of Milliman and Robertson for the National
Affordability of Health Insurance, Health Care
Center for Policy Analysis concluded that mental
News, July 1, 2007.
health parity legislation tends to drive up costs by
46. Ibid.
as much as 5 to 10 percent. Merrill Matthews Jr.,
"Do We Need Mental Health Parity?" National
47. Quoted in Tumulty, "Obama Channels
Center for Policy Analysis Brief Analysis no. 297,
Hillary on Health Care."
June 30, 1999.
48. America's Health Insurance Plans, http:
32. Aswini Anburajan, "Obama on Mandates, Bill
//www.ahip.org/content/default.aspx?bc=31|42.
Clinton," MSNBC.com, "First Read," November
28, 2007, http://firstread.msnbc.msn.com/arch
49. Obama'08, "Plan for a Healthy America."
ive/2007/11/28/485042.aspx.
50. Ibid.
33. Sharon Long, "On the Road to Universal
Coverage: Impacts of Reform in Massachusetts at
51. A Section 125 "cafeteria plan," sometimes
One Year," Health Affairs, June 3, 2008.
referred to as a "flexible spending account," allows
a worker to pay certain expenses before taxes are
34. Jonathan Gruber, "Covering the Uninsured in
deducted from their paycheck. These expenses
the U.S.," National Bureau for Economic Re-
include daycare, insurance premiums, and most
search Working Paper no. 13758, January 2008.
out-of-pocket medical costs. Section 125 refers to
the IRS tax code.
35. Kevin Sack, "2 Plans and Many Questions on
the Uninsured," New York Times, February 23,
52. Obama, University of Iowa.
2008.
53. Pharmaceutical Manufacturers Association,
36. Ibid.
"Facts about the U.S. Pharmaceutical Industry,"
2002.
37. Obama, University of Iowa.
54. Joseph DiMasi et al., "The Price of Innovation:
38. Ibid.
New Estimates of Drug Development Costs,"
Journal of Health Economics (February 2003).
39. Bradley Herring and Mark Pauley, "The Effect
of State Community Rating Regulations on
55. See Roger Pilon, "Drug Reimportation: The
Premiums and Coverage in the Individual Health
Free Market Solution," Cato Institute Policy
Insurance Market," U.S. Department of Health
Analysis no. 521, August 4, 2004.
and Human Services, August 2006.
56. Quoted in Doug Bandow, "Demonizing Those
40. Congressional Budget Office, "The Price Sensi-
Who Cure Us," National Review Online, July 24,
tivity of Demand for Nongroup Health Insurance,"
2003.
Background Paper, August 2005, http://www.cbo.
gov/ftpdocs/66xx/doc6620/08-24-HealthInsur
57. HR 2427, The Pharmaceutical Market Access
ance.pdf .
Act of 2003.
41. Marl Liow and Drew Davidoff, "The Impact of
58. Congressional Budget Office, "Letter to the
Guaranteed Issue and Community Rating in the
Honorable Ron Wyden on Issues Regarding Drug
State of New York, Milliman & Robertson,
Price Negotiation in Medicare," April 10, 2007.
August 18, 1994.
59. Benjamin Zycher, "The Human Cost of Federal
42. Quoted in Tumulty, "Obama Channels
Price Negotiations: The Medicare Prescription
Hillary on Health Care."
Drug Benefit and Pharmaceutical Innovation,"
Medical Progress Report no. 3, November 2006.
43. "Barack Obama's Plan for a Healthy America."
60. Obama'08, "Plan for a Healthy America.
44. By comparison, property and casualty insur-
ance has an 8.3 percent profit margin, and life
61. The term "pay for performance," known as
insurance has an 8.2 percent margin. Joseph
P4P, encompasses a wide variety of measures
Paduda, "Insurance Industry Profit Margins,"
designed to link payment to quality in the deliv-
Managed Care Matters, December 9, 2004, citing
ery of health care services.
data from Weiss Ratings.
62. Michael Cannon, "Pay-for-Performance: Is
45. J. P. Wieske, "High Loss Ratios Undermine the
21