This morning the Council of Economic Advisers is out with a new report (pdf) on health reform and the economy, which serves as an update to their report in June.  The report is an interesting and accessible read, and essential for anybody interested in the topic of health reform, costs, and America's economy.  For a top line, here is one of their core conclusions:

Taken together, it is likely that the combination of provisions other than the excise tax could generate an additional reduction in the growth rate of private sector health care costs of 0.5 percentage point. This would imply a total slowing of private-sector cost growth of approximately 1.0 percentage point per year. Assuming that all of this slowing of cost growth is reflected in private health insurance premiums, an average family policy premium could be lower in 2019 by approximately $1000 than it otherwise would have been.

So what does this translate to for American families? 

Median family income that is $6,800 higher by 2030. This increase in the growth rate of GDP resulting from slowing the growth rate of health care costs translates into substantial increases in the median family income.

That's just one key data point in the report - take a look at the rest (pdf).

UPDATE: It should also be noted that CEA's calculations are not the high end in estimating the benefits for families, as the report goes on to note:

Recent research by Harvard economist David Cutler and Commonwealth Fund president Karen Davis suggests even greater savings from reform. Their estimates imply that a typical family in 2019 would pay nearly $2,000 less in health insurance premiums than they otherwise would have paid. Combining that with lower out-of-pocket costs, total savings would be more than $2,500.

Furthermore, given the amount of legitimate discussion about the costs of reform to government, it is important to mention that these savings will be reflected in the federal government's balance sheets in much the same way they are reflected in family checkbooks:

Taken together, the combination of Medicare- and Medicaid-related provisions in the Senate’s Patient Protection and Affordable Care Act are estimated to reduce the annual growth rate of Federal spending on both programs by 1.0 percentage point in the upcoming decade and by an even greater amount in the subsequent decade.

Combined with 1.0 percentage point lower private health spending, the overall effect of reform on health care spending growth is approximately 1.0 percentage point  lower per year overall.

After accepting the Nobel Peace Prize in Oslo, Norway, the President and First Lady Michelle Obama made sure to stop by the U.S. Embassy, where they greeted a group of excited staffers. The informal meeting between the President and Embassy workers was followed by a trip to the airport in the presidential motorcade where they boarded Air Force One for their trip home to Washington, D.C.

President Barack Obama greets the U.S. Embassy staff in Oslo, Norway, Dec. 11, 2009. (Official White House Photo by Pete Souza ) December 11, 2009. (Official White House Photo by Pete Souza)

Opponents of reform continue to prove they are willing to say or do anything to defend the status quo.  Today, they're out of the gate with a predictable distortion of a new report from the Actuary of the Centers for Medicare and Medicaid Services.  The alarmist headline of their press release screams that the Senate health reform bill "makes health care more expensive than doing nothing at all."

But here's what a more thorough reading reveals: the report confirms that the bill adds years to the life of Medicare, lowers costs for seniors, and slows the rate of health care cost growth.

Since the report comes from the folks who report to the Medicare trustees, it makes sense to start by looking at what it says about the cost of Medicare.

On that front, the report finds that the Senate health reform bill will extend the life of the Medicare trust fund by nine years.  It also provides real savings for seniors.  By 2019, the CMS reports, the bill saves seniors nearly $700 per couple per year, reducing premiums by more than $300 per year and out of pocket costs by another $370 per year.

More broadly, the report finds that reform will have a "a significant downward impact on future health care cost growth rates."  As savings from reform kick in, national health expenditures are projected to increase at a slower annual rate under the Senate bill than under the status quo.

And those results come even as the CMS takes a more conservative approach to measuring savings than many other independent experts have taken – meaning they may well underestimate the full effects of reform.  The CBO and other independent experts cite savings from additional critical cost-control provisions such as:

• Injecting accountability, competition, and choice into the system through the new insurance exchange.
• Giving providers incentives to coordinate care.
• Transforming Medicare payment policies – which in turn influence the private sector – to reward quality of care.

