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In Part II of a two-part podcast on the institute’s latest Project FDA report, Blue Pill or Red Pill: The Limits of Comparative Effectiveness Research, Paul Howard interviews author Eric Sun about the anti-psychotic trial analyzed in the report and how efforts at cutting healthcare costs through drug coverage restriction may actually increase costs and worsen health outcomes.

In Part I of a two-part podcast on the institute’s latest Project FDA report, Blue Pill or Red Pill: The Limits of Comparative Effectiveness Research, Paul Howard interviews author Tomas Philipson about key findings in the report.

In this edition of Innovative Ideas, Paul Howard and Stephen Parente discuss their op-ed, Built To Fail: Health Insurance Exchanges Under The Affordable Care Act, and how a national health-insurance exchange was originally a conservative idea supported by the Heritage Foundation, among others. Howard and Parente suggest compromise on the part of the GOP and others to see real healthcare reform.

". . .letting the states get waivers to essentially build their own exchanges and really decide on their own what's the best way to make this work operationally to hit the spirit of the intention of having a clearinghouse for these insurance products might be a better way to go. And maybe with some of the other precedents already set for granting waivers in the law, a practical way to go that may not raise as many eyebrows as it would have, say a year ago." – Stephen Parente

Paul Howard interviews Peter Pitts, President and co-founder of the Center for Medicine in the Public Interest and Partner/Director Global Healthcare, Porter Novelli.

Paul Howard, director of the Center for Medical Progress at the Manhattan Institute is interviewed by Howard Husock, vice president for policy research at institute, about his latest paper Building a Market-Based Health Insurance Exchange in New York.

In this edition of Innovative Ideas, Paul Howard interviews Grace-Marie Turner, president of the Galen Institute about Obamacare and what it means for various entitlement programs including Medicare and Medicaid.

"The debate we're having right now about entitlement policy is so important, because we're looking at who's really going to control these decisions is it going to be Washington bureaucrats as Obamacare not only does but doubles down on, or are we going to do as Paul Ryan and the House Republicans have proposed and move this into a much more flexible program that gives doctors and patients more controls, that forces the marketplace to begin to innovate around solutions that give people more value, more transparency in cost, greater efficiency, better coordinated care, all the things that the marketplace can do that we know Washington just doesn't do well." - Grace-Marie Turner

In this edition of Innovative Ideas, Paul Howard interviews Scott Harington, a Professor of Health Care Management and Insurance and Risk Management at the University of Pennsylvania's Wharton School of Business on his paper,"Incentivizing Comparative Effectiveness Research.

"This type of information, first comparative effectiveness research, but maybe ultimately cost effectiveness research, will provide the basis for determining what is reimbursed under public insurance programs and perhaps ultimately private insurance programs so there's naturally a great degree of angst by some and hope by others that we can use this information to more or less save money without reducing quality by deciding we're only going to pay for what works and we're only going to pay for something that improves health outcomes if according to some criterion the value of the benefit is greater than the cost of the additional treatment."

Paul Howard, senior fellow and director for the Center for Medical Progress at the Manhattan Institute, interviews James C. Capretta, a Fellow at the Ethics and Public Policy Center about the future of the Patient Protection and Affordable Care Act on its one-year anniversary, and as detailed in Capretta’s co-authored book, Why Obamacare is Wrong for America.

“It’s [Patient Protection and Affordable Care Act] not settled policy just by the way it was brought into existence. . .You had the president win in a pretty big election in 2008 and came in with big majorities in both the House and the Senate and for just an instant, they [Democrats] could then say to themselves, ‘We could pass the healthcare bill of our dreams if we really put our minds to it. And if we do, we could secure something that might be viewed as a big Democratic victory for all time.’ It was almost too tempting for them to do that, so they did. What comes with that is half the country very strongly opposed, because they never bought into it, they rightly view it as something motivated by a lot of partisan interest, and it wasn’t a consensus-building approach, it was more, ‘Here’s our way, we have the power to put it in place and we’re going to do it.’ Because it came about that way, it isn’t settled policy. People are very upset by it’s passage, and want to move toward something that has a more broad-based consensus. It’s unstable politically.”
– James Capretta

Paul Howard interviews Tevi Troy, senior fellow at the Hudson Institute and former Deputy Secretary of the U.S. Department of Health and Human Services about the Obama Administration’s claims that the Affordable Care Act already gives the states all the flexibility they are calling for to create truly competitive health insurance exchanges. Tevi and Paul discuss the flexibility that the states really need as opposed to what they are likely to get from President Obama and Secretary Sebelius.

"Most conservatives are okay with an [health] exchange, but an exchange that is set around the idea of flexibility, maximum flexibility, and not having set limits, giving governors the ability to design it in a way that works for their state. . .Massachusetts plan is not something Utah is going to want and vice-versa. You want to see the states be laboratories of democracy."
—Tevi Troy

Paul Howard speaks with Howard Husock, VP of Policy Research at the Manhattan Institute, about why retail health clinics, in light of the new healthcare legislation, are so important to avoiding a crisis in care in New York State and nationally.

Tevi Troy is a Senior Fellow at the Hudson Institute, a Senior Fellow at the Potomac Institute, and a writer and consultant on health care and domestic policy.

"You just don’t want to have a government entity [National Institutes of Health] doing this kind of creation of applied research because they’re not that good at it. The reason they’re not that good at it is because pharmaceutical companies understand the market, understand what can sell, understand the process of how to get things through the FDA. . .and they’re just better at it than a government entity which doesn’t have the same type of incentive structure that can lead people to make the smart decisions that can make a compound that can actually work."
—Tevi Troy

Paul A. Offit, MD is the Chief of the Division of Infectious Diseases and the Director of the Vaccine Education Center at the Children’s Hospital of Philadelphia. Dr. Offit is also the Maurice R. Hilleman Professor of Vaccinology, and a Professor of Pediatrics at the University of Pennsylvania School of Medicine. His latest book is DEADLY CHOICES: How the Anti-Vaccine Movement Threatens Us All (Basic Books, December 28, 2010.)

