Laurence Kotlikoff, 19 February 2020

The US has spent the entire post-war period running a massive and ever-growing Ponzi scheme that takes from the young and gives to the old. This column discusses how the scheme has been and is being run by expanding take-as-you-go-financed Social Security, Medicare, and Medicaid systems, by running huge official deficits, and by imposing a larger share of taxes on the young and a smaller share on the old. Take as you go, whether done on or off the books, has done precisely as theoretically predicted – reduced the US’s national saving rate from 13% in the 1950s and 1960s to 3% in the last two decades. This underlies, in large part, a commensurate drop in the domestic investment rate, which was also 13% between 1950 and 1969 and is now running at 4%. The textbook predicted consequence? Lower median labour productivity and median real wage growth.

Michele Fioretti, Hongming Wang, 19 January 2020

As health spending continues to rise globally, pay-for-performance can be an attractive policy tool for promoting high-quality services at lower costs. But there are concerns that it weakens the finances of poor-performing hospitals in low-income areas. This column examines the efficiency and equity consequences of the introduction of pay-for-performance in the Medicare insurance programme in the US. It finds that after the payment reform, high-quality insurers selected healthier enrollees, shifting the distribution of high-quality insurance to the healthiest counties and worsening regional disparities in healthcare access.

Michael Keane, 26 May 2019

Launched in 2006, Medicare Part D allows beneficiaries to enrol in subsidised drug coverage plans sold by private insurers, but navigating the different plans can be complex and lead to sub-optimal choices. This column uses Medicare administrative data for 2006-2010 to understand the quality of consumer decision-making in the Part D marketplace. It finds that the vast majority of elderly place too much weight on premiums relative to out-of-pocket costs, care a great deal about the particular combination of plan features, and are highly likely to choose the same plan every year regardless of changes in prices and alternatives.

Maryaline Catillon, David M. Cutler, Thomas E. Getzen, 09 February 2019

Growth in life expectancy during the last two centuries has been attributed to environmental change, productivity growth, improved nutrition, and better hygiene, rather than to advances in medical care. This column traces the development of medical care and the extension of longevity in the US from 1800 forward to provide a long-term look at health and health care in the US. It demonstrates that the contribution of medical care to life-expectancy gains changed over time. 

Kevin Callison, Robert Kaestner, Jason Ward, 13 October 2018

Researchers have long observed substantial geographic variation in the use of health care services. This column uses data on health care use among individuals who are uninsured as they approach age 65 and become eligible for Medicare to argue that most geographic variation is the result of supply-side factors that allow providers to exercise discretion over the levels of care provided. Policies aimed at reducing these discrepancies across regions may not only ‘bend the cost curve’, but may also directly reduce health risks arising from individuals receiving ineffective or unneccesary health care services.

Events

CEPR Policy Research