So how did reform's opponents manage to use this report to claim that costs will increase?  They cherry-picked total expenditures at a singular, fixed point in time – ignoring the overall rate of cost growth, the impact on Medicare and America’s seniors, and the fact that millions of more Americans will be covered.

It’s the kind of claim folks here in Washington love. It might be technically "true" but it hardly explains the truth.

Linda Douglass is with the White House Office of Health Reform

The first deadline of President Obama’s Executive Order on Federal Sustainability (EO 13514) was recently met when EPA announced new guidance for Federal agencies to reduce stormwater runoff from Federal building projects.

The new stormwater guidance for Federal building projects calls for innovative approaches for preserving local water systems by using porous pavement, green roofs, rainwater capture for landscape irrigation, and other strategies.  Managing stormwater on building sites – including strategies to make sure more rain is absorbed into the ground instead of channeled into municipal sewer systems – is an important way the Federal Government is leading by example. 

Most stormwater from building sites runs off into municipal sewer systems. In cities like Washington, DC that have combined storm sewers, which are water treatment systems that treat rain water and municipal sewage the same way, big rainfalls associated with storms can create overflows that are harmful to water quality in local rivers and streams.

Look for local examples of leadership from the Federal Agencies in your own communities – like the green roof on the EPA Laboratory Annex in Cincinnati, or USDA’s rainwater capture system at the People’s Garden on the National Mall.

Nancy Sutley is the Chair of the White House Council on Environmental Quality

Comment on this post at the OSTP blog.

Yesterday we announced the launch of the Public Access Forum, sponsored by the White House Office of Science and Technology Policy.  Beginning with today’s post, we look forward to a productive online discussion.

One of our nation's most important assets is the trove of data produced by federally funded scientists and published in scholarly journals. The question that this Forum will address is: To what extent and under what circumstances should such research articles—funded by taxpayers but with value added by scholarly publishers—be made freely available on the Internet?

The Forum is set to run through Jan. 7, 2010, during which time we will focus sequentially on three broad themes (you can access the full schedule here). In the first phase of this forum (Dec. 10th-20th) we want to focus on the topic of Implementation. Among the questions we’d like to have you, the public and various stakeholders, consider are:

• Who should enact public access policies? Many agencies fund research the results of which ultimately appear in scholarly journals. The National Institutes of Health requires that research funded by its grants be made available to the public online at no charge within 12 months after publication. Which other Federal agencies may be good candidates to adopt public access policies? Are there objective reasons why some should promulgate public access policies and others not? What criteria are appropriate to consider when an agency weighs the potential costs (including administrative and management burdens) and benefits of increased public access?
• How should a public access policy be designed?

1. Timing. At what point in time should peer-reviewed papers be made public via a public access policy relative to the date a publisher releases the final version? Are there empirical data to support an optimal length of time?  Different fields of science advance at different rates—a factor that can influence the short- and long-term value of new findings to scientists, publishers and others. Should the delay period be the same or vary across disciplines? If it should vary, what should be the minimum or maximum length of time between publication and public release for various disciplines? Should the delay period be the same or vary for levels of access (e.g. final peer reviewed manuscript or final published article, access under fair use versus alternative license)?
2. Version. What version of the paper should be made public under a public access policy (e.g., the author’s peer-reviewed manuscript or the final published version)?  What are the relative advantages and disadvantages of different versions of a scientific paper?
3. Mandatory v. Voluntary. The NIH mandatory policy was enacted after a voluntary policy at the agency failed to generate high levels of participation. Are there other approaches to increasing participation that would have advantages over mandatory participation?
4. Other. What other structural characteristics of a public access policy ought to be taken into account to best accommodate the needs and interests of authors, primary and secondary publishers, libraries, universities, the federal government, users of scientific literature and the public?
We invite your comments and in particular encourage you to be specific in your thoughts and proposals, providing empirical data and specific supporting examples whenever possible so this discussion can generate maximum practical value. You may want to start by reading a more complete description of this issue as it appeared in the Federal Register.

