James P. Gelfand joined the U.S. Chamber of Commerce in August 2007. He is responsible for health policy issues pending before Congress and the federal agencies, including the protection of ERISA preemption, mental health parity, small business health plans, privacy and confidentiality, consumerist health options, and comprehensive health reform.
He joined the Chamber from The ERISA Industry Committee, where he served as the manager of health policy, focusing on research and advocacy for health issues of concern to Fortune 100 companies.
Gelfand attended Northwestern University in Evanston, Illinois, graduating with distinction in political science and legal studies. Previously, he worked at the National Center for Public Policy Research, where he co-authored the 2007 edition of Shattered Dreams: One Hundred Stories of Government Abuse. He also worked in litigation support at the international law firm Sidley, Austin, Brown and Wood.
Gelfand has a background in investigative reporting and formerly served on the editorial board of the Northwestern Chronicle. He is a regular contributor to health policy publications. He is a scholar of ancient Latin and Greek and a student at The George Washington University Law School. Gelfand lives in Washington, D.C.
Texas Governor Rick Perry last night made some important comments on Fox Business Network about this. Essentially, "opt out" is not a real "opt out", unless you enjoy taxing citizens and businesses in your state to pay for a program that only operates in other states. I echo the sentiments of Mike Cannon below. Further, consider the implications of punting this to the states. Right now a cabal of far leftist groups have vowed to spend nearly $100 million pushing a public option. On the federal level, this won't go that far, because they have powerful opponents (like the business… Read more
The reason support for health reform is tanking right now is because Pelosi, Dodd, Obama, and the other leaders took too much of the advice posted here. Rather than take the public's concerns seriously and take the time to educate them on the issue, those in power instead take the view that the public are fools and are easily mislead (after all, they think Iraq supported al-Queda and they question the President's birth certificate). "Let's just pass it ASAP before people have a chance to figure out what it really does." You have to think someone is stupid if you expect them to believe "we have to… Read more
David Nexxon correctly points out (albeit by accident) that the House bill, like the Senate HELP bill, focuses on what sponsors believe are "moral imperatives." They pay precious little heed to what outside observers like the U.S. Chamber and the CBO think of as "economic realities." (By the way, the CBO is nonpartisan and highly respected, and headed by a Democrat, despite the attacks you see being levied on Elmendorf now that he has failed to play along with the wink-and-smile "this is an investment, costs of inaction" game.) The private sector and public programs are buckling under the skyrocketing costs… Read more
Unfortunately, many in Congress have divorced themselves from reality and think that a mandate on employers to provide health insurance coverage or pay new taxes will help workers. This couldn’t be further from the truth. Marilyn’s question this week demonstrates that these politicians have moved on in their deliberations from whether to have a mandate, to just how exactly they will implement one. Rather than pick the “best bad policy” from the three approaches listed above, I think it would be valuable to take a step back. First of all, who is insisting on these policies? Unions and the… Read more
There are times when government has an important role to play in society, stepping up and creating the structures within which market forces and the spirit of enterprise can combine to lead to successes for individuals and for societal goals. That is one of the reasons the Chamber strongly supports creating an Exchange where people can easily compare health insurance plans and engage in smart, one-stop shopping. However, people should never cede their freedoms – including the freedom to choose a plan that best fits one’s needs – to government bureaucracies. The push to create Federal Health Board with nearly… Read more
I see no reason to worry - if Medicare continues eeking closer to engulfing the entire general revenue, eating up all the funds that we would like to use for national defense, education, welfare, transportation, etc., there is an easy solution: Just keep eliminating the Medicare trigger, write more IOUs, and pay no attention! Seriously though, Medicare's unfunded liabilities are more than $30 TRILLION dollars - there's no way we are ever going to pay for that, so why lose sleep over such an impossible task? As long as stakeholders have a kneejerk reaction of saying no to every Medicare reform… Read more
We come down in the middle on this one. On the one hand, we agree that CBO scoring mechanisms are not equipped to properly estimate the savings that can be achieved through health care changes, largely because the savings are often more apparent beyond the 10-year window CBO is confined to, and because CBO does not use epidemiological prjection models. Therefore, adhering to strict pay-go rules would not make sense for health reform. On the other hand, we oppose wasteful spending.We oppose lying to the public and calling all spending "investments" that therefore will not bankrupt our grandchildren. And we oppose… Read more
At a May 2008 briefing organized by the Alliance for Health Reform, speakers discussed the Massachusetts health reform law. The presentation I found most interesting was by Matt Fishman of Partners HealthCare, who explained the inside baseball of what went on in putting together the legislation: “So the stakeholders involved focused on coverage first… The 1988 Employer Mandate had not worked… We also knew that we would not reach agreement on a package if we try to do coverage and cost in the same vehicle.” There you have it – what they passed in Massachusetts was not real health reform.… Read more
