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Working Paper
The geography of Medicare
There is a great deal of geographic variation in Medicare spending. For example, while the average Medicare cost per beneficiary was around $5200 in 1996, Medicare spending, adjusted for differences in regional prices and demographic composition, was about $8000 per person in Miami, but only $3500 in Minneapolis. In this paper, we explore the source of this variation. We find that a substantial amount can be explained by differences across areas in the health of the elderly population. This finding suggests that some of the geographic variation in Medicare spending is efficient. But even ...
Working Paper
Restraining the Leviathan: property tax limitations in Massachusetts
We examine the effects of Proposition 2-1/2--a property tax limitation law approved by Massachusetts voters in 1980--and assess voter satisfaction with these effects. We find that the proposition had a smaller effect on local revenues and spending than expected, as a result of both amendments to the law and a strong economy. Voters in 1980 believed there was significant waste in local government, partly because of an inability to monitor local officials. Proposition 2-1/2 curbed these agency losses, but direct local override votes and municipal expenditure patterns imply that the proposition ...
Working Paper
The birth and growth of the social-insurance state : explaining old-age and medical insurance across countries
We seek to explain why countries have adopted national Old-Age Insurance and Health Insurance programs. Theoretical work has posited several factors that could lead to this adoption: the strain from expanding capitalism; the need for political legitimacy; the desire to transfer to similar people; increased wealth; and the outcome of leviathan government. We relate the probability of a country?s creating social insurance to proxies for each of these theories. We find weak evidence that the probability of adopting a system declines with increases in wealth and with greater ethnic heterogeneity. ...
Working Paper
Demographics and medical care spending: standard and non-standard effects
In this paper, we examine the effects of likely demographic changes on medical spending for the elderly. Standard forecasts highlight the potential for greater life expectancy to increase costs: medical costs generally increase with age, and greater life expectancy means that more of the elderly will be in the older age groups. Two factors work in the other direction, however. First, increases in life expectancy mean that a smaller share of the elderly will be in the last year of life, when medical costs generally are very high. Furthermore, more of the elderly will be dying at older ages, ...
Conference Paper
What is good care, and what is bad?
National health care goals generally include providing broad access to appropriate amounts of high-quality health care at appropriate cost to the ultimate payers. Yet all countries, regardless of how they deliver and finance health care, struggle to achieve a sustainable balance among the implicit tradeoffs. Does this struggle stem from the limited scope for competition in health care or from information asymmetries? Or does it simply reflect the inherent difficulty of measuring health care output and quality? Alternatively, does it result from deep-seated human behavior - a tendency for ...
Journal Article
Perspective: tobacco manufacturers are now compensating states for smoking-related costs: how will this affect the economy?
Smoking out the social and economic benefits of the 1998 tobacco settlement for Massachusetts.
Working Paper
Generational aspects of Medicare
This paper examines the generational aspect of the current Medicare system and some stylized reforms. We find that the rates of return on Medicare for today's workers are higher than those for Social Security and that the Medicare system is shifting a greater share of the burden on future workers than is Social Security. Nonetheless, the rates of return on Medicare, using the Medicare Trustees assumptions, are still not that high--roughly 2 percent for today's youngest workers. But forecasting future Medicare expenditures is quite difficult. Under an alternative higher-cost baseline, which we ...