Importantly, this is a community-moderated blog. That means we count on you to keep the forum focused and on-topic—something you can do by “voting” on comments. Voting is an expression of how germane to the topic a comment is.  Voting up a comment expresses approval of the relevance. If enough people vote down a comment, the comment in question “collapses” into a link so that it doesn’t interrupt the flow of discussion. Please read the complete Terms of Participation, where you can also learn how to “flag” comments such as spam or obscenities that violate the Terms.

We welcome your thoughtful comments in this open and participatory forum.

Diane DiEuliis is Assistant Director of Life Sciences and Robynn Sturm is Assistant Deputy Chief Technology Officer in the Office of Science and Technology Policy

On Tuesday, December 8, the Office of National AIDS Policy (ONAP) and the Council on Women and Girls co-hosted a Women and HIV Meeting at the White House.  The purpose of the meeting was to examine effective approaches to lowering HIV incidence in women, reducing racial disparities in infection rates and access to care, and improving services for women and girls living with HIV. 

It was an insightful discussion on lessons learned specific to women and will help inform the development of the National HIV/AIDS Strategy (NHAS).  This Strategy has three primary goals:  reducing HIV incidence, increasing access to care and optimizing health outcomes, and reducing HIV-related health disparities. 

Meeting attendees included representatives from organizations across the country, including national advocacy groups, service providers, state and county government, Federal agencies, and researchers. Women living with HIV were well represented. 

After being welcomed by ONAP Director Jeffrey Crowley, the meeting participants heard remarks from Valerie Jarrett, Senior Advisor to the President and Chair of the White House Council on Women and Girls, and the new Surgeon General Regina Benjamin, M.D.  Both relayed their personal and professional commitment to strengthening our nation’s response to HIV/AIDS.  They also addressed why women must be a priority population in the NHAS because of the disease’s disproportionate impact on women.

We had an excellent panel of presenters at the meeting, which covered racial/ethnic and gender disparities related to HIV/AIDS and gender-based and community-level prevention strategies.  Dr. Ada Adimora of the University of North Carolina at Chapel Hill described how social networks and factors like incarceration rates among Black men influence the risk of HIV infection among Black women.  Dawn Averitt Bridge of The Well Project proposed integrated approaches to HIV, STI, and reproductive health care and stressed the need for more research to identify effective interventions. 

Following the presentations, a panel discussion addressed HIV and related civil rights issues, and noted how health insurance reform is critical for improving access to HIV care and treatment.  Comments from audience members highlighted that people living with HIV still face discrimination, and that there’s a need for increased availability of female-controlled prevention methods.  The stimulating discussion raised key issues for ONAP to consider in developing the NHAS – including the need for HIV education to help health professionals provide culturally sensitive care.

Melody Barnes, Director of the White House Domestic Policy Council, made remarks about President Obama’s commitment to fighting the HIV/AIDS epidemic in the U.S.  And Tina Tchen, Director of the Office of Public Engagement and Executive Director of the White House Council on Women and Girls, provided closing remarks inviting future public engagement on HIV and related issues. 

Bringing together a diverse group of experts to share ideas was a great way to help ONAP move ahead on developing a National HIV/AIDS Strategy that prioritizes women’s health issues.   We look forward to continuing the dialogue on this issue.  
   
Adelle Simmons is a Policy Advisor in the White House Office of National AIDS Policy

Read translations of the speech in the following languages: Arabic | Chinese | French | Persian | Russian | Spanish

This morning the President spoke at the Nobel Peace Prize Ceremony at the Oslo City Hall.  His speech accepting the prize was well worth reading in full, an excerpt is below:

Of course, we know that for most of history, this concept of "just war" was rarely observed.  The capacity of human beings to think up new ways to kill one another proved inexhaustible, as did our capacity to exempt from mercy those who look different or pray to a different God.  Wars between armies gave way to wars between nations -- total wars in which the distinction between combatant and civilian became blurred.  In the span of 30 years, such carnage would twice engulf this continent.  And while it's hard to conceive of a cause more just than the defeat of the Third Reich and the Axis powers, World War II was a conflict in which the total number of civilians who died exceeded the number of soldiers who perished. 