"Ultimately I think the attitude has is going to have to change, because the fact of the matter is when you choose not to vaccinate yourself or your child you are not only making a choice for yourself or your child, you’re making a choice for those who come in contact with you or your child. There are 500,000 people, roughly, in the United States who cannot be vaccinated, because they’re getting chemotherapy for their cancer or immunosuppressant therapy for their transplants. . .they depend on those around them to be protected. And you’re starting to hear from them now. You’re starting to hear from parents that are angry that they have a child with Leukemia that is going to a day care center and they want to know exactly how many people in that day care center aren't vaccinated because they know it puts their child at special risk."
—Dr. Paul Offit

Will autism fraud report be a vaccine booster?
2 new books challenge myths, fears about vaccines
Junk Science Isn't a Victimless Crime

Paul Howard a Manhattan Institute senior fellow and director of the Manhattan Institute's Center for Medical Progress, reads from his Winter 2011 City Journal article with Doug Holtz-Eakin, “A Medicaid Rebellion: How States Can Force Changes in the Program.”

"Adding financial insult to medical injury, Medicaid spending currently consumes about 20 percent of state budgets, crowding out spending on everything from education to infrastructure. It is also part of the trifecta of federal programs—Medicare, Medicaid, and Social Security—driving the federal budget over a deficit cliff."
—Paul Howard

State Medicaid Reform After Obamacare
The Medicaid Monster
Heathcare Reform and Medicaid

Dr. Marc Siegel is a prolific writer, an Associate Professor of Medicine and a Fellow in the Master Scholars Society at New York University School of Medicine, a columnist for the Los Angeles Times and a Fox News Medical Contributor.

"If they [FDA] take away Avastin, which is a great approach to [fighting] breast cancer, we’re not going to be able to figure out what the next generation drug is for breast cancer along that line of this type of targeted therapy. We don’t need to get rid of Avastin we need to work on Avastin to make it something even better."
—Dr. Marc Siegel

FDA begins process to remove breast cancer indication from Avastin label
US FDA to halt breast cancer use for Roche’s Avastin, but EMA says it’s OK in combo with paclitaxel; no immediate somatropin concerns
Fox Business discusses the Avastin for breast cancer rejection

Richard A. Epstein is a Manhattan Institute visiting scholar and one of the nation's most prolific legal thinkers. Epstein was appointed the Laurence A. Tisch Professor of Law at New York University School of Law in 2010. He will continue to serve as the James Parker Hall Distinguished Service Professor of Law at the University of Chicago, where he has taught since 1972, until January 1, 2011. He has also been, since 2000, the Peter and Kirstin Bedford Senior Fellow at the Hoover Institution.

"The United States cannot dragoon anybody into a series of involuntary transactions in which they do not wish to participate. What the United States can tell you is if you want to buy a car, you have to buy insurance; you have to contribute to an assigned risk pool; but we cannot make you buy a car, so we can force you to buy insurance and force you to go into an assigned risk pool."
— Richard Epstein

Text: Judge Hudson's Decision Striking Down Part Of Health Law
The Commerce Clause and ObamaCare's Undoing
A Noxious Commandment
Thoughts on Today's Ruling Striking Down the Individual Health Insurance Mandate

David Gratzer, a physician, is a senior fellow at the Manhattan Institute. His research interests include consumer-driven health care, Medicare and Medicaid, drug reimportation, and FDA reform. The late Milton Friedman, Nobel Laureate in Economics, wrote that Gratzer is "a natural-born economist." Gratzer's most recent book, with Foreword by Milton Friedman, is The Cure: How Capitalism Can Save American Health Care (Encounter Books, October 2006).

"I would suggest that it is unhelpful for us to find scapegoats and look at the more plausible explanation which is that the American diet has changed dramatically in the last few decades.  We’re eating too much and as a result, we weigh too much. . .What I think is so unsettling about the McVictim syndrome is that it gives us a scapegoat and as a result, takes people off the hook for being irresponsible for their own actions."
— Dr. David Gratzer

Obesity Trends Among U.S. Adults
U.S. Obesity Rates by State
Even moderate weight loss provides cardiovascular benefits

Michael W. Hodin is an adjunct senior fellow at the Council on Foreign Relations and regular contributor to The Fiscal Times’ blog “Age and Reason”. He is the former vice president for public affairs and policy at Pfizer Inc.

"With longevity we must find a way to frame up the ‘new middle age’ from 55 to 75, that’s where the demographic realities are and again not just in America, but worldwide . . . and with that new middle age comes a different life-course approach to work and retirement but that only makes sense if we can stay healthy longer and so healthy aging is very much around addressing Alzheimer’s."
—Michael W. Hodin

The Age of Alzheimer’s
Curing Alzheimer’s
World Alzheimer Report 2010: The Global Economic Impact of Dementia

Stephen Parente is a finance and insurance professor in the University of Michigan Carlson School of Management, he talks to Paul Howard about high risk pools and insurance exchanges under Obamacare.

"If we really want to do something…before 2014, [a federal health insurance charter] could actually be a way…to allow for some price competition before 2014, and essentially be a light duty exchange mechanism where the subsidies are not required yet. . .furthermore, it could be a way to “hot deck” the high risk [pools] that have not taken off [even though] they've been available since September."
—Stephen Parente

The GOP Can Outsmart ObamaCare
Consumer Response to a National Marketplace for Individual Insurance
Insurance Regulation Reform: The Optional Federal Charter

Dr. David Gratzer is a physician and a senior fellow at the Manhattan Institute his most recent book is The Cure: How Capitalism Can Save American Health Care. He talks with Paul Howard about the dangers of a “repeal-only” mindset on the part of Republicans and proposes immediate solutions to the problems with Obamacare.

"We have to find realistic solutions beyond a symbolic vote at the end of January when the new Congress is sworn in; what are we going to be doing on January 1st, February 1st, March 1st. . .I would suggest an agenda to take out the worst aspects of Obamacare and also try to build more of a patient-friendly, patient-centered health care system."
—Dr. David Gratzer

Try Small Reforms To ObamaCare Before Going All-Out For Repeal
Big hole in GOP health repeal plan
Sen. Coburn: GOP should repeatedly attempt to repeal health reform

Peter Pitts is President and co-founder of the Center for Medicine in the Public Interest and Partner/Director Global Healthcare, Porter Novelli. Prior to founding CMPI, Pitts was a Senior Fellow for healthcare studies at the Pacific Research Institute.

