Publications

Our health-care system is experiencing rapid, powerful change, far more consequential than is generally recognized. Although these changes are welcomed by many in the health-policy community (see our assessment a year ago), even those who applaud them have been surprised at their speed and impact.

We often hear that there’s a tradeoff between saving lives and economic performance. In this case of COVID-19, there’s not. They go together.

Since 1962, a new drug cannot be sold in the United States unless the U.S. Food and Drug Administration (FDA) is convinced that it is safe and efficacious: that is, not only will it not harm the people who take it, but also it will do them some good. It is easy to understand why there is a public interest in the safety of drugs. But why is government given the power to determine whether a drug works or not? And what difference does that make?

Critics of President Trump’s response to the coronavirus crisis characterize it as knee-jerk, spur-of-the-moment, and grasping at any straw within reach. In fact, many of the recent executive actions we have seen reflect a new approach to health policy that has been underway almost since the day Donald Trump was sworn into office.

One of the strange features of the national health care conversation is how it has evolved. What is often referred to as Obamacare began as an attempt to insure the uninsured. In fact, the initial Congressional Budget Office estimates predicted the Affordable Care Act would be largely successful in doing just that.

One of the strange features of the national health care conversation is how it has evolved. What is often referred to as Obamacare began as an attempt to insure the uninsured. In fact, the initial Congressional Budget Office estimates predicted the Affordable Care Act would be largely successful in doing just that.

When people think about drug pricing in the United States, they tend to think of the sky-high prices of some newer drugs. High prices do cause real problems. Some people in need may go without.

Tax reform championed by Donald Trump and passed by a Republican Congress was a boon for middle-income families. According to a study by the Atlanta Federal Reserve Bank, the average household in America can expect a lifetime gain of about $25,000.

More than 61,300 people in the US died from drug overdoses in 2017, up from the previous year’s record of 54,800. That’s more than the number of Americans who died in the Vietnam War. And it’s happening every year.

President Donald Trump says he wants health reform that will be better than Obamacare, better than what we had before Obamacare, and better than the Democrats’ Medicare for All. And he’s not alone. Numerous surveys show that health reform remains a top priority for Americans, who are concerned about high costs, access, and choice.

Senior citizens are discriminated against by a number of unwise public policies. People on Social Security lose benefits if they earn even a modest amount of wage income. Medicare is paying doctors the way it did in the last century – long before the existence of email or iPhones. Seniors are the only people in our society who can’t have a Health Savings Account – from which to pay bills not covered by health insurance.

Quite a few Democratic candidates for office this year are campaigning on the idea of enrolling everyone in Medicare. It’s not just the left. A significant number of doctors in the American Medical Association are for it. Public opinion polls show that 70 percent of Americans like the idea.

Many view the 2017 Republican tax reform (Tax Cut and Jobs Act) as a giveaway to the rich. “The most regressive tax cut in the past 50 years,” proclaimed one Washington Post blogger. “The most regressive tax policy change of our lifetimes,” wrote a contributor to The Hill. A big tax cut for (primarily rich) stockholders, opined New York Times columnist Paul Krugman. The Tax Policy Center (Brookings/Urban Institute) claimed that the top 1 percent would receive 82.8% of the reform’s total reduction in taxation. The Joint Committee on Taxation shows top-income households receiving much larger tax cuts than low-income households.

The architects of Obamacare promised a U.S. health care revolution that would control costs, improve quality, and provide coverage for all. They guaranteed access to health care regardless of income or health status. They promised that coverage for all would reduce costs by preventing disease. After more than eight years, Obamacare has failed to make good on its promises. Thanks to its poor design, it continues to increase health care costs, degrade health care quality, and weaken the market for private coverage. This Brief Analysis identifies the Obamacare promises and describes how they have been broken.

The single most important economic and sociological change in our society in modern times has been the entry of women into the labor market. Today, three of every four women of working age are employed -- more than double the share a half-century ago.

The War on Poverty began in 1965. Half a century later, America has spent more than $26 trillion on that effort,1 four times what we have spent on all the military wars from the American Revolution to the present.2 What do we have to show for all that spending?

The Tax Cut and Jobs Act of 2017 represents the most significant change in U.S. taxation since 1986. What difference does it make?

The Tax Cut and Jobs Act of 2017 (TCJA) represents the most significant change in U.S. taxation policy since 1986. The bill’s fairness has been studied and debated, with some studies suggesting the reform is regressive.