In the wake of such destruction, and with the advent of the nuclear age, it became clear to victor and vanquished alike that the world needed institutions to prevent another world war.  And so, a quarter century after the United States Senate rejected the League of Nations -- an idea for which Woodrow Wilson received this prize -- America led the world in constructing an architecture to keep the peace:  a Marshall Plan and a United Nations, mechanisms to govern the waging of war, treaties to protect human rights, prevent genocide, restrict the most dangerous weapons.

In many ways, these efforts succeeded.  Yes, terrible wars have been fought, and atrocities committed.  But there has been no Third World War.  The Cold War ended with jubilant crowds dismantling a wall.  Commerce has stitched much of the world together.  Billions have been lifted from poverty.  The ideals of liberty and self-determination, equality and the rule of law have haltingly advanced.  We are the heirs of the fortitude and foresight of generations past, and it is a legacy for which my own country is rightfully proud. 

And yet, a decade into a new century, this old architecture is buckling under the weight of new threats.  The world may no longer shudder at the prospect of war between two nuclear superpowers, but proliferation may increase the risk of catastrophe.  Terrorism has long been a tactic, but modern technology allows a few small men with outsized rage to murder innocents on a horrific scale. 

Moreover, wars between nations have increasingly given way to wars within nations.  The resurgence of ethnic or sectarian conflicts; the growth of secessionist movements, insurgencies, and failed states -- all these things have increasingly trapped civilians in unending chaos.  In today's wars, many more civilians are killed than soldiers; the seeds of future conflict are sown, economies are wrecked, civil societies torn asunder, refugees amassed, children scarred.

I do not bring with me today a definitive solution to the problems of war.  What I do know is that meeting these challenges will require the same vision, hard work, and persistence of those men and women who acted so boldly decades ago.  And it will require us to think in new ways about the notions of just war and the imperatives of a just peace. 

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Nearly seven months ago, approximately 50 disability advocates, representatives of national teacher organizations, other education professionals and Administration officials gathered at the White House to discuss restraint and seclusion in schools. President Obama and his Administration are committed to ensuring that every child learns in a safe and secure school environment. Improper use of restraint and seclusion techniques to subdue children deemed by teachers as unruly or otherwise disruptive disproportionately affects children with disabilities, many of whom fall victim to instructors and care-givers who lack proper training. 

The Preventing Harmful Restraint and Seclusion in Schools Act, introduced by House Education and Labor Committee Chairman George Miller, Representative Cathy McMorris Rodgers, and Senator Chris Dodd, will protect all children from harmful and improper types of restraint and seclusion. We applaud Senator Dodd, Chairman Miller, and Representative McMorris Rodgers for their hard work and their commitment to protecting children.  

Working in collaboration with these members of Congress, President Obama's Administration is committed to ending harmful restraint and seclusion. On July 31, after Congressional hearings on the subject, Education Secretary Arne Duncan wrote to all Chief State School Officers, urging them to review their current policies and guidelines regarding the use of restraint and seclusion techniques in schools and, if appropriate, develop or revise them to ensure student safety

On Tuesday, Secretary Duncan wrote to Senator Dodd, Chairman Miller and Representative McMorris Rodgers, applauding them for identifying key legislative principles and committing to work with Congress. Secretary Duncan's recommendations align well with the legislation they have introduced, and provide an important blueprint for the Administration, Congress and advocates to work together to protect America's children.

This much-needed legislation illustrates that, when we work together to find common ground, we can overcome any hurdle. We look forward to working with Congress, advocates, teachers, and education professionals to ensure that all of America's children can learn in a safe, secure environment.