"House hearings are going to be structured in a way to support the concept of personalized medicine and spending up-front relative to prevention of all kinds. If you view yourself as the major player, which the Government is and the Government wants to save money, then you have this cost centric system as opposed to a longer term patient system where a patient is kept healthier earlier, which is ultimately how we’re going to save our system and reduce costs."
—Peter Pitts

Few Democrats survive healthcare vote
The GOP Can Outsmart ObamaCare
Obamacare in Pictures

Richard A. Epstein is a Manhattan Institute visiting scholar. He is one of the nation's most prolific legal thinkers, with writings spanning a broad array of fields, including common law subjects of property, contracts and torts. Professor Epstein's influence is profound: he is one of the three most cited law professors in the United States and the most cited professor writing largely in private law. He talks with Paul Howard about the danger of conflict-of-interest regulation in stifling medical innovation.

"We need to get ourselves into de-regulatory mode. Not because we're anarchists, not because we believe conflicts don't exist but because we understand that matters of degree when wrongly calibrated and wrongly decided can often be even more deadly than decisions that make "yes" or "no," "up" or "down," kinds of choices."
—Richard Epstein

Lifesaving Salesmen, Thomas P. Stossel, M.D., City Journal Online
Swing Vote at the FDA, David R. Henderson, Charles L. Hooper, AMedical Progress Today

Thomas Miller, a resident fellow at the American Enterprise Institute and former senior health economist for the Joint Economic Committee (JEC) discusses how states can fight Obamacare by implementing market-based insurance exchanges. He talks with Paul Howard about how to develop better insurance exchanges and the important role governors will play in the coming months.

"The political environment is changing. Ultimately, what most people want is something that works; not some abstract ideology; not some takeover at a higher level politically. If states can actually put something out there which looks like a better approach than what currently exists and certainly what is about to be imposed upon them, they’ve got a chance to make some progress."
—Thomas Miller

Health Care: Washington's Way or the Highway
Utah's Response To The Federal Request For Comments On Implementing Health Insurance Exchanges

William C. Carpenter, the Chief Operating Officer for Salient Corporation, discusses fraud, waste, and abuse in New York's nearly $50 billion Medicaid program, as well as how to design better, less expensive Medicaid options that also improve health outcomes for some of New York’s most vulnerable residents.

"Let's say fraud is 5% and abuse is 5% and waste is 10%, just at that first level. We're at about 20% cost. But then waste in system because people are not efficient in [how] they take of their health and the resources needed to take care of recipients are not always available, it's another 10-20% bringing the total to 30-40% [of Medicaid spending] if we could get the health care system efficient. It's a staggering amount of money."
—William C. Carpenter

Medicaid Fraud and Reform in New York State
“Priority Community Healthcare Opens in Chemung County”
Combating Medicaid Fraud in New York State

Randy E. Barnett is the Carmack Waterhouse Professor of Legal Theory at the Georgetown University Law Center, where he teaches constitutional law and contracts. Mr. Barnett discusses the constitutionality of the individual mandate to buy health insurance in the Affordable Care Act.

"What Congress is trying to do for the first time in American history is to mandate—under its Commerce Clause power—that individuals enter into economic activity who are not engaged in it now [buying health insurance] . . . therefore, it goes beyond a Supreme Court doctrine that currently exists which both defines and limits when Congress can reach intrastate activity."
—Randy Barnett

Commandeering the People: Why the Individual Health Insurance Mandate is Unconstitutional
Is health-care reform constitutional?
The Insurance Mandate in Peril

Scott Gottlieb, M.D., a practicing physician and resident scholar at the American Enterprise Institute, discusses why, six months passing, the Affordable Care Act remains deeply unpopular—and is apt to remain so for the foreseeable future.

"The essential element of the Obama health care plan that's fundamentally flawed, is that they basically say we're going to set up state based exchanges and we're going to let plans get sold [and compete] in those exchanges, but it has to be the same plan. If you look at the regulation, it's one plan."
—Scott Gottlieb

Break It, Own It
Health "Reform" Will Haunt Dems
Medical Loss Ratio Debate Drags On, Drags Down Stock Prices

Sally C. Pipes is the president and chief executive officer of the Pacific Research Institute and author most recently of The Truth About Obamacare. She talks about the many unintended consequences of health care reform, and why what we’re seeing now is just the tip of the iceberg.

"People say [repealing the health care reform legislation] can't be done, but Medicare catastrophic was repealed in 1989 so it can be done, but it takes a very stiff backbone and a strong leader."
—Sally C. Pipes

Poison pill could be among drug imports
Mass. health meltdown is your future
Sign Of Times Under ObamaCare: 'The Doctor Is Out — Permanently'

E.J. McMahon, Manhattan Institute senior fellow and research director at the Empire Center for New York State Policy, discusses the “Early Retiree Reinsurance Program” set up under the new federal health care law to subsidize employer-sponsored health insurance for retirees who haven't yet reached the Medicare eligibility age of 65:

"[Is the HHS] implicitly inviting state and local governments to dump their unfunded retiree liabilities into the Federal government’s lap? We don’t know."
—E.J. McMahon

Obama Deploys $5 Billion to Fund Early Retiree Health
The Early Retiree Reinsurance Program: $5 Billion Will Last About Two Years,
Conn. OK'd for federal early retirement funds

Douglas Holtz-Eakin, president of the American Action Forum, and Paul Howard discuss Obamacare's debilitating effects on small businesses.

"The indirect costs [of Obamacare to small businesses] . . . are we're likely to have higher insurance premiums as a result of this, employers are going to bear at least part of that cost, [small businesses] are going to have to rework their insurance packages to meet the requirements of the law—indeed some of them may rework compensation broadly and stop providing insurance—and they'll have to deal with an environment that's very confusing. They'll have lots of new rules that they don't' understand . . . and indeed they may be in a very deficit-ridden environment where they see higher insurance rates, higher taxes, or both."
—Douglas Holtz-Eakin

Health Law Needs Repeal
The Patient Protection and Affordable Care Act: Will Small Business Need Protection From Its Cost?
Bay State Health-Care Blues

Dr. Janet Woodcock, director of the Center for Drug Evaluation and Research (CDER) at the Food and Drug Administration, and Paul Howard discuss genetic testing, the role of the FDA in regulation, and the importance of public-private collaboration.

