Committee for a Responsible Federal Budget Annual Conference
Fiscal Policy Experts Explore Policies, Politics Needed to Address Looming Crises
A detailed recap of day's conversations -- including the afternoon round table, OMB Director Robert Portman's spech, and the subsequent dinner panel -- is provided below.
Budget Round Table
Leon Panetta remarked that "we govern either by leadership or by crisis," a theme that he was to repeat throughout the board meeting. "At this point," he continued, "we know what the policy solutions on these issues need to be"; the real challenge is how to implement those solutions at a time of deep hostility and mistrust between the two political parties. In that respect, Maya's third question may be the most important of all.
2) Social Security is often spoken of as the easiest of the three major entitlement programs to fix, but this gets it backwards. When dealing with health care, there is an opportunity to eliminate waste and inefficiency without affecting health outcomes. On the other hand, Social Security is a cash-transfer program, so the only way to cut costs is to reduce benefits.
3) There is no crisis unique to Medicaid and Medicare. The problem is with systemic inefficiencies in the health care system, and so it follows that the solution is not to cut benefits, but to figure out a way to bring down costs.
As Alice Rivlin pointed out, however, much of the relevant work has already been done by Dr. Jack Wennberg and his team at Dartmouth Medical School, who have published a series of studies on the variation in health care costs across the United States. Dr. Wennberg found that it costs 2.5 times as much to be treated in Miami as it does to be treated in Minneapolis, but that there is no appreciable difference in the quality of health outcomes between the two cities. The solution to rising health care costs, she stated, is a system that rewards doctors for following best practice guidelines and producing good outcomes. The current system incentivizes overtreatment by paying doctors more for every procedure they perform.
But Tim Penny evinced skepticism, contending that 1) even if it were possible to come to an agreement on best practices, getting buy-in from the medical community would be difficult; and 2) the states that spend more money on health care tend to be the largest states with the biggest Congressional delegations, presenting an intractable political problem to anyone who wants to scale back that funding.
- Joe Antos, American Enterprise Institute
- Bruce Bartlett, Columnist
- Lily Batchelder, New York University
- Jim Bates, House Budget Committee
- Richard Berner, Morgan Stanley
- Bob Bixby, Concord Coalition
- Chuck Blahous, National Economic Council
- Mark Bloomfield, American Council for Capital Formation
- Chuck Bowsher, Committee for a Responsible Federal Budget*
- David Broder, The Washington Post
- Jeff Brown, Social Security Advisory Board
- Arthur Burris, House Budget Committee
- Stuart Butler, Heritage Foundation
- George Callas, Office of U.S. Senator George Voinovich (R-OH)
- Robert Carroll, U.S. Treasury
- David Certner, AARP
- Jim Cooper, U.S. Representative (D-TN)
- Carol Cox Wait, Committee for a Responsible Federal Budget*
- Reid Cramer, New America Foundation
- Richard Darman, Carlyle Group*
- Sandy Davis, Congressional Budget Office
- Alison Fraser, Heritage Foundation
- Bill Frenzel, Brookings Institution*
- Tom Gallagher, ISI
- Darren Gersh, Nightly Business Report, PBS
- Jagdeesh Gokhale, Cato Institute
- Steve Goss, Social Security Administration
- William H. Gray, Buchanan Ingersoll & Rooney*
- Bob Greenstein, Center on Budget and Policy Priorities
- Itai Grinberg, Skadden, Arps, Slate Meagher & Flom
- Paul Hewitt, Generations United
- Bill Hoagland, CIGNA Corporation*
- Scott Hodge, Tax Foundation
- Arlene Holen, Congressional Budget Office
- Doug Holtz-Eakin, Council on Foreign Relations*
- Margaret Hostetler, AARP
- Joe Humphreys, Social Security Advisory Board
- Sue Irving, Government Accountability Office
- Jim Jones, Manatt/Jones Global Strategies*
- Tom Kahn, House Budget Committee
- Jim Kolbe, German Marshall Fund*
- Morton Kondracke, Roll Call
- Karen Kornbluh, Office of U.S. Senator Barack Obama (D-IL)
- Jeff Lemieux, AHIP
- Jeff Liebman, Harvard University
- Ed Lorenzen, Office of U.S. Representative Steny Hoyer (D-MD)
- Maya MacGuineas, Committee for a Responsible Federal Budget
- Thomas Mann, Brookings Institution
- Ruth Marcus, The Washington Post
- Donald Marron, Congressional Budget Office
- Jim McIntyre, McIntyre Law Firm*
- Diana Meredith, House Budget Committee
- David Minge, Minnesota Court of Appeals*
- Evelyn Morton, AARP
- William Niskanen, Cato Institute
- Ellen Nissenbaum, Center on Budget and Policy Priorities
- Marne Obernauer, Beverage Distributors Company*
- Susan Offutt, Government Accountability Office
- Van Ooms, Committee for Economic Development
- Peter Orszag, Congressional Budget Office
- Leon Panetta, Panetta Institute*
- Tim Penny, Hubert H. Humphrey Institute of Public Affairs*
- Rob Portman, Office of Management and Budget
- Paul Posner, George Mason University
- Wendell Primus, Office of U.S. Representative Nancy Pelosi (D-CA)
- Bob Reischauer, Urban Institute
- Alice Rivlin, Brookings Institution
- Beth Robinson, Office of Management and Budget
- Laurie Rubiner, Office of U.S. Senator Hillary Clinton (D-NY)
- Paul Ryan, U.S. Representative (R-WI)
- Andrew Samwick, Dartmouth University
- Isabelle Sawhill, Brookings Institution
- Jim Slattery, Wiley Rein LLP*
- Austin Smythe, Office of Management and Budget
- Charlie Stenholm, Olsson, Frank and Weeda, P.C.
- Eugene Steuerle, Urban Institute*
- Phillip Swagel, U.S. Treasury
- Susan Tanaka, Committee for a Responsible Federal Budget*
- Tim VandenBerg, Washington Analysis
- George Voinovich, U.S. Senator (R-OH)
- Alice Wade, Social Security Administration
- David Walker, Government Accountability Office
- Kathleen Weldon, Biogen
- Rachel White, New America Foundation
- Frank Wolf, U.S. Representative (R-VA)
- Rich Wolf, USA Today
- Judy Woodruff, News Hour with Jim Lehrer
- Stephen Zimmerman, Dykema