Editor's note: This is the third post from the Nashville Health Care Council's 2013 Leadership Health Care Delegation to Washington. Click here for other entries from this year and last.

Attendees of Leadership Health Care’s 2013 Delegation to Washington, D.C., were treated to a keynote speech by David Wasserman, house editor for The Cook Political Report. Founded in 1984, The Cook Political Report provides analyses of Presidential, U.S. Senate, House and gubernatorial races. In addition to his current role, Wasserman served as an analyst for the NBC News Election Night Decision Desk in 2012, 2010 and 2008, and has appeared on a number of networks.

Wasserman hosted a lively discussion with the group on political forecasting trends and gave the audience insight on the current political landscape and what’s in store for the 2014 and 2016 elections. After the event had wrapped up, Wasserman took a few minutes to further discuss health care policy, including the big choices many Republican governors need to make in the next year and a half.

Editor's note: This is the first in a series of posts from the Nashville Health Care Council's Leadership Health Care Delegation to Washington. Look for more information from the trip in the coming days.

The prospects for reforming entitlement programs led the conversation during the first day of sessions in the Nashville Health Care Council’s Leadership Health Care 11th annual delegation to Washington, D.C. Health care policy and political experts spoke to 80 delegates from Nashville and across the country about the budgetary dynamics that are creating pressure for long-term entitlement reform and what, if any, changes we might expect in the coming years.

“There’s no way you can look at the long-term fiscal health of the country and think you can avoid taking on entitlements,” said Gail Wilensky, economist and senior fellow with Project Hope and the former administrator of the Health Care Financing Administration.

Wilensky, pictured above, said the country spent 5.6 percent of GDP on entitlement programs last year, which is nearly three times what we were spending in 1985, and projections show that by about 2030 or 2035 entitlement program spending will grow to between 9.5 percent and 10.5 percent of GDP on Medicare and Medicaid alone. When you add in Social Security, entitlement programs will account for about 17 percent of the U.S. economy.

The main challenge of entitlement reform, Wilensky said, is Medicare. She and members of a later panel discussion about entitlement reform agreed that any reforms to Medicare will need to do more than simply reduce reimbursements to health care providers. Reforms will need to include changes that affect the actual Medicare beneficiary, such as increasing the eligibility age from 65 to 67.

“It’s pretty straightforward” why entitlement programs have not had any meaningful reform to date while other programs have seen obvious funding reductions, said Joseph Antos, the Wilson H. Taylor Scholar in Health Care and Retirement Policy with the American Enterprise Institute. “Other programs tend not to provide direct income support to individual voters.”

In the near term, cuts will probably continue to be more “hidden” within reduced payments to providers, said Stuart Butler, Distinguished Fellow and director of the Center for Policy Innovation at the Heritage Foundation. “But the fact is, that does have an effect, and over the long haul it will start to hollow out those programs,” Butler said. “And that may be the only way you can do it, rather than an explicit decision to make fundamental change to the program.”

Some of the larger, more fundamental changes that should perhaps be on the table, according to the panelists, include income-related premiums for Medicare, restructuring Medicare cost sharing, repositioning Medicare as more of a “true insurance program” where individuals with the highest incomes pay the full cost of premiums and individuals only get a benefit when something goes wrong.

In a separate presentation on the state of affairs in Washington, Michael Ramlet, principal of public affairs firm Purple Strategies, said a lot of the discussions about changes to Medicare are purely hypothetical.

“I don’t think there will be any major moves in the Medicare environment; it’s not a place right now where there’s a lot of compromise.”

Ramlet explained that discussions in Washington are instead focused on issues such as the nuts and bolts of how to run insurance exchanges — the number of individuals who will be enrolled, the levels at which they will participate in exchanges, how much premiums will cost, how to make the “Herculean lift” of allowing multiple federal agencies share the data necessary to make exchanges work.

“This is where 2014 will be really interesting,” he said. “We’re trying to do a big technical lift, where at the same time you know insurance plans are changing a lot, and no one really knows what’s going to happen.”

From left: Joseph Antos of the American Enterprise Institute, Stuart Butler of The Heritage Foundation and Paul Van de Water from the Center on Budget and Policy Priorities

U.S. Sen. John Kerry and his wife Teresa have committed to selling their shares in a number of U.S. companies if his nomination to be secretary of state is confirmed. Among those equity holdings are some very well-known names — Coca-Cola, Microsoft and 3M — as well as one of the better-known names from these parts: Tractor Supply.

Haven't yet taken the time to run through the fiscal deal approved by lawmakers earlier this week? The tax team at Waller has pulled together a pithy 18-page primer to get you up to speed. Check it out here.

Given its economic development successes, we've long looked at Williamson County as a good barometer of the broader ECD climate. Now it seems like the county's corporate recruitment pipeline also reflects pretty accurately how D.C.'s fiscal mess is affecting corporate ambitions.

Since last October, the overall number of potential projects being tracked by Director Matt Largen and his team hasn't changed much. On the plus side, both the number of jobs and the amount of office space in play have grown by at least 10 percent. But the capital investment dollars that are mulling a Williamson County destination — $124 million now versus $332 million last fall — serve as the starket anecdotal evidence we've seen so far about just how much CEOs are tightening the spending reins ahead of the fiscal cliff.

It's also worth noting that the growing buzz around Nashville's tech scene appears to be reaching a wider audience: Nine IT projects are on Williamson's radar, three times the year-ago number. (See news of Compass Datacenters' big local plans.)

The Planet Money team over at NPR has mashed the numbers on where we — as in taxpayers and the federal government — stand when it comes to being paid back the billions from the 2008 bailouts to auto manufacturers, financial institutions and other parties. It's a mixed report card with only the banks producing a payback profit so far.

The attention being paid to Mitt Romney's tax records could reach a fever pitch in the next month if claims by an anonymous hacker/group's claims of infiltrating the Cool Springs office of CPA giant PricewaterhouseCoopers turn out to be true. The hacker says it entered the firm's Corporate Centre offices on the night of Aug. 25 and set about downloading many Romney files.

"Once on the 3rd floor, the team moved down the stairs to the 2nd floor and setup shop in an empty office room. During the night, suite 260 was entered, and all available 1040 tax forms for Romney were copied. A package was sent to the PWC on suite 260 with a flash drive containing a copy of the 1040 files, plus copies were sent to the Democratic office in the county and copies were sent to the GOP office in the county at the beginning of the week also containing flash drives with copies of Romney's tax returns before 2010."

Our man Ken Whitehouse has more details — including a $1 million Bitcoin payoff plan and a Sept. 28 data release date — from the case.