"No company wants to develop new clinical trial methods; that's not their business. . . . However we need new scientific trial methods, for example to evaluate use of genetic tests along with new drugs that come along, and so we need to come together in different ways to develop that regulatory science."
— Janet Woodcock

Critical Path 2010 Update
Dr. Woodcock Comments on The Critical Path Initiative
The Critical Path Initiative: Report on Key Achievements in 2009

Rita Numerof, Ph.D., and Paul Howard discuss Obamacare's effects on the health care industry, and what is being done to advance evidence-based medicine.

"The legislation that was passed earlier this year only addressed . . . the issue of insurance reform, and at . . . an enormous expense and bureaucratic oversight. But the legislation really didn't address the ultimate objective of better health outcomes at lower costs in a direct way; it didn't address the issue of delivery reform; and it didn't address the issue of payment reform."
—Rita Numerof

Follow the Money . . . Where Healthcare Policy is Headed
Regulation's Impact On Innovation: A Two-Edged Sword

James C. Capretta is a Fellow in the Economics and Ethics Program at the Ethics and Public Policy Center (EPPC). Previously, he was an Associate Director at the White House Office of Management and Budget (OMB) from 2001 to 2004, where he was the top budget official for health care, Social Security, education, and welfare programs. This week, Capretta talks about the broken promises already emerging from Obamacare.

"What they've done though in regulatory rule-making, is essentially narrow the definition of what can be considered a grandfathered plan so narrowly that virtually no employer will be able to qualify for it. . . . Employers are coming to the realization that they have lost complete control over their job-based plans. . . . And the plans that existed previously are going to vanish."
—James C. Capretta

About Those Presidential Promises

Tomas J. Philipson, Ph.D., is the chairman of the Manhattan Institute's Project FDA and the Daniel Levin Professor of Public Policy Studies at the University of Chicago. From 2003-04 he served as a Senior Economic Advisor to the head of the Food and Drug Administration (FDA), and from 2004-2005 he served as a Senior Economic Advisor to the head of the Centers for Medicare and Medicaid Services (CMS).

Eric Sun, M.D., Ph.D., is a resident in the department of anesthesiology at Stanford University and a visiting fellow at the Bing Center for Health Economics at the RAND Corporation.

This week, Tomas and Eric discuss their new report, "Cost of Caution: The Impact on Patients of Delayed Drug Approvals," and how to save lives by streamlining the FDA's drug-development process. The report was released last week on Capitol Hill to influential staffers, scholars, and policy makers.

"What this report is concerned with is essentially that even though the latter part of the [FDA's drug-approval process], the time that FDA takes to evaluate the [trial] data, has gone down dramatically, . . . the time to conduct these trials from phase one to three has not, and that's really the bulk of development time from idea to market . . . . And that is really what affects patients waiting for these treatments to go on the market"
—Tomas Philipson

No Refills
Desperately Seeking Cures
Report: FDA Science and Mission at Risk
FDA's Critical Path Initiative

THE MISSING LINK: Advancing Personalized Medicine
Raymond L. Woosley is founder, president, and CEO of the Critical Path Institute (C-Path), an independent, non-profit organization uniquely dedicated to implementing the FDA's Critical Path Initiative. He has served as President of the American Society for Clinical Pharmacology and Therapeutics and the Association for Medical School Pharmacology Chairs. In this episode, Dr. Woosley discusses how advances in new sciences, like genomics, require new drug development tools and public-private collaborations to bring safer and more effective medicines to market.  He also discusses C-Path’s groundbreaking work in support of the FDA's Critical Path Initiative.

"Some place where the industry and the regulators and the patients can come together, . . . where these pre-competitive, applied science challenges can be met, is missing right now. We're all doing very good work, but it needs to be increased and it needs to be coordinated."
—Raymond L. Woosley

Research at the interface of industry, academia and regulatory science
Next-generation biomarkers for detecting kidney toxicity
Innovative Medicines Initiative site
Critical Path Initiative

NEW CANCER RESEARCH: Promising Developments
Dr. Daniel P. Petrylak is an Associate Professor of Medicine, and program director of the Genitourinary Oncology section in the division of Hematology and Oncology, at Columbia University Medical Center. This week, Petrylak discusses recent results of new cancer drugs presented at the ASCO (American Society of Clinical Oncology) meetings in Chicago.

"The only way to properly answer these questions is through clinical trials. And although these may be expensive to do in the short term, in the long term we’re going to be having cost savings."
—Daniel Petrylak

Ipilimumab Improves Survival for Patients with Metastatic Melanoma
Cancer Immunotherapies Coming of Age

THE HUMAN GNOME PROJECT: After 10 Years, What's Next?
Dr. Stephen Eck, M.D., Ph.D., is a Hematologist/Oncologist at Eli Lilly & Company with experience in drug development both in academic and commercial settings. Dr. Eck joined Lilly in 2007 as Vice President of Translational Medicine & Pharmacogenomics. In 2009, Dr. Eck assumed leadership of the newly formed Tailored Therapeuttics Hub, a group dedicated exclusively to the development of Lilly’s Personalized Medicine strategy. Dr. Eck reflects on the 10th anniversary of the completion of the Human Genome Project and the future of personalized medicine.

"We're now seeing many drugs in the mid-to-late stage pipelines of large companies and biotech companies that are the result of the human genome mapping. . . . I think we have to appreciate the fact that from finding the gene to getting the drug is a journey of several years. . . . Equally important, though, is that the genomic revolution has built some tools that will enable personalized medicine."
—Dr. Stephen Eck

10 Years on, ‘The Genome Revolution Is Only Just Beginning’
Has the revolution arrived?

Sean Khozin is a practicing physician in New York City and the co-founder of Hello Health, a web-based electronic medical record system and communication platform that enables doctors and patients to connect online via email, instant messaging, and video chat. This week, Khozin discusses over-the-counter genomics testing and the integration of technology into the direct care model.