Quintus Fabius Maximus was a Roman general famous for his tactics. He was nicknamed “the delayer” because, rather than seek a direct confrontation with Carthage, he pursued a piecemeal strategy of harassment, creating a war of attrition rather than a contest of might. Today the adjective “Fabian” is used to describe strategies that use small steps and “avoid decisive contests.” Today advocates of single-payer, socialized medicine know they have lost the public debate. President Obama didn’t even bother to invite them to his health reform summit, until they whined and threatened protests. The most hardcore advocates continue to fight a… Read more
The most important thing to garner from below is that everyone believes we need to reform, fix, refinance, and improve Medicare. It is insolvent, it underpays doctors, it still operates as if the generational shifts of the past few decades never took place, it cost-shifts to private payers, and its trust fund IOUs do not bode well for its fiscal future. Medicare does not delve deep enough into value-based purchasing, it has very little in the way of coordination of care, and is only in the last few months beginning to encourage the use of health information technology. Next time… Read more
The problem of covering the uninsured has been one that politicians and policy wonks have struggled with for a very long time. It must be addressed under the auspices of a comprehensive reform that reigns in costs as well as expands coverage. The stimulus bill’s Medicaid bailout and COBRA subsidy can serve only as a temporary band-aid. I read both Newt and Dr. Reinhardt’s entries this week with great interest, because neither is full of empty platitudes, and both bring up some very important points that we need to think about. This got me thinking about several views I see… Read more
I apologize in advance for dampening the mood. So far this year (and we are only 40 days in), we have spent or arranged to spend: $31 billion to expand the State Children’s Health Insurance Program. $87 billion to bail out the Medicaid program. $30 billion to subsidize COBRA coverage for discharged employees. $21 billion to fund health information technology and comparative effectiveness. Obviously some of this is subject to change during continuing negotiations, but the point is we have already spent a huge amount of money, very quickly, on health care. Every dollar we spend on this expends not… Read more
Across the board, everyone seems to agree that investing in HIT is a great idea. We can make our health care system more affordable while simultaneously increasing quality and patient safety. What's not to like? As usual, the devil is in the details. Congress tried to pass HIT legislation in the 110th Congress, but many provisions were controversial, and there were serious disagreements between the House and Senate. Worse, in the 109th Congress, HIT legislation was debated ad nauseum, and eventually passed in both the House and the Senate... but the two bills were never reconciled, so no final law… Read more
There are some serious problems associated with expanding and subsidizing COBRA coverage, and we should consider them carefully before including such provisions in a stimulus package. Studies have found that on average, COBRA enrollees cost employers about 145% as much as other covered lives - this is hardly offset by the 2% administrative fee enrollees pay. Some companies have reported that COBRA enrollees cost them more than twice as much as others. Part of the reason for this is adverse selection - if you leave your job, chances are you can probably find cheaper coverage than paying 102% of your… Read more
In a few days time I am sure this thread will be chock full of experts lavishing praise on Hillary's individual mandate proposal and McCain's proposal to tax currently tax-exempt health benefits. These two ideas are very popular among talking heads, health policy wonks, and a lot of very smart people. But don't assume they'll play in Peoria. At think tanks and in policy shops we can discuss ideas that would clearly be troubling to hundreds of millions of Americans - and yes, this includes forcing every man, woman, and child to purchase health insurance. It also includes raising taxes… Read more
I don’t think anyone is 100 percent positive what kind of effects or market distortions a new government health plan would bring about, but here is what we know for sure: (1) The plan would be modeled after Medicare. Medicare is in dire financial straights. Listing the problems with Medicare would take a lot of space – but the question is, will Medicare be modernized and improved? Will the new plan include cost-saving efficiencies, or would it just be more of the same? (2) The plan might have undue market advantages. Government is always able to “negotiate” the lowest rates… Read more
I have two main concerns with Mr. Daschle's proposal for a Federal Health Board. First - is this a legislative punt? It seems that there are diverging views in Congress on all of the complicated health care issues of the day. This has prevented legislation from passing on medical malpractice, bio-similars, health information technology, comparative effectiveness, and the list goes on. This gridlock is not necessarily a bad thing - it is in all of our best interests for a robust debate to be conducted, for legislators and constituents to have time to be educated on these issues, before policy… Read more
Marilyn's post makes an important point - one that, all too often, policy wonks ignore. Remember what Barack Obama said about an individual mandate, back in January of 2008? "The problem is not that folks are trying to avoid getting health care; the problem is they can't afford it." How can you mandate something that is so expensive, and has such unpredictable increases in costs? Talk about individual mandates is usually accompanied with the goal of forcing a massive influx of new funds into the health care system. Just as insurance companies would not mind if everyone was forced to… Read more
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