicare Advisory Council, or IMAC, the new executive branch agency would advance new policies that some hope would slow down runaway Medicare spending.Under the proposal, unless Congress can muster a two-thirds vote of the House and the Senate, those policies would automatically go into effect.

But according to the Congressional Budget Office (CBO), the IMAC is MedPAC on weak tea.The new agency would not be expected to cut Medicare costs.Instead, their recommendations would not increase Medicare spending.That’s taking the Hippocratic Oath a little too far.Yes, do no harm.But how about doing some good?

Ironically, the Democrats recognize that there is too much political meddling in the health system at the same time that they want to impose more federal control.Medicare has been hamstrung by Congress micromanaging the program, resulting in higher costs and poorer performance.Even when Congress has permitted more competitive approaches, such as expanding the reach of private Medicare Advantage plans, politicians have been unable to resist trying to dictate outcomes by building in payment floors and exceptions that favor one constituent or another.That means more spending, not less.A new agency not subject to the political pressures on the Hill might be an improvement, although CBO argues that the new agency would not have much impact.

But let’s not dismiss the IMAC idea too quickly.There is a chance that the agency might take an interventionist role, as we have seen when other regulatory agencies have been headed by activists.The IMAC might like telling Medicare how to run its business, and what Medicare does sets the pattern for private healthcare.Even well-meaning “budget neutral” proposals could impose new inefficiencies that would result in less value for our healthcare dollar.A powerful new health board would further centralize decisions about a health system that is inherently local.

The better approach—one that really does take the politics out of reform—puts the decision-making in the hands of consumers.We’ve tried everything else.What do we have to lose?

http://www.urban.org/toolkit/conference-papers/hp-roundtable/antos.cfm?renderforprint=1 URBAN INSTITUTE Expert Comments: Joe Antos Urban Institute > Toolkit > Selected Conference Papers > Budgetary Approaches to Health Policy > Note: Some suggestions presumably could be implemented in the near term, but others would wait for major reform legislation or require other developments that could be many years in the making. Some suggestions may be good policy but would increase federal outlays or might have little impact on the budget. Some items below are comments rather than suggestions for

legislative or regulatory action. Many of these suggestions are tied together and would not have the desired effect if attempted in isolation.

Consumers

1. As health coverage purchasers/enrollees

• Reduce counterproductive state insurance regulations, including most benefit mandates and premium restrictions.

• Permit insurance sales across state lines, with either enhanced federal oversight or harmonizing state regulatory regimes.

• Permit insurance purchase through non-traditional organizations (such as churches), which may reach populations that would otherwise not purchase coverage.

• Directly subsidize individuals with little means, either through refundable tax credits or more direct cash subsidies for the purchase of insurance.

• Cap the tax preference for employer-sponsored insurance at a high level, but index the cap at CPI rather than the growth of health spending..

• Create/promote information clearinghouses to facilitate the provision of comparative information on plan choices to individuals. Such clearinghouses could also allow consumers to enroll in the plan of their choice.

• Like FEHBP, have the clearinghouses provide standardized information to allow comparisons across plans, but do not interfere with comparative information offered by private sector entities (e.g., the Checkbook guide to FEHBP plan choices). Information should include consumer-friendly comparisons of premiums, major aspects of benefit structure (including cost-sharing requirements, main categories of coverage, breadth of provider network, etc.), and measures of consumer satisfaction.

• It is not useful to require employers to provide more information on the cost of insurance on the pay stub (which few ever read, and the information does not lead to changed behavior since the employee cannot change plans during the year).

• Do not micromanage insurers and plans: avoid standardizing benefits, setting premium limits (including community rating), requiring certain levels of cost-sharing.

• Do not open state or federal employee plans to other populations, as that raises unsustainable expectations of generous benefits at heavily subsidized prices.

2. As purchasers of health services:

• Maintain a level playing field among types of coverage. Do not bias subsidies in favor of high-deductible coverage. Reduce the bias that currently exists in the tax system against out-of-pocket payments (capping the exclusion, see above).

• HSA restrictions should be modified to reflect the involuntary nature of some medical services. In-patient hospital admissions are involuntary and should be subject to a lower deductible (or leave that decision up to the insurance market).

• Modify FSAs to permit limited carry-over, thus reducing end-of-year spending on non-essential health services.

• Patients need access to better information about the likely value of the service (in terms of improving health status and the possible negative side effects of treatment), the likely quality of care offered by the provider, and the cost to the patient prior to the delivery of the service—along with similar information for treatment alternatives. (I don't see a mandate here.)

• Consumers would benefit from knowing the package price (that is, what the consumer would pay) of all services associated with an episode of care (including charges that are unavoidable but not covered by insurance), but only if there are meaningful alternatives from which to choose. Partial capitation is a method that health plans may use to pay

providers, but there is no obvious consumer use of partial capitation rates. The consumer is interested in what he or she pays, not what someone else pays.

• Comparative performance data on providers, and possibly patient satisfaction information, would be useful for those consumers who seek such information.