Kareem Dale is an Associate Director in the White House Office of Public Engagement and Special Assistant to the President for Disability Policy

Each year millions of visitors stream through the rotunda of the National Archives in Washington, DC, to view the Constitution, the Bill of Rights, and the Declaration of Independence.  These foundational documents of our democracy are on public display because of the importance of openness in government.

Openness promotes accountability by enabling journalists, researchers, government officials, and the public to scrutinize, question, and ultimately improve how government works.  But, as with many aspects of Democracy, openness must evolve. The Progress Report on Open Government to the American People describes how the Administration is doing just that.

Recently, for example, the Obama Administration began to publish online the names of everyone who visits the White House offices; provide online access to White House staff financial reports and salaries; disclose and limit lobbyist contacts; publish the membership of Federal advisory committees in downloadable form; and create unprecedented ways to track how the government spends taxpayer dollars. Advancing that trend, yesterday the White House released an historic Directive requiring all agencies to adopt aggressive open government policies that will further promote the principles of transparency, participation and collaboration. (For those who can’t wait till the end, click here to see what others have said about the Administration’s Open Government policy and why it matters.)

This new degree of openness is enabled in part by 21st century technology, which makes it possible for government to open its doors and databases more than ever before.  From online listening tours and chats to web-based brainstorming by government officials with the American public, the White House and federal agencies are opening up the way they work to improve accountability in government and deepen our democracy.

But creating an open government – one that is committed to transparency and civic engagement – does more than promote accountability. Working in the open fosters collaboration between government, private industry, and the public to improve the lives of Americans in their communities.

To mark the publication of the Directive and the Report, every Cabinet Department is launching a new open government project.

For example, Department of Homeland Security (DHS) is unveiling “Virtual USA,” a collaboration among DHS, eight states, and the emergency response community that uses new technology to share emergency response information seamlessly among Federal, state, local, and tribal first responders. The Virtual USA system links these partners’ disparate tools and technologies to share the location and status of power and water lines, flood detectors, helicopter-capable landing sites, emergency vehicle and ambulance locations, weather and traffic conditions, evacuation routes, and school and government building floor plans, and does so without requiring any participating entity to change either the system it now uses or the way it does business.

During a recent Virginia Nuclear Power Plant exercise, the ability of decision-makers to gather, analyze, and disseminate information via the Virtual USA information-sharing system reduced by 70 percent the time it took to make a decision about evacuation.  In addition, Virtual USA provides mechanisms for Americans in their own communities to contribute information to complement that of police, fire, and other government workers, essentially crowdsourcing a more detailed picture of disaster and recovery capabilities.

The Department of Agriculture is using open government innovations to address the obesity epidemic, one the Administration's top priorities. This week the Department made available for download on Data.gov nutrition data for standard portion sizes of more than 1,000 most common food items. In addition,  it is launching a national competition that challenges entrepreneurs, software developers, and students to leverage the newly released data to create educational games to help children make healthy eating decisions.  By making reliable government data available to the American people and inviting their collaboration in developing new products and tools for the public good, the Department of Agriculture is taking the values of openness and translating them into practical ways to address a national priority.

Open government initiatives are also helping fledgling businesses convert government information into entrepreneurial opportunities that can create jobs and strengthen economic growth. Government agencies are home to treasure troves of data and information, but much of it is buried in websites or exists in formats too cumbersome to be of practical use. Now a group of six departments and agencies has worked together to offer easy access to information on publicly-funded technologies that are available for license, opportunities for Federal funding and partnerships, and potential private-sector partnerships.  By making information from multiple agencies available in RSS and XML feeds on Data.gov, the government empowers innovators to find the information they need and receive real-time updates instead of having to probe government websites repeatedly.

At the same time, the United States Patent and Trademark Office has committed to make all published patents available for download so they can be easily searched by entrepreneurs and innovators.