"There's... an opportunity, once genomics medicine is more accurate, and once we have more evidence on what to do with that information, to incorporate that into the process of delivering care. But at the end of the day, what you need as a prerequisite is being able to establish a strong therapeutic relationship with your physician."
— Sean Khozin

Hello Health, Goodbye Hassle
Walgreens Delays Selling Genetic Test
Walgreens’ Genetic Tests on Hold, Under Congressional Investigation

Scott Gottlieb, M.D., a practicing physician and a resident fellow at the American Enterprise Institute discusses the unanticipated problems and costs from the health care bill that are now emerging for the pharmaceutical industry.

"If a drug has been on the market for a long period of time, and has taken a lot of price increases over that time, they have to pay that discount back to the government . . . so drug companies can actually be in a situation where they are rebating more than 100% of the revenue of of a product back to the government."
— Scott Gottlieb

The Drug Stock Sell-Off
Lilly’s Health-Care Costs Set Stage for Drugmakers

David Gratzer, a practicing physician and a senior fellow at the Manhattan Institute, discusses First Lady Michelle Obama's task force recommendations on childhood obesity, which were released on Tuesday, May 11, 2010.

"Where I disagree with Michelle Obama is her final recommendation. . .Rather than trying to get the federal government to fix the federal government [lunch] program that doesn't work particularly well, I would devolve this over to the state government—not unlike welfare, which was done 14 years ago—and let the state governments experiment."
— David Gratzer

Getting It Right on Obesity
White House Task Force on Childhood Obesity Report to the President

Art Carden is an Assistant Professor of Economics and Business at Rhodes College in Memphis, Tennessee. In addition, he is an Adjunct Fellow with the Independent Institute and a member of the Adjunct Faculty of the Ludwig von Mises Institute. This week, Carden discusses his research on how Wal-Mart's revolutionary product distribution system sharply lowers food prices facing consumers—and may also affect obesity rates in the U.S.

"If I know that someone else is going to pick up the bill for the heart attack I'm going to have someday because of my decision to supersize my meal, then the cost to me of supersizing that meal is lower, then I'm going to do it. If I know that I'm going to have to foot the entire bill for my heart attack, then I have less of an incentive to supersize my meal."
— Art Carden

Wal-Mart's Weight Effect
Supersizing Supercenters? The Impact of Wal-Mart Supercenters on Body Mass Index and Obesity

Peter Suderman is an associate editor of Reason magazine, where he writes regularly on health-care, tech policy, and pop culture. He discusses the unintended consequences of state health care reform efforts in Tennessee, Maine, and Massachusetts—and the implications for recently passed federal legislation.

"For a lot of people, the penalty is not going to be sufficient reason to purchase insurance. . .we're going to see a lot of stories about how you can game the system and a lot of stories about people who do this successfully and save money."
— Peter Suderman

Health Care's History of Fiscal Folly
The Lie of Fiscal Responsibility
How Democrats used deceptive accounting to make history with health care reform.
The States’ Failed Experiments
The major provisions of ObamaCare have already been tried. And they don’t look good

Scott Harrington, a health insurance expert and professor at the Wharton School at the University of Pennsylvania, explains how one of the central provisions in the legislation—a mandate for all U.S. citizens to have health insurance or pay a fine—is likely to play out once the mandate takes affect in 2014.

"What we should try to work for under the existing regulation is to try to make sure that regulations are developed that really emphasize and preserve state and regional flexibility so that we don't end up having a system where under some mechanism the different state and regional exchanges are taking orders from Washington."
—Scott Harrington

Demonizing the Insurance Industry Is Not the Answer
The Adverse-Selection Problem
Current Democratic health-care proposals will have unintended consequences—bad ones

Tevi Troy is a Visiting Senior Fellow at the Hudson Institute, a Senior Fellow at the Potomac Institute, and a writer and consultant on health care and domestic policy. He is the former Deputy Secretary of United States Department of Health and Human Services (HHS) in the administration of George W. Bush.

"The way that the [health care] legislation is implemented could have a real impact on whether we can have market-based reforms in the future . . . And I hope that in the implementation process, you see a lot more transparency and give consumers options."
—Tevi Troy

With Obamacare, implementation is tricky
Tevi Troy Discussing the Health Care Bill on Fox and Friends

Stephen T. Parente is an Associate Professor in the Department of Finance in the Carlson School of Management at University of Minnesota where he specializes in health economics, health insurance, medical technology evaluation and health information technology. He has extensive experience directing empirical analyses utilizing primary and secondary data bases and is acknowledged as a national expert on using administrative databases, particularly Medicare and health insurer data, for health policy research.

"As the [health] bill evolves and more things are added to it . . . I think it becomes a different dynamic of what the U.S. can actually afford and then maybe a high deductible health credit is our only way out to keep some sort of a lid on [costs] without it exploding."
—Stephen T. Parente

The Uninsured: It Will Get Worse Before It Gets Better
Another Trillion?
The CBO may have underestimated the cost of health reform.

Douglas Holtz-Eakin, president American Action Forum and Commissioner on the Congressionally-chartered Financial Crisis Inquiry Commission. Since 2001, he has served in a variety of important policy positions. During 2001-2002, he was the Chief Economist of the President’s Council of Economic Advisers (where he had also served during 1989-1990 as a Senior Staff Economist). At CEA he helped to formulate policies addressing the 2000-2001 recession and the aftermath of the terrorist attacks of September 11, 2001. From 2003-2005 he was the 6th Director of the non-partisan Congressional Budget Office, which provides budgetary and policy analysis to the U.S. Congress.

