David Cutler

Last month, I had the privilege of speaking at commencement exercises for the health professional schools at Nova Southeastern University. It was a homecoming of sorts: I spent most of my childhood in South Florida, about fifteen miles from the campus. But a lot has changed. When I left in the late 1980s, the sports/concert arena where I spoke did not exist. Neither did the hockey team that plays there. As for NSU, I remember it as a small, relatively obscure school, with maybe a few thousand students overall and no significant presence in health care.

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Several dozen organizations filed “friend of the court” briefs for the lawsuit challenging the Affordable Care Act. And virtually none of these briefs are likely to have much impact. But, based on what transpired at oral arguments, one brief appears to have gotten the attention of conservative justices. That is deeply worrisome, because the brief betrays some fundamental misunderstandings of how health care actually works.  The brief comes from the American Action Forum, a conservative advocacy group that opposes the law, and has the signature of 101 economists and policy experts.

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A new internet video from the Romney campaign focuses on Ann Romney’s diagnosis with Multiple Sclerosis and how it affected the rest of the family. The ad’s apparent purpose is to humanize Romney—to portray him as a sympathetic, loving husband. That's just fine. MS is a serious, life-altering diagnosis and Romney is, by all accounts, a devoted family man. If telling people about this part of Romney's life makes him seem less aloof or more sensitive, I have no problem with that.

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Editor's Note: After looking at the economic platform of Mitt Romney’s presidential campaign, this installment of our series on his policy plans examines the details of his health care agenda. The gist: Repeal the Affordable Care Act; end Medicare and Medicaid as we know it, by turning the former into a voucher program and the latter into a block grant scheme; unravel private insurance, by changing the tax treatment of benefits and undermining state regulation. The good. Not much. Once in a while he talks up worthwhile reforms designed to improve the quality of care.

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Over the last two decades, the health care sector has been a remarkable engine of job growth in the United States. Even as the economy plods along, health care has been responsible for adding an average of 22,500 jobs per month in 2011 through July. Health care jobs now represent about 11 percent of American employment, as compared to 8 percent in 2001.

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House Budget Chairman Paul Ryan has published his proposal for downsizing the federal government. In the hours and days to come, you're going to hear a lot of different numbers from his proposal. But let me draw your attention to a figure that's not in there: 32 million. Based on the available information, that's roughly the number of people likely to lose health insurance, relative to current law, if the budget were to become reality. The spending blueprint calls explicitly for repealing the Affordable Care Act.

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Second Opinion

Few health care experts are more intimidating or effective than Gail Wilensky. An economist trained at the University of Michigan, Wilensky served as director of Medicare and Medicaid under George H.W. Bush. Later, she became chairperson of the Medicare Payment Advisory Commission, a highly respected, blue-ribbon commission that advises Medicare on what to pay for medical services. Since that time, she’s held multiple positions in the advocacy and nonprofit worlds.

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The GOP's Trick Play

I don’t know for certain whether the Affordable Care Act will save money, cost money, or roughly break even. Nobody does. And if conservatives want to argue it's more likely to cost money--because, say, the subsidies are going to grow faster than the official projections suggest--that's a reasonable point to make. I think the evidence for that claim is pretty weak, but I can see how somebody could believe it and make a good faith argument along those lines. But I'm positively baffled by this argument that Democrats gamed the congressional budgeting system.

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Republicans are convinced the Affordable Care Act will cost too much because future lawmakers will never let the law's spending cuts take effect. I think the Republicans are wrong, for reasons I detailed on Monday.

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My latest Kaiser Health News Column, about last week's report from the Congressional Budget Office: Here we are again, arguing about whether health care reform will make the government’s balance sheet better or worse. The occasion for this latest round of debate is a new report by the Congressional Budget Office—one that predicts what the entire federal budget will look like several decades into the future. Critics of health care reform say the report backs up what they’ve been saying all along—that, because of reform, tomorrow’s budget deficits will be even worse than they are today.

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