Changes in family structure may explain anywhere from 15 to 40 percent of the increased inequality in recent decades. Readers may wonder why there is such a broad range of estimates. It depends on the time period examined, the income rungs examined, and assumptions about how much the absent parent might have brought into the household.
Mr. Western’s estimate that the rise in single parenthood explains 21 percent of the growth in inequality comes from a 2008 article in the American Sociological Review (with Christine Percheski and Deirdre Bloom). He examined the change from 1975 to 2005.
Gary Burtless looked at different years (1979 to 1996) for the European Economic Review but came up with the same figure: 21 percent. He also found that the increased tendency of educated people to marry each other accounted for another 13 percent of inequality’s growth.
The other estimate cited in the article comes from Robert Lerman of the Urban Institute. His unpublished analysis examines families with children at the 25th percentile and the 75th percentile. In 1975, the higher group had 2.16 times the income of the lower group. By 2008, it had risen to 3.09. Mr. Lerman estimated that 40 percent of that rise was the result of increasing single parenthood.
More can be found here. Economist Russ Roberts dives deeper into the data here.
A study posted on Tim Taylors blog finds:
“To paint an accurate picture of how health care cost growth is affecting the finances of a typical American family, RAND Health researchers combined data from multiple sources to depict the effects of rising health care costs on a median income married couple with two children covered by employer-sponsored insurance. The analysis compared the family’s health care cost burden in 1999 with that incurred in 2009. The take-away message: Although family income grew throughout the decade, the financial benefits that the family might have realized were largely consumed by health care cost growth, leaving them with only $95 more per month than in 1999. Had health care costs tracked the rise in the Consumer Price Index, rather than outpacing it, an average American family would have had an additional $450 per month—more than $5,000 per year—to spend on other priorities.”
Full post can be found here.
Part of Obamacare was a transitional “High Risk Pool” program to cover people who were unable to get insurance until the rest of the law’s provisions kicked in in 2014. The program allocated $5 billion. Medicare’s chief actuary assumed that it would attract 400,000 people; the CBO projected 200,000–but only because they assumed that HHS would use its authority to limit enrollment in order to keep the program below its budgetary cap.
The experience was not quite what had been expected. By January 2011, 8,000 people had enrolled, a number that rose to 12,000 by April. As of October 2011, by dramatically relaxing the requirements, lowering premiums, and paying brokers to enroll people, HHS had managed to get that number up to 41,000. Where were all the people with pre-existing conditions who couldn’t get insurance–the ones whose plight had been the impetus behind ObamaCare?
Full post can be found here.
What about life expectancy statistics — a favorite of the critics, since Americans don’t score very high? It turns out that when you remove outcomes doctors have almost no impact on — death from fatal injuries (car accidents, violent crime, etc.) — U.S. life expectancy jumps from 19th in the world to number one! — John Goodman, answering the question, Do We Really Spend More and Get Less with regard to Healthcare?
“What is true is that the U.S. Medicare is expensive compared with, say, Canadian Medicare (yes, that’s what they call their system) or the French health care system (which is complicated, but largely single-payer in its essentials); that’s because Medicare American-style is very open-ended, reluctant to say no to paying for medically dubious procedures, and also fails to make use of its pricing power over drugs and other items. So Medicare will have to start saying no; it will have to provide incentives to move away from fee for service, and so on and so forth. But such changes would not mean a fundamental change in the way Medicare works.” — Paul Krugman
Kevin Drum, blogging at Mother Jones, comes up with a great idea to help solve medicare’s cost problem:
So Medicare stays roughly the same, but every time you receive medical care you also get a bill. You don’t have to pay it, though. It’s just there for accounting purposes. When you die, the bill gets paid out of your estate. If your estate is small or nonexistent, you’ve gotten lots of free medical care. If it’s large, you’ll pay for it all. If you’re somewhere in between, you’ll end up paying for part of the care you’ve received.
Obviously this gives people incentives to spend all their money before they die. That’s fine. I suspect they wouldn’t end up spending as much as you’d think. What it does mean, though, is that Medicare has first claim on their estate, not their kids.
A great idea. It has my support!