Government

1. As managers of public programs:

• Improvements for Medicare Advantage (MA): Reduce micromanagement by Congress and CMS, which results in constantly shifting requirements and inhibits innovation—FEHBP is a model that maintains a reasonable balance of federal oversight and plan management of their own operations. Full competition with traditional Medicare (that is, the actuarial cost of traditional Medicare would be included in the bidding process and the Part B premium would be determined through that process on a regional basis)--watered down in MMA to be a demonstration—should be considered. To promote fairer competition, randomly assign new beneficiaries turning age 65 to traditional Medicare or MA plans (allowing immediate reassignment at the beneficiary's request). Eliminating the default selection of traditional Medicare would cause more new beneficiaries to consciously consider alternatives that might be to their advantage.

• Improvement for traditional Medicare: Full competition with MA (see previous bullet). On a less-grand scale, more could be done to reduce the "stove pipe" effect: pay on a more complete episode basis for major interventions (such as hospitalization, but including more pre- and post-admission services related to the particular condition being treated). Bundle outpatient pharmaceuticals into an episode payment for the doctor, or other incentives for careful prescribing, particularly for chronic disease. If effective disease management methods are identified, make them mandatory. Rationalize the cost-sharing structure, abolish the artificial distinctions between Parts A, B, and D, have a single deductible, have no limits on hospital days, eliminate the strange copayment structure for hospital days and simplify.

• Limit outlays for the drug benefit: Retract the requirement that all drugs be covered in 6 disease categories, which has chilled enthusiasm for cost containment. Convert Part D to a capitated subsidy rather than an unlimited entitlement—one model is the subsidized discount card program, but there are other approaches. Focus subsidies on the needy, reduce subsidies to the wealthy.

• Risk selection: Before leaping to the conclusion that risk selection is rampant, get data on actual enrollment during 2006 when the drug benefit is in place. Risk selection may be down considerably if MA plan enrollment increases significantly. MA plans are receiving extra payments associated with trying to lure them back to the program; if the full cost of traditional Medicare were captured through the full competition proposal, such extra payments might not be needed. Better risk adjusters are needed, but there is a limit to the accuracy of such adjusters.

• Medicaid: Capitated payments using good risk adjusters would hold states harmless from some exogenous risks but not all. The "swap"—giving full responsibility for non-Medicare participants in Medicaid to the states, giving full responsibility for Medicare participants in Medicaid to the feds—eliminates the destructive overlap in financing and responsibility. States should not simply be relieved of the cost, however—some reasonable "clawback" is needed.

2. As regulators/facilitators:

• See changes in insurance regulation, mentioned above. • FDA regulatory process could be streamlined to allow faster decisions on new drugs and to

allow more modern manufacturing processes. Change FDA statute to recognize the risks

to some patients of not approving a drug as well as the risk of approving a drug. Do not mandate comparative clinical trials for drugs, which would yield limited information but would substantially increase approval times. Investigate whether meta analyses of the literature can lead to unbiased assessments of the use of drugs or other services—don't assume that this is the inevitable outcome.

• New federal agency: This is rarely the positive answer to any problem. Top-down imposition of professional standards, even based on evidence, will not guarantee compliance. Moreover, the evidence will likely change, but a regulatory approach will be slow to react. More work should be done to exploit Medicare data to determine how well treatments do in actual practice, rather than in rarefied clinical trials. However, changing physician behavior will require a grass-roots professional effort.

• Government help to provide information: Government may be uniquely situated to collect data on medical practice, including indicators of value, quality of care, and price. Difficulty interpreting these data, however, means that others (including directly interested parties) should be able to provide their own interpretations. Data and useful information are often two different concepts.

Providers/Other Intermediaries

• Aggressive anti-trust is essential to promote effective competition. Prosecution may not be enough to assure competition—FTC has lost most of its hospital merger cases.

• A minimum disclosure statement that can be understood by the non-expert would help consumer decision-making, but firms should be able to go beyond the minimum in marketing.

• New incentives for good decisions: Pay for performance in Medicare depends on how performance is measured, and is impeded by the current need to extract such information in a non-automated way. Medicare/caid could require certain actions (such as compliance with a disease management mechanism) as conditions of payment, but we should not provide incentives or mandate their use by private insurers. If the interventions work, they will be adopted.

• More bundling of payments under FFS would reduce some inefficiencies, but that can be a difficult technical task. Episode payments would be sensible if feasible. (This presumably refers only to Medicare/caid—the government should not dictate how private payers structure their payments.)

• Information intermediaries (II's) may be a good idea. They would have different skills than fiscal intermediaries (FI's)—II's have to structure information to be understandable to consumers and maybe providers, for example, while FI's rarely produce understandable information.

Other Strategies

• Dropping the entitlement treatment in the budget is important. Health programs will remain difficult to meddle with by politicians even without that protection. The presumption of unlimited spending creates an imposing inappropriate incentive.

• Commissions deliberate, but rarely cause difficult actions to be taken by Congress. A base-closing commission analogy might be promising for some applications, but closing facilities is not the answer to the health cost problem.

• Cap the tax exclusion. • Health IT: Medicare could take the lead on minimal electronic standards. Federal subsidies

for health IT will do little to accelerate adoption, which requires behavioral change among providers.