These are just a few of the innovative approaches being announced this week to continue the process of lifting the veil from the workings and resources of the Federal Government. By turning its philosophical commitment to openness into real policies and practices, the Obama Administration is empowering all Americans to address the many pressing challenges of our time.

P.S. We’re not the only ones who think this is big.  An array of experts on government transparency and accountability are praising the Obama Administration’s unprecedented Open Government Directive.  The following is just a sample of their reactions:

U.S. Senator Patrick Leahy, Chairman, Senate Judiciary Committee: “I commend President Obama for issuing an historic directive on government transparency, participation and collaboration that will make our government more accessible and accountable to the American people.  I am particularly pleased that, for the first time, the public will have immediate access to government data that for too long had been shielded from view by excessive secrecy and outdated technologies.” [Press Release, 12/8/09]

U.S. Senator Joe Lieberman, Chairman, Homeland Security and Governmental Affairs Committee: “The President’s Open Government Directive is heartily welcomed by those of us who have worked to make government more transparent and accountable to the American people. Back in 2002, I authored and Congress passed the E-Government Act, which helped spur Federal agencies to make documents and services more accessible to the general public. The Federal government has come a long way since 2002 and today, it takes a giant step closer to taking full advantage of available information technologies to maximize not just the transparency, participation, and collaboration of people with their government but also to maximize management efficiency.” [Press Release, 12/8/09]

In alphabetical order by last name:

Steven Aftergood, Federation of American Scientists: "It's an ambitious attempt to open up the government and to change the way that agencies do business.” [USA Today, 12/8/09]

Gary D. Bass, Executive Director, OMB Watch: "The results appear to be well worth the wait. The president demanded the directive be built around three main principles -- transparency, participation, and collaboration. The new directive, issued today, delivers on all three principles with specific requirements and deadlines for all agencies." [Washington Post, 12/8/09]

Carolyn J. Lukensmeyer, President and Founder, AmericaSpeaks: “I applaud the Obama Administration for taking bold steps today to open the government and make it more transparent and accountable. Clearly the President and his team have listened to and taken seriously Americans all across the country who want a stronger voice and a seat at the table in American democracy.”

Patrice McDermott, Director, OpenTheGovernment.org: “The Open Government Directive, when fully implemented, will take the Federal government many steps toward real openness. Far from representing the end of the process, today’s announcement is the beginning of an on-going effort to build transparency and accountability into the way government operates.” [Press Release, 12/8/09]

Ellen Miller, Executive Director and Co-Founder, Sunlight Foundation: “The Open Government Directive issued today demonstrates the seriousness of administration's commitment to data transparency and citizen engagement. It is evidence that the administration recognizes that transparency is government's responsibility. At the same time, it shows the administration is matching aspirational goals with concrete policies and accountability measures." [Washington Post, 12/8/09]

Peter M. Shane, Author of Madison’s Nightmare: “What is arguably most impressive about the Directive, as highlighted in a public briefing by CIO Vivek Kundra and [sic] CTO Aneesh Chopra, is its specificity and focus on execution.” [Huffington Post, 12/8/09]

Jim Tozzi, Advisory Board, Center for Regulatory Effectiveness: “The Open Government initiative is a real piece of work – an excellent document.”  [Communication to opengov@ostp.gov, 12/9/2009]

Anne Weismann, Chief Counsel, Citizens for Responsibility and Ethics in Washington (CREW): “This directive represents the kind of bold and far reaching initiative President Obama promised on his first full day in office.  By establishing a new paradigm of public access to government information, the administration has paved the way for a truly transparent and accountable government.” [CREW Press Release, 12/8/09]

John Wonderlich, Policy Director, Sunlight Foundation: "[W]e are very excited. They're really taking on a lot of initiatives and doing so in an aggressive fashion. We couldn't have written it better ourselves. It's very ambitious." [CNET.com, 12/8/09]

Norm Eisen is Special Counsel to the President for Ethics and Government Reform
Beth Noveck is United States Deputy Chief Technology Officer and Director of the White House Open Government Initiative