"The presumption with the credit agencies has always been that the US will get its act together, slow the growth of spending, and it will get rid of these large deficits. If we pass this [health care] bill, we will have taken a decisive step in the wrong direction." – Douglas Holtz-Eakin

Recommended Reading:
Health Care Reform and the Numbers, American Action Forum, 03-10-10
Reconciliation isn’t the Answer to Health Reform, Douglas Holtz-Eakin, American Action Forum, 03-10-10
Testimony of Douglas Holtz-Eakin
United States Senate Committee on the Budget

Tomas Philipson, chairman of the Manhattan Institute’s Project FDA, professor at the Harris School for Public Policy at the University of Chicago, former Bush Administration Senior Economic Advisor to the head of the Food and Drug Administration (FDA) during 2003-04, and Senior Economic Advisor to the head of the Centers for Medicare and Medicaid Services (CMS) in 2004-05, talks to Paul Howard about comparative effectiveness research

Recommended Reading:
The Blue Pill Or The Red Pill?, Tomas Philipson,, 1-14-10
The Impact of Comparative Effectiveness Research on Health and Health Care Spending, Anirban Basu, Tomas J. Philipson, January 2010

Richard Amerling, MD, Director of Outpatient Dialysis at Beth Israel Medical Center in New York, Associate Professor of Clinical Medicine at Albert Einstein College of Medicine, and a Director of the Association of American Physicians and Surgeons, talks to Paul Howard, director of the Center for Medical Progress at the Manhattan Institute, about impending severe cuts in funding for dialysis due to take effect in January, 2011. Dr. Amerling says these cuts will lead to rationing of certain medicines used currently for these patients, and may force some dialysis units out of business.

Recommended Reading:
Doctors Are Like Frogs Being Slowly Boiled, Richard Amerling, Wall Street Journal Letter to the Editor, 11-3-09

Recommended Links:
What do doctors fear the most about Obama Care?, NewsMax.TV
AAPS Director and Member on Glenn Beck Show, Fox News

Paul Offit, MD, Chief of the Division of Infectious Diseases and the Director of the Vaccine Education Center at the Children’s Hospital of Philadelphia. Dr. Offit is also the Maurice R. Hilleman Professor of Vaccinology, and a Professor of Pediatrics at the University of Pennsylvania School of Medicine, talks to Paul Howard, director of the Center for Medical Progress, about seasonal flu vaccines and shortages, H1N1, and what lessons we can learn from our first brush with a global pandemic since the U.S. began upgrading its capacity to produce vaccine and respond to flu pandemics several years ago.

Recommended Reading:
Inoculated Against Facts, Paul Offit, New York Times, 3-31-08
Autism's False Prophets: Bad Science, Risky Medicine, and the Search for a Cure, Paul Offit, September 2008

David Gratzer, senior fellow at the Manhattan Institute, talks to Paul Howard, director of the Center for Medical Progress, about his new broadside, “Why Obama’s government takeover of health care will be a disaster”

"Some countries spend less on healthcare but the way they have gone about doing that is by rationing care- everything is free, nothing is readily available." – David Gratzer

Recommended Reading:
"Why Obama’s government takeover of health care will be a disaster", David Gratzer, Encounter Books, November 2009

Mary Kate Scott, founder and CEO of Scott & Co, talks to Paul Howard, director of the Center for Medical Progress, about the retail clinic model and what the future of the model may hold for consumer-driven health care.

"They have looked at healthcare from the consumer or the patients point of view and have thought about what is it that that patient would really like to experience in healthcare?" – Mary Kate Scott


Stephen T. Parente, Academic Director, Medical Industry Leadership Institute Carson School Of Management, Finance & Insurance, University of Minnesota, and Tarren Bragdon, adjunct fellow at the Manhattan Institute and CEO of the Maine Heritage Policy Center, talks to Paul Howard, director of the Center for Medical Progress about "Healthier Choice: An Examination of Market-Based Reforms for New York's Uninsured".

"Only 5 states have Guaranteed Issue and Community Rating and they all have very expensive small individual insurance markets. 35 other states have a much more competitive flexible market…it’s more the case of Congress swimming against the tide of what’s happening in the states." – Tarren Bragdon

"Healthier Choice: An Examination of Market-Based Reforms for New York's Uninsured", Stephen T. Parente and Tarren Bragdon, September 22, 2009

Scott Harrington, professor of health-care management and insurance and risk management at the University of Pennsylvania's Wharton School and an adjunct scholar at the American Enterprise Institute, talks to Paul Howard, director of the Center for Medical Progress about healthcare co-ops.

"The basic idea is that the government would subsidize at the state or regional level some co-operative health insurance organization.." – Scott Harrington



Fact-Checking the President on Health Insurance, Scott Harrington, Wall Street Journal, 9-14-09
Health Co-ops: Slow Road to Government Care, Scott Harrington, Wall Street Journal, 8-19-09
What the States’ Experience with Mandates Should Tell Us about Universal Healthcare Coverage, Scott Harrington, The American, 8-11-09
Reform Needs Healthy Life Incentives, Scott Harrington, Wall Street Journal, 6-29-09
The 'Public Plan' Would Be the Only Plan, Scott Harrington, Wall Street Journal, 6-16-09

John Cochrane, professor of finance at the University of Chicago and an adjunct fellow at the Cato Institute, talks to Paul Howard, director of the Center for Medical Progress about what to do about preexisting conditions.

"Twenty years ago if you got a long term disease there wasn’t much we could do for you so you weren’t that expensive." – John Cochrane

What to Do About Pre-existing Conditions, John Cochrane, Wall Street Journal, 8-14-09
Health-Status Insurance, John Cochrane, Cato Institute, 2-18-09

Megan McArdle, is a journalist and blogger for The Atlantic, talks to Paul Howard, director of the Center for Medical Progress about the difference between rationing through price signals in the market and rationing through government agencies.

"The people who are doing the allocation don’t actually have the same incentives as the people for whom they’re doing the rationing." – Megan McArdle

Asymmetrical Information, Megan McArdle’s blog, The Atlantic
Rationing By Any Other Name, Megan McArdle, The Atlantic, 8-10-09

David Hyman, Director of the Epstein Program in Health Law and Policy at the University of Illinois, talks to Paul Howard, director of the Center for Medical Progress on competition in health insurance markets.

"What makes a market competitive is that there are lots of players in it and none of them have market power, the ability to dictate terms to other participants" – David

Health Insurance: Market Failure or Government Failure?, David A. Hyman , U Illinois Law & Economics Research Paper, April 6, 2009
Malpractice Payouts and Malpractice Insurance, David Hyman, Geneva Papers on Risk and Insurance, 2008

James Capretta, fellow in the Economics and Ethics Program of the Ethics and Public Policy Center, talks to Paul Howard, director of the Center for Medical Progress, about the most problematic aspects of healthcare legislation on Capitol Hill.

