34 Ways to Solve our Fiscal Crisis

To mark the start of the government’s fiscal year, we asked prominent Americans the one thing they would do to get America on track. Their ideas are a blueprint for strengthening the country.

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The Fiscal Times
September 30, 2010


Almost all of our contributors agree that spiraling health care costs could bankrupt the country and sap the investment dollars needed to jumpstart the economy. Here's what they said:

We will not solve the health care financial debate by changing insurance coverage because obesity-driven ailments will bankrupt any plan devised by even the wisest legislators ...

Instead, we need to make it easy to make the healthy decisions in our communities. The battle needs to be waged in our kitchens, living rooms, and bedrooms. And changing the culture around healthy living depends on each of us understanding that we are all stakeholders. We need to see weight loss as a patriotic move that improves our ability to compete in business and balance our accounts.

- Dr. Mehmet Oz, Author and TV Host


Rudolph PennerControlling the budget is impossible unless we control health costs. Controlling health costs is impossible while we pay for almost all treatments demanded by eligibles. We have to put health costs on a strict budget, much as the health systems of Canada and the U.K. We can start by using income-related, subsidized vouchers for the purchase of Medicare insurance and a block grant for Medicaid.

- Rudolph Penner, Fellow, Urban Institute


Dr. Bob GreensteinRising health care costs are the largest cause of projected federal deficits, and the new health reform law contains a wide range of measures that can restructure the nation's health system and slow the growth of costs. It establishes insurance exchanges that can foster competition among health plans based on price and quality, reduces overpayments to the private insurance plans that participate in Medicare, and discourages high-cost insurance plans by imposing an excise tax on them. If fully implemented, these and other provisions of health reform will start bending the "cost curve" projections of soaring health care costs in the years to come.

'We must aggressively reform the health care payment and delivery system by conducting a wide range of pilot and demonstration projects.'

But that will not be enough. We also must aggressively reform the health care payment and delivery system by conducting a wide range of pilot and demonstration projects, establishing a new Medicare payment method to reward accountable care organizations, conducting more research on the comparative effectiveness of different medical procedures and treatments, and creating an Independent Payment Advisory Board to develop proposals to slow Medicare and private health spending and improve the quality of care. And we must implement the results as they emerge.

Health reform begins the process of testing, experimenting, and implementing that health experts agree is needed to slow the growth of health care costs in the coming years. We must move boldly down that path.

- Robert Greenstein, Executive Director, Center on Budget and Policy Priorities


Dr. Sherwin NulandIf the past is prologue, the one area of huge national expenditure most likely to rise rapidly in the coming years is health care.

Not surprisingly, it is also an area particularly susceptible to waste and profiteering - particularly because so much of the spending will predictably go toward increasingly complex and expensive new technologies that hospitals and physicians will seize upon as absolutely necessary to their efforts in diagnosis and treatment. But misuse and overuse of technology has contributed massive amounts to the cost of care. Oversight has now become mandatory, and it should be done through the Institute of Medicine. In addition to savings created by such means, billions will be spared by attention to the following factors, each of which adds considerably to the total bill for our nation's health care:

  1. Physician entrepreneurship and advertising.
  2. Competition between individual health care facilities, which results in duplication of personnel and resources; the large expense of advertisements and other forms of publicizing; more efficient centralization of resources (including the elimination of some clinics and hospitals) can eliminate considerable waste.
  3. A tort system rife with opportunity for misbegotten gains.
  4. Overspecialization, and oversupply of expensive personnel. We should determine the nation's medical manpower needs, mandating the training of only the number of specialists required and providing incentives to encourage family practice. We should also explore the effectiveness and increased utilization of highly trained nurses, physician assistants and similar personnel.
  5. Our current non-system of preventive medicine, despite all the lip-service devoted to its crucial importance.

- Dr. Sherwin Nuland, Clinical Professor of Surgery at Yale University