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Journal Article
Medicare: usual and customary remedies will no longer work
A description of the structural deficiencies that have led to Medicare's impending bankruptcy, and a discussion of the merits of alternative approaches to extending the program's long-term viability. The author argues that the best approach is to adopt a "defined contribution" plan that will restore consumers' interest in economizing on health care services and boost competition among providers and insurers.
Report
An Aggregate Model for Policy Analysis with Demographic Change
Many countries are facing challenging fiscal financing issues as their populations age and the number of workers per retiree falls. Policymakers need transparent and robust analyses of alternative policies to deal with demographic changes. In this paper, we propose a simple framework that can easily be matched to aggregate data from the national accounts. We demonstrate the usefulness of our framework by comparing quantitative results for our aggregate model with those of a related model that includes within-age-cohort heterogeneity through productivity differences. When we assess proposals ...
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 ...
Journal Article
Analyzing the relationship between health insurance, health costs, and health care utilization
Using data the Health and Retirement Survey and the Assets and Health Dynamics among the Oldest Old, this article provides an empirical analysis of the determinants of whether an individual purchases health insurance. The authors describe the relationship between health costs and health care utilization of individuals aged 50 and explore how these factors vary with access to health insurance.
Journal Article
Policy Update: Understanding the Inflation Reduction Act
In August, President Biden signed into law a spending, revenue, and deficit reduction bill titled the Inflation Reduction Act (IRA). Born out of the never-enacted Build Back Better Act, a $1.8 trillion stimulus and revenue package proposed at the beginning of the Biden administration, the IRA is the result of extended negotiations that changed the bill from a broad social and economic stimulus bill into one focused on clean energy, health care, and deficit reduction. These changes secured the final votes needed to pass the legislation on a party-line basis. It represents one of the largest ...
Working Paper
Social security and Medicare policy from the perspective of generational accounting
An application of the generational accounting method of fiscal policy analysis to projected spending paths for Social Security and Medicare suggesting that, under realistic assumptions for these programs, future generations as well as current young Americans could bear a significantly larger share of the burden of government spending than previously thought.
Journal Article
The future of Medicare and Social Security : future funding of both programs 'woefully inadequate'
The cost of Medicare benefits will soon exceed the program's available funds, and its financial woes will far surpass Social Security's as healthcare costs continue to rise faster than economic growth.
Working Paper
The Consequences of Medicare Pricing: An Explanation of Treatment Choice
Primary care physicians (PCPs) provide more specialty procedures in less-urban areas, where specialists are fewer. Using a structural random-coefficient model and the demographic and time variation in the data, this paper shows that changes in policy-set reimbursements lead to a reallocation of the suddenly-more-remunerative procedures away from specialists and toward PCPs, and this effect is stronger, the more rural an area is. A reimbursement-unit increase for a given procedure leads to outside-metro PCPs gaining 7-15% market share more than metro PCPs in that procedure, at the expense of ...