"The bills that are moving in Congress are structurally flawed for one major reason- they essentially force Americans into government approved insurance with the premiums rising at a pretty rapid rate that will be costly for a lot of people” – James Capretta

Obamacare: It's Even Worse Than You Think, Weekly Standard, James C. Capretta and Yuval Levin, 8-3-09
Wrong Big Picture, Dangerous Fine Print, National Review Online, James Capretta and Tevi Troy, 7-31-09
The House Bill Costs Far More Than $1 Trillion, Kaiser Health News, James Capretta, 7-24-09

David Gratzer, a physician and senior fellow at the Manhattan Institute, talks to Paul Howard, director of the Center for Medical Progress, about the public plan option and what dangers it presents.

“The public plan option would be at an unfair advantage over other plans…it would be reimbursing doctors at a fraction of the price others do” –David Gratzer

'Cost': Health Care's Four-Letter Word,, 07-24-09
Regulation, Not Size, Is Health Care's Biggest Problem, Washington Examiner, 07-22-09
A Medicare-Style Public Option in Healthcare Would Kill Private Insurance, U.S. News and World Report, 07-17-09
Improving Our Tangled Healthcare Mess, The Boston Globe, 07-13-09

Diana Furchtgott-Roth, an adjunct fellow at the Manhattan Institute and a columnist for, talks to Paul Howard, director of the Center for Medical Progress, about the Democrats legislation in the House of Representatives to reform healthcare markets.

“What is so frustrating and maddening about this bill is the employers have to provide the same kind of coverage that is in the health exchange plan or the public plan which is a gold plated plan… if employers offered a simple, catastrophic plan…that would not be permitted.”- Diana Furchtgott-Roth

A Very Unhealthy Health Bill, Diana Furchtgott-Roth, RealClearMarkets, 07-16-09
Socialized Medicine Through the Eyes of a Recipient, Diana Furchtgott-Roth, RealClearMarkets, 06-25-09
We Face Major Healthcare Choices, Diana Furchtgott-Roth, RealClearMarkets, 06-04-09

Elias Zerhouni, senior fellow in the Global Health Program at the Bill and Melinda Gates Foundation and former director the U.S. National Institutes of Health, talks to Paul Howard, director of the Center for Medical Progress, about U.S. leadership in biomedical innovation, the role of innovation in healthcare reform, and what the U.S. can do to ensure that it can remain the leader in biomedical innovation in the 21st century.


"It's an era of… precision medicine, no longer can you have a one size fits all type of medicine if you want to be effective in both at providing good healthcare and at a reasonable cost" – Elias Zerhouni

The Promise of Personalized Medicine, NIH Medline Plus, Winter 2007
Extracting Knowledge From Science: A Conversation With Elias Zerhouni, Health Affairs, May/June 2006
Translational and Clinical Science — Time for a New Vision, Elias Zerhouni, New England Journal of Medicine, October 2005

Gail Wilensky, an economist and a senior fellow at Project HOPE, talks to Paul Howard, director of the Center for Medical Progress, about arguments that the President and members of Congress have made arguing for a public insurance plan to compete with private insurers and what other models are available to improve choice and competition in health insurance markets.

"I believe people who reference the public plan as a way to hold down costs are assuming that the public plan would use the power of a very forceful government to set below market rates as in the case in Medicare and that really is something that would put the private plans at a real disadvantage.” – Gail Wilensky

The Policies And Politics Of Creating A Comparative Clinical Effectiveness Research Center, Gail Wilensky, Business Economics, Gail Wilensky
Reforming Medicare's Physician Payment System, Gail Wilensky, 2-12-09
Value-Based Insurance Design, Michael E. Chernew, Allison B. Rosen and A. Mark Fendrick, 1-30-07

Stephen Parente, Academic Director, Medical Industry Leadership Institute Carson School Of Management, Finance & Insurance, University of Minnesota, talks to Paul Howard, director of the Center for Medical Progress, about his idea for medical banking.

“No matter what money moves in the healthcare system today, it must go through banks” - Steve Parente

Health Information Technology and Financing’s Next Frontier: The Potential of Medical Banking, Stephen Parente, Business Economics, January 2009

Joseph Antos, the Wilson H. Taylor Scholar in Health Care and Retirement Policy at the American Enterprise Institute, talks to Paul Howard, director of the Center for Medical Progress, about health spending disparities across the U.S. and what they tell us about American healthcare.


“One of the most important things we can do is give patients better information about what is going on” -Joseph Antos

What Can a Texas Town Teach Us About Healthcare?, Joseph Antos, The Enterprise Blog, 6-1-09
The Cost Conundrum, Atul Gawande, The New Yorker, 6-1-09
Obama Targets Wrong Tax for Health Reform, Joseph Antos, the Detroit News, 5-30-09
Uncle Sam, M.D., AEI Scholars on Health Care and Pharmaceutical Reform, April 2009

Sidney Taurel, former CEO and Chairman of Eli Lilly, talks to Paul Howard, director of the Center for Medical Progress, about the future of the pharmaceutical industry, the future of healthcare, and the importance of thinking of healthcare as an investment in human capital.

From the Broad Brush to the Fine Point: How to Enable Personalized Medicine, Sidney Taurel, 12-12-08

Betsy McCaughey, Chairman of the Committee to Reduce Infection Deaths and former Lt. Governor of New York State, talks to Paul Howard, director of the Center for Medical Progress, about the truth about healthcare reforms that have been proposed.

“We should not be thinking about healthcare as a cost problem, it’s much more constructive to think of it as a growth industry. . . we’re not in the middle of a healthcare spending crisis."- Betsy McCaughey

Obama's Voodoo Health Economics, Wall Street Journal, 6-5-09
The Attack On Doctors' Hippocratic Oath, Investor’s Business Daily, 4-29-09
Ruin Your Health With the Obama Stimulus Plan: Betsy McCaughey, Bloomberg News, 2-9-09

Dana Goldman, Senior Principal Researcher at the RAND Corporation, talks to Paul Howard, director of the Center for Medical Progress, about misconceptions on how to cut healthcare costs.

