Health Care Heavy Hitters

James Capretta, a Conservative Health Care Policy Expert, Is Suddenly a Hot Ticket

Conservative? Definitely. James Capretta is the first Milton Friedman Chair at the American Enterprise Institute. But he says partisanship makes health care unstable, politically and otherwise.

Howard Wolinsky

In Jim Capretta’s view, the failure and lack of fix of the ACA can be traced back to the fact that it passed with the support of one party.

Now, the conservative voice of reason on American health care policy and a fellow at the American Enterprise Institute thinks the same thing is happening again as Congressional Republicans tried to uproot Obamacare and replace it with something more to their liking.

“It would be far preferable for the country to reach some stability around health policy that both parties bought into,” Capretta said in an interview conducted before the Senate failed to pass a Republican repeal-and-replace bill.

The partisanship of the ACA has led to both political and programmatic instability around the law, he noted. “I fear that the exercise the Republicans are engaged in right now is going to have the same result, just in a slightly different direction," Capretta said. "So that it, too, is going to be subject to a lot of attack by opponents who are not invested in it. That means it could be subject to substantial revision at the next opportunity when the other party is in power. So you could have this swinging back and forth instead of some stability that might bring a little bit more coherence to the system.”

Partisanship may be bad for policy, but it can be a blessing for policy experts as journalists and the public try to figure out what lies behind all the political maneuvering. Experts with  conservative point of view have been in demand, a group that includes Avik Roy, Joseph Antos (who like Capretta is at the American Enterprise Institute), and Michael Cannon. But Capretta has stood out as sensible and rational in a time of national division, so he is on the contact list of scores, if not hundreds, of journalists and politicians. And Capretta is prolific. He has written for Health Affairs, where he is a member of the editorial board; the JAMA Forum, National Review, the Wall Street Journal, and the Weekly Standard. When health care is in the news, he is a familiar face on PBS NewsHour, Fox News, CNBC, and Bloomberg Television.

“Even if I don’t always agree with him, I find him very thoughtful and knowledgeable,” says Gail Wilensky, a Republican health care economist. "I think very highly of Jim. He's smart. He writes well."

Capretta, 53, earned a B.A. in government at Notre Dame and then went on to get a master's in public policy at Duke. He considered himself more of a Democrat until graduate school.

“When I got to graduate school and then beyond, and started studying more economic matters, I started to take on the view that it was very important to have the incentives right for a strong and growing economy and that was not inconsistent with also having a safety net to serve people when they needed it,” says Capretta. “I believe in limited government.”

After grad school, Capretta started as a career civil servant in the Office of Management and Budget. In the ’90s, he took a position as a senior policy analyst at the Senate Budget Committee, where he was responsible for health care issues. He served as associate director in the White House’s Office of Management and Budget from 2001 to 2004 when George W. Bush was president and was responsible for all health care, Social Security, welfare, labor and education issues.

Five years ago, Capretta joined the American Enterprise Institute, which he described as “the premier think tank devoted to defending the principles of a free society and free enterprise, as well the important role of the U.S. in world affairs.” He doesn’t like the common media characterization of AEI as right wing.

Last year, he was named the first Milton Friedman Chair at AEI. Friedman, the Nobel Prize–winning economist, is revered at AEI because of his strong belief in free markets; not surprisingly, Capretta is a Friedman fan.

When it comes to health care economics and policy, he has been influenced by Alain Enthoven, a Stanford economist and leader of the managed competition school for health care reform, and Mark Pauly, a University of Pennsylvania economist who favors market-based reforms but with less regulation. “I would put myself in between [Enthoven and Pauly],” he says.

Capretta has recently laid out his thoughts about reforming Medicare in a series of papers published by the Mercatus Center at George Mason University.  “I really think it’s important to organize and clarify Medicare’s choices for the beneficiaries in a better fashion so that it will intensify competition amongst the options, cut costs, and make it easier for managed care companies to do well by cutting costs and increasing value,” he said.

He also favors amending health savings accounts so patients could buy directly from managed care entities without calling that purchase a premium. “So if somebody already has got a high-deductible plan, but they need to buy access to services with their balances in the HSA account, they should be able to do that directly with the managed care entity without it being called an insurance premium with all the regulations that come with that,” he said.

Howard Wolinsky is an independent health care journalist based in Chicago.

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