According to Erskine Bowles, legislators must work together to implement a practical solution for the nation’s economic woes. Mr. Bowles spoke with AAOS Now after he and former Senator Alan K. Simpson delivered the keynote address at the 2013 Annual Meeting in Chicago.


Published 4/1/2013
Peter Pollack

Bowles Encourages Grass Roots Participation

Erskine B. Bowles

AAOS Now: How would you describe real tort reform?

Mr. Bowles: I don’t know if we can get caps on economic damages and all punitive damages. But I know that doctors in hospitals practice defensive medicine. They almost have to with today’s laws, and so we’ve got to have some kind of real tort reform that gives them the freedom to not do that extra test, or require that extra procedure that is an unnecessary addition to the cost.

AAOS Now: You said that healthcare spending as percentage of gross domestic product (GDP) was about 10 percent in 1980 and could reach 30 percent by the end of the decade. Is there an ideal target percentage of GDP for healthcare spending?

Mr. Bowles: I’d like to see the rate of growth of healthcare spending slowed to the rate of growth of the economy on a per capita basis. I think if we can do that, everything else will fall in line. So we don’t have to really reduce the percentage of money that we’re spending on health care today, relative to the economy; we’ve just got to slow the rate of growth. If we do that, we’ll be all right.

AAOS Now: Is it possible to reduce healthcare spending without directly affecting providers?

Mr. Bowles: One of the things our plan calls for is a permanent “doc fix” [for the Medicare Sustainable Growth Rate formula].

My best guess is, over the short term, you might see some minor decrease in provider payment. And then over the longer term, we’ve got to make sure that we compensate people for quality, not quantity, and that we encourage bundled services and coordinated care.

AAOS Now: Is there any way to pass a true fiscal solution through our gridlocked Congress?

Mr. Bowles: It’s going to be really, really difficult. If it does happen, it’ll happen—in my opinion—between now and Oct. 1 [the beginning of the next fiscal year]. So if you’re in favor of trying to see us put our fiscal house in order, if you’re in favor of trying to make sure we’re not the first generation that leaves the country worse off than we found it, then I think now is the time to push your members of Congress to reach some kind of bipartisan, balanced solution to this problem.

Look, I wish we could grow our way out of this problem, but we can’t. And we certainly can’t tax our way out of it. And if I thought we could solely cut our way out of it, without making such deep cuts in things that are so important for America to invest in, like education, infrastructure, research … and without hurting the truly disadvantaged, then I’d do it with just cuts. But I think the right mix is about one-quarter revenue, three-quarters spending cuts.

You know, there is some movement. Lots of Senators on both sides have recently indicated a willingness to compromise: Democrats who’ve said they’re willing to make the cuts in entitlement programs, Republicans who are prepared to do a little bit more revenue by reforming the tax code. If we do that and combine it with other things like cuts in defense and other mandatory programs, we can get there. The problem is not economics; the problem is politics.

AAOS Now: What are some concrete ways to apply pressure on our representatives?

Mr. Bowles: By signing our petition, which is at

When a guy like Bob Corker (R-Tenn.) says, “Look, if the Democrats get serious about entitlement reform, then I’m willing to have more revenue come in from the tax code,” some people on the far right will attack him and not vote for him again.

By using and those people in Tennessee who have signed our petition, we can support him. So [he knows] we’ve got his back when other people on the extremes begin to attack him for doing what’s basically right for the country.

And the same thing goes for Democrats who are willing to support entitlement reform. You know they’re going to immediately be attacked by somebody like AARP. And we want to make sure we’ve got their backs so they will know they’re not out there all by themselves.

AAOS Now: Is there a solution to the issue of gerrymandering and redistricting, which has been blamed for some of the intransigent positions held by political leaders.

Mr. Bowles: The only thing I’ve heard that could change it is … California decided this year to have a commission redraw the districts so that the districts made more sense.

If you look at North Carolina, we have one district that runs all the way from Fayetteville in the east to Charlotte in the west. Basically it takes in all the African-Americans, and they comprise that district. So that’s an all-Democrat district. But it means all of the districts that surround it are Republican districts. It’s fair, because all is fair in love and war, but it also means that there’s no incentive for that Democrat or that Republican to ever compromise. All they have to do is appeal to their base in order to get reelected.

AAOS Now: At the Orthopaedic Political Action Committee luncheon, former Sen. Jon Kyl (R-Ariz.) suggested that senators tend to be a little less extreme, just because they have to represent their entire state.

Mr. Bowles: And they’re only elected every 6 years. These guys that are running for reelection 2 years from now began their next campaign the day after they were elected, because they have to raise so much money. It also means they don’t spend any time in Washington getting to know their fellow members because they’re coming in Tuesday, they’re leaving Thursday, and while they’re in town they’re going to fundraiser after fundraiser.

AAOS Now: Sen. Kyl also discussed the effect 24-hour news coverage has on elections.

Mr. Bowles: The media acts as an echo chamber. If you’re a Republican and you only listen to your guys talk on Fox News, or you’re a Democrat and you only listen to your guys talk on MSNBC, then you’re just having your own opinions reinforced, and you’re not open to any kind of new ideas.

I’ve had lots of things in my life, where my opinion has changed over time, because I learned something new.

Read more about Mr. Simpson’s and Mr. Bowles’ keynote address at the AAOS 2013 Annual Meeting in the AAOS Now Daily Edition, March 23.

More information on Mr. Simpson’s and Mr. Bowles’ economic proposals are available at and

Peter Pollack is a staff writer for AAOS Now. He can be reached at