Dr. Don Berwick, former administrator of the Centers for Medicare & Medicaid, and Jim Capretta, who serviced as associate director at the White House Office of Management and Budget under President George W. Bush, took sharply different stances on what shifting costs to patients could mean during a wide-ranging debate hosted by the Pioneer Institute. Berwick, now a senior fellow at the Center for American Progress, called the idea of giving patients more "skin in the game" a "vicious idea." But Capretta, a fellow at the Ethics and Public Policy Center, said the idea has had dramatic results in some cases.