“Leaving the specific details aside, Ryan’s and Obama’s health care initiatives are complementary, not competitive with each other. Without a functioning individual insurance market, you can’t voucherize Medicare. And without pushing most individuals into the individual insurance market, that individual market won’t really be the giant risk pool you need to drive the health care system in a more efficient direction. Obama’s plan nudged beneficiaries of private, employer-sponsored insurance into the national pool. Ryan’s proposal shoves the beneficiaries of government-provided insurance into that same pool.” — Noah Millman, writing at The American Scene Blog
“Over the next few days you will read a lot of “downgrade and dismiss” directed at Paul Ryan and his plan and indeed it is quite possible his proposal is not a workable one (I haven’t read it yet). But don’t fall for the downgrade and dismiss bait, keep on returning to the question of how much individual choice should be allowed into health care cost control. Why not divvy up the cost control work between the Board and some degree of individual choice across Medicare benefits? You don’t have to combine that choice with the cost-increasing aspects of Medicare Advantage-like plans.” — Tyler Cowen, on the benefit of giving consumers more choice in Medicare
“Expect there to be a lot of angry back and forth over this in the next week or so. But one thing to keep in mind is that this Medicare plan is not effectively very different from what the Democrats claim ObamaCare is going to do: which is to say, cap the amount of money spent on providing health benefits to those who are not rich enough to opt out of the public system. The Democrats want to do so by having a central committee of experts decide what our health dollars get spent on; the GOP wants to put those decisions into the hands of consumers. But this is not an argument about who loves old, sick people more. Both parties are promising to halt the rapid growth of government health care expenditures, which is definitionally going to fall hardest on old, sick people.” — Megan McArdle on the Paul Ryan plan
The parallels are obvious: In both fields (1) we have systematically suppressed normal market forces; (2) the entity that pays the bill is usually separate from the beneficiaries of the spending; (3) providers of the services see the payers, not the beneficiaries, as their real customers and often shape their practice to satisfy the payers’ demands — even if the beneficiaries are made worse off; (4) even though the providers and the payers are in a constant tug-of-war over what is to be paid for and how much, the beneficiaries are almost never part of these discussions; and (5) there is rampant inefficiency on a scale not found in other markets.
The full post can be found here.
“In four years’ time, the minimum cost of labor will be a $7.25 cash minimum wage and a $5.89 health minimum wage (family), for a total of $13.14 an hour or about $27,331 a year. (I think you can see already that no one is going to want to hire low-wage workers with families.)” — John Goodman, on the affects of Obamacare
“CBO Director Dr. Douglas Elmendorf has posted the slides he used in a presentation Wednesday to the Institute of Medicine, titled “Health Costs and the Federal Budget.” The presentation obliterates the claims of the President and his allies about the effects of the new laws on federal health spending and the budget…Never before have I seen a CBO Director so bluntly refute the policy claims of a President and his Budget Director.” –Keith Hennessey
” the C.B.O. has released a new estimate of how much additional discretionary spending — on implementation costs, further subsidies for new and existing programs, etc. — health care reform is likely to generate over the first 10 years. The total comes to $115 billion above and beyond the official price tag, a sum that would almost wipe out the bill’s projected deficit savings in the first decade.” –Ross Douthat, on the just added ObamaCare bill
“All of this hints at the problems that plague many of the studies Ezra and others have been citing, showing marvelous results from insurance: as I said in the beginning, uninsured are not like the rest of us. Do I think that my risks would shoot up to match those found by the studies Ezra likes? No I do not, and I doubt that Ezra would try to argue otherwise. I have immense resources at my disposal, most of them non-monetary. There are many ways in which I would like to even out those differences, but privilege cannot be transferred into someone else’s checking account. Indeed, as libertarians are fond of pointing out, government systems can frequently end up catering to privilege even more than the private sector; check out which post codes in Britain or Canada get the best medical services, or check out the massive disparities between the educations received by the poor children in New York City public schools, and the educations received by the middle class kids whose parents lightheartedly imagine that by siphoning an excess share of the system’s resources into their little darlings, they are somehow supporting the cause of educational equality.” — Megan McArdle, responding to Ezra Klein on the studies citing the benefits of health insurance
Thousands of consumers are gaming Massachusetts’ 2006 health insurance law by buying insurance when they need to cover pricey medical care, such as fertility treatments and knee surgery, and then swiftly dropping coverage, a practice that insurance executives say is driving up costs for other people and small businesses.
In 2009 alone, 936 people signed up for coverage with Blue Cross and Blue Shield of Massachusetts for three months or less and ran up claims of more than $1,000 per month while in the plan. Their medical spending while insured was more than four times the average for consumers who buy coverage on their own and retain it in a normal fashion, according to data the state’s largest private insurer provided the Globe.
Boston Globe has more here. Jeffrey Miron comments here.
“Massachusetts offers a snapshot of how giving more people insurance naturally drives demand. The Massachusetts Medical Society last fall reported just over half of internists and 40 percent of family and general practitioners weren’t accepting new patients, an increase in recent years as the state implemented nearly universal coverage.” — Associated Press Link via John Goodman