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Sustainable Health Spending and the US Federal Budget

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Sustainable Health Spending and the US Federal Budget Sustainable Health Spending and the U.S. Federal Budget— SYMPOSIUM Washington, DC, July 24, 2012 Sustainable Health Spending Growth Relative to Growth in GDP: 2011– 2035 2.5% 1.9% 2.0% 1.5% 1.5% 1.0% 1.0% 0.5% 0.5% 0.0% -0.5% 0.0% 0.7% -1.0% - -1.5% -1.4% -2.0% 18.5% 19.5% 20.5% 21.5% 22.5% 23.5% 24.5% Federal Tax Revenues as Share of GDP *Assumes 13.1% of GDP spent on social security, defense, and other non-health Example: GDP+0 is sustainable with tax revenues at 20.5% of GDP Symposium Monograph Judith Lave, Paul Hughes-Cromwick, Thomas Getzen, eds. November 13, 2012 Contributors: Joseph Antos, Ceci Connolly, Ziad Haydar, Karen Ignagni, Joanne Kenen, David Lansky, Donald Marron, Arnold Milstein, Len Nichols, Alice Rivlin, Charles Roehrig Altarum Institute Center for Sustainable Health Spending www.altarum.org/cshs Follow us on Twitter: @ALTARUM_CSHS ALTARUM Altarum Institute Contents Acknowledgements ................................................................................................................................................................ii Contributors ..........................................................................................................................................................................iii Preface .................................................................................................................................................................................viii Summary and Reflections—Thomas Getzen ........................................................................................................................x Introduction ................................................................................................................................................................................................................ 1 Jeff Moore ................................................................................................................................................................................................................... 1 Ceci Connolly ............................................................................................................................................................................................................. 1 I. Federal Health Spending: What Path Is Implied Under U.S. Budget Deficit Control? ..................................................................................................................................................2 Alice Rivlin ................................................................................................................................................................................................................... 2 Joseph Antos ............................................................................................................................................................................................................. 3 Session I. Questions and Answers....................................................................................................................................................................... 8 II. Overall Health Spending: What Path Are We On? ......................................................................................................... 10 Len Nichols ................................................................................................................................................................................................................10 Arnold Milstein .......................................................................................................................................................................................................16 Ceci Connolly ...........................................................................................................................................................................................................20 Ziad Haydar ...............................................................................................................................................................................................................20 Session II. Questions and Answers ...................................................................................................................................................................22 III. Sustainable Health Spending: What Does a Viable Path Look Like? .......................................................................... 24 Charles Roehrig ......................................................................................................................................................................................................24 Donald Marron ........................................................................................................................................................................................................28 IV. Roundtable: Are We Already on a Sustainable Health Spending Path? ..................................................................... 31 Joanne Kenen ..........................................................................................................................................................................................................31 David Lansky ............................................................................................................................................................................................................31 Karen Ignagni ...........................................................................................................................................................................................................34 Session IV. Questions and Answers ..................................................................................................................................................................38 List of Acronyms .................................................................................................................................................................. 40 Sustainable Health Spending and the U.S. Federal Budget i Altarum Institute Acknowledgements The Center gratefully thanks the Robert Wood Johnson Foundation for their generous support of this symposium. We specifically express our gratitude to Andrew Hyman, the Senior Program Officer who directs the foundation’s coverage team, and Anne Weiss, the Senior Program Officer who directs the foundation’s quality/equality health care team, for having the vision to see the underlying value in this endeavor; and to David Adler, communications officer, for his encouragement and editorial assistance. The content is solely the responsibility of the authors and does not necessarily represent the views of the Robert Wood Johnson Foundation. Core members of the Altarum Center for Sustainable Health Spending (CSHS) provided pivotal guidance at each juncture of symposium planning and execution: Charles Roehrig, CSHS Director; Ani Turner, CSHS Deputy Director; and George Miller, Altarum Institute Fellow and Senior Analyst. Jeffrey Moore and Marijka Lischak were also essential to the successful planning of the event. Superb logistics, communications, media, and audiovisual assistance was provided by David Arbor, Rebecca Armendariz, Alison Gary, Tim Green, Marijka Lischak, Alan Merritt, Jonathan Metz, Kristen Perosino, Brandon Ray, Tamar Shealy, Chris Weaver, and Jim Wetherill. Production of the monograph was expertly executed by Iza Bobowski with the assis- tance of Liz Ritter and Roy Quini. The Center thanks Stephen Gilberg and Debra Foulks for supplemental editorial assistance. Sustainable Health Spending and the U.S. Federal Budget ii Altarum Institute Contributors Joseph R. Antos, PhD, is the Wilson H. During her years in journalism, Ms. Connolly reported on six Taylor Scholar in Health Care and Retire- U.S. presidential campaigns and was a major contributor to the ment Policy at the American Enterprise book Deadlock: The Inside Story of America’s Closest Election. Institute (AEI) and an Adjunct Professor She spent more than 2 years based in Mexico City, traveling in the School of Public Health at the extensively throughout Latin America. She produced a daily University of North Carolina at Chapel blog on Mexico’s 2006 presidential race as well as a multimedia Hill. He is also a Commissioner on the project on HIV/AIDS along the U.S.-Mexico border. Maryland Health Services Cost Review Ms. Connolly is a board member for the nonprofit Whitman Commission. His research focuses on the economics of health Walker Health and the first nonphysician to receive the Mayo policy, including Medicare reform, health insurance regulation, Clinic’s prestigious Plummer Society Award for promoting and the uninsured. He has testified before Congress on federal deeper understanding of science and medicine. She also serves health policy and has been quoted in the media, including The on the National Advisory Board of the Center for Sustainable Wall Street Journal, The Washington Post, Businessweek, CNN, Health Spending and was the recipient of a fellowship at and C-SPAN. Prior to coming to AEI, Dr. Antos was the Assistant Harvard’s Kennedy School of Government. Director for health and human resources at the Congressional Budget Office (CBO). While at CBO, he directed the analysis of Ms. Connolly has appeared on PBS’s “Washington Week,” CBS’s the major legislative proposals affecting Medicare, Medicaid,
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