...“Everyone should now understand that, if there is not a delay, next year will be the scene of an epic disaster for American health care,” Capretta, along with National Affairs editor Yuval Levin, wrote in April. “Jim is the indispensable man on healthcare, just from top to bottom,” Levin said in an interview. “Because he has the deep understanding that he does of what’s wrong with the law, he’s seen things first and seen things clearest.” Capretta’s expertise on healthcare has made him a regular fixture on Fox News, in publications such as the Weekly Standard, and before Congress over the past months. “Every member [of Congress] who wants to be smart about healthcare talks to him, and so it’s not a coincidence that the Republican critique sounds like him and that the Republican alternatives look like his, because they really are,” Levin said. “Some people have lots of experience in and around government. Others have a thorough knowledge of health care policy. Jim has both. And he’s smart and savvy. My rule: Always listen to Jim!” said William Kristol, the editor-in-chief of the Weekly Standard. Overwhelming Complexity Capretta began his career by analyzing federal agency budgets for the Office of Management and Budget (OMB), the president’s arm that oversees the implementation of federal laws. He continued to work in government for the next 16 years, ultimately concluding his career back at OMB as an associate director under President George W. Bush. Capretta credits his time at OMB with giving him a sense of the possibilities and limits of government policy—and showing him where Obamacare was going wrong. “I had a sense from that [time at OMB] about what’s really possible and the limitations of that kind of process to handle some kind of major complex undertaking,” he said. “And so it was from those experiences that I realized that what they were proposing to do and the challenges that they were taking on in this law were beyond anything that had been done in a long, long time, and it was going to be very difficult to pull off easily,” Capretta said. While the government has other complex programs, such as the Earned Income Tax Credit and food stamps, they developed gradually over many years. With Obamacare, in contrast, the administration was trying to implement in three years a national system coordinating states, federal agencies, and private insurers, and all run online. “Just on its face it looked like a monumental challenge to do this well,” Capretta said. The complexity soon swamped the administration, and private insurers started to worry about whether the law would be implemented smoothly. “Just like everybody else, I had heard from people in the industry, anecdotal for sure, but I had heard enough that they were very, very concerned, the things were way behind schedule, and that the administration … was giving no one confidence that this thing would go smoothly at launch,” Capretta said. “Even me on the outside, I had no real inside information about anything, [but] I could tell it wasn’t going to go well, just from reading the law and reading the tea leaves of what was coming out,” Capretta said. Deeper Problems Capretta does not see the website as the biggest issue with the law, though. “The president’s right and his team is right about this: this [website] isn’t the fundamental issue at stake here,” Capretta said. “Essentially trying to force a lot of people into products that they don’t want, that still remains the most fundamental problem. And I don’t think that they’re going to be able to solve that—ever,” Capretta said. Obamacare requires every individual to carry health insurance or else pay a penalty, the so-called “individual mandate.” The law further requires all health insurance plans to have certain minimum benefits, and as a result many insurance companies have recently notified their customers that their former plans are no longer available because of Obamacare’s minimum requirements. These customers now have to buy more comprehensive—and often more expensive—plans as a result. “I think the country needs a more flexible, consumer driven, decentralized approach to this, not trying to centralize all decision-making in HHS,” Capretta said. Under Capretta’s proposal, the government gives each person a fixed amount of money to help them buy insurance, leaving people free to buy the insurance they want. Various Republican reform proposals, including the one from Paul Ryan several years ago, have adopted this approach....
Posted on: Sun, 10 Nov 2013 22:26:53 +0000
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