“There’s evidence that would suggest that we’re wasting 30% of our dollars but without knowing which dollar and which is being wasted, you run the risk that if you cut by 30% you will harm people’s health.” – Dana Goldman

Regulating Drug Prices, Dana P. Goldman, Darius N. Lakdawalla, Pierre-Carl Michaud, Neeraj Sood, Robert J. Lempert, Ze Cong,Han de Vries, Italo Gutierrez, January 2009
U.S. Pharmaceutical Policy in a Global Marketplace, Darius N. Lakdawalla, Dana P. Goldman, Pierre-Carl Michaud, Neeraj Sood, Robert J. Lempert, Ze Cong, Han de Vries, Italo Gutierrez, December 16, 2008
The Effect Of Regulation On Pharmaceutical Revenues: Experience In Nineteen Countries, Neeraj Sood, Han de Vries, Italo Gutierrez, Darius N. Lakdawalla, and Dana P. Goldman, December 2008
Life Expectancy Is Better Than Age as a General Predictor of Health Care Expenditures, Baoping Shang, Dana P. Goldman, April 2008
Modeling the Health and Medical Care Spending of the Future Elderly, Dana P. Goldman, David M. Cutler, Paul G. Shekelle, Jay Bhattacharya, Baoping Shang, Geoffrey F. Joyce, Michael Hurd, Dawn Matsui, Sydne Newberry, Constantijn (Stan) Panis, Michael W. Rich, Catherine K. Su, Emmett B. Keeler, Darius N. Lakdawalla, Matthew E. Chernew, Feng Pan, Eduardo Ortiz, Robert H. Brook, A. M. Garber, Shannon Rhodes, 2008
Socioeconomic Differences in the Adoption of New Medical Technologies, D. Goldman and J. Smith, American Economic Review Papers and Proceedings, Vol. 95, No. 2, 2005

Regina Herzlinger, senior fellow at the Manhattan Institute, talks to Paul Howard, director of the Center for Medical Progress, about the state of the healthcare marketplace in the U.S.

“The first rule of any market is that consumers by things for themselves and that’s violated in healthcare because we have this arcane tax law that promotes agents who do or buy for us.” – Regina Herzlinger

Can the United States Provide Health Care For All?, McKinsey & Company, 05-18-09
Health Care Reform that Will Kill the U.S. Economy, Huffington Post, 04-27-09
Creating a Real Healthcare Market, The Boston Globe, 02-18-09

Douglas Holtz-Eakin, former CBO director, talks to Paul Howard, director of the Center for Medical Progress, about the principles and priorities policymakers should follow in order to achieve sustainable healthcare reform.

“It should be the case that value and reforms to the delivery system come first, expansion in coverage comes second”- Douglas Holtz-Eakin

Forging a New Plan For Health Care: Principles and Priorities for Sustainable Reform

Dr. Tom Price, U.S Representative (R-GA), talks to Paul Howard, director of the Center for Medical Progress, about the politics of health reform in Congress and how we can move towards a more patient centered healthcare reform system.

"A lot of the reforms that we talked about seem to make it their goal to make certain that everyone receives exactly the same thing…The problem is that each and every individual patient... is different even though they may have the same diagnosis. What we need is system that is responsive to patients needs and their families needs but is not a cookie cutter kind of system which is what we see in other nations."
— Dr.Tom Price, U.S. Representative (R-GA)


Official Website of Rep. Tom Price
Republican Study Committee

GOP Should Fight Health Care Rationing, Dr. Tom Price, Wall Street Journal, 1-7-09
Getting health care reform right, Dr. Tom Price, Washington Times, 4-1-09
To Reform, Create a Real Marketplace, Dr. Tom Price, Politico, 5-3-09
H.R. 2626: Comprehensive Health Coverage And Reform Enhancement Act of 2007, Rep. Tom Price, 6-7-07

William Winkenwerder, former assistant secretary of health affairs at the Department of Defense, talks to Paul Howard, director of the Center for Medical Progress, about public and private sector examples of successful health care innovation and what we can learn from them for the debate over health care reform.

"The U.S. has been, far and away, the leader in investment in new medical technologies, new treatments, new pharmaceuticals... and the world has benefited from that."
— Dr. William Winkenwerder, Jr.


The Wrong Stimulus for Health Care, William Winkenwerder, Jr. and Grace-Marie Turner, National Review Online, 02-10-09
Casualties of War—Military Care for the Wounded from Iraq and Afghanistan, Atul Gawande, New England Journal of Medicine, 12-09-04

Arnold Kling, economist and author, talks to Paul Howard, director of the Center for Medical Progress, about rising health care costs, why insurance now pays for routine health care expenses, and how we can promote innovation and competition in markets dominated by 3rd party payers.

"In this country, 90 percent of personal healthcare spending is paid for by third parties…so that means we are insulated from the financial consequences of our medical decisions."
— Arnold Kling



Insulation vs. Insurance, Arnold Kling, Cato Unbound, 1-8-07
Crisis of Abundance, Arnold Kling, 2006

Dan Petrylak, associate professor of medicine and director of the genitourinary oncology program at the Columbia University Medical Center, talks to Paul Howard, director of the Center for Medical Progress, about the future of cancer care, and how to make better, more effective treatments a reality.

"Realistically, what we would like to do is to extend life, but to extend life with the best possible quality."
— Dan Petrylak


Project FDA
Cancer Drug Development and Approval
The Cancer Genome Atlas
Medicines in Development for Cancer 2009

Borrow From The HIV Battle Plan To Help Win War Against Cancer, Tomas Philipson, Investor's Business Daily, 03-14-09

Evan Falchuk, president of Best Doctors, talks to Paul Howard, director of the Center for Medical Progress, about how we define "the best" in health care and how can we leverage individual excellence to drive system wide improvements.

"If you're ill you don't need a Congressional hearing... you just need to get the right diagnosis and treatment and the system should be fixated on that problem not on the particular mechanism of reimbursement"
— Evan Falchuck


Best Doctors:
See First Blog:
Atal Gawande:

Why 'Quality' Care is Dangerous, Jerome Groopman and Pamela Hartzband, Wall Street Journal, 04-08-09


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