High deductible health insurance is an irritation for many of us. In fact, health insurance with, say, a $10,000 deductible is almost like not having health insurance at all.

A plan to radically reform the U.S. income tax system has been proposed by House Speaker Paul Ryan and House Ways & Means Chairman Kevin Brady. On the personal side, the system would become simpler, fairer, and flatter. On the corporate side, the current system would be replaced by a cash flow tax, similar to a valueadded tax with a carve out for wages.

John Baden is an intellectual entrepreneur. Together with his colleagues in Bozeman, Montana, he pioneered a new approach to environmental policy. It harmonizes three values: ecology, prosperity and liberty.

This is a unique, first-of-its-kind model developed by Boston University Professor Laurence Kotlikoff and his colleagues. It can be used to evaluate major tax and spending proposals. It is the principal alternative to the Tax Policy Center model – which was developed by the Brookings Institution and the Urban Institute and which is defective in a number of ways.

Why are pharmaceutical prices so high while the prices of so many other items we buy are low and even falling? One reason is a lack of competition. Drug companies typically have a monopoly on the drugs they sell, and monopolists charge higher prices than they would if they had to compete.

Think Colorado would be an ideal state for retirement? You may want to hold that thought until after the November 8th election. On the ballot is Amendment 69, a proposition designed to create free health care for everyone in the state. It comes with a heavy price tag. A new tax will claim 10 percent of most people’s income. It also comes with a great deal of regulation. A government agency (ColoradoCare) will assume virtually complete control over health care in the state, including the power to set doctor fees and hospital charges for every medical procedure.

People in their 60s who keep on working can face extremely high tax rates – much higher than the rates faced by millionaires and billionaires, according to a new study.

Here is something I bet you don’t know. On March 23, 2010, President Obama signed into law a bill that wiped out more than $50 trillion in Medicare’s unfunded liability. That’s not a misprint. That’s trillion with a “t.” The savings is almost three times the size of our entire economy. Further, in doing this he also solved the long term budgetary problem of Medicare. Unless some future Congress and some future president change the law, Medicare’s growth going forward will stay in line with the growth of our economy – ensuring that the program will remain affordable, indefinitely into the future.

After six years of living with ObamaCare, Republicans have finally produced an alternative. Other GOP proposals in recent years have been narrowly focused on the 20 million or so people who have been insured by ObamaCare. The new proposal is aimed at 250 million people. It will affect health insurance for the entire population not covered by Medicare.

Wherever we look around the world today we almost always find that normal market processes have been systematically suppressed in health care. As a rule, no one ever sees a real price for any medical service. No patient. No doctor. No employer. No employee. Further, we have not replaced the price system with an alternative that would allow people to make rational choices.

After six years of living with Obamacare, Republicans have finally produced an alternative. Other GOP proposals in recent years have been narrowly focused on the 20 million or so people who have been insured by Obamacare. The new proposal is aimed at 250 million people. It will affect health insurance for the entire population not covered by Medicare.

The news isn’t good for the ObamaCare exchanges. Most buyers this year are facing higher premiums, higher deductibles and narrower networks than last year and we are seeing more people drop their coverage as the months go by. That last fact is the most alarming. Last year, 1.3 million people dropped out of the exchanges after having signed up in the open enrollment period. In general, those who drop their coverage tend to be healthy. But, if the only ones who remain are the old and the sick, the prospect of a death spiral looms larger.

Social Security is a bad deal for almost all young workers. That is, they can expect to pay more – and in some cases hundreds of thousands of dollars more -- in taxes than they will receive in benefits. This observation is not even controversial.

There are two things almost all health economists are in agreement about: (1) you cannot have successful reform of the health care system if you ignore the 150 million people who get health insurance through an employer, and (2) the way we currently subsidize employer-provided health insurance is very wasteful and inefficient.

The Obamacare exchanges are highly regulated markets in which every buyer and every seller faces the wrong price. As a result, every buyer and every seller faces perverse incentives.

Do you know what is the most severe fine, penalty or punitive tax imposed under Obamacare?

One of the strangest things about Obamacare is that it is trying to force millions of families to obtain the wrong kind of insurance. When they turn it down, these families often end up with no insurance at all.

It is generally accepted that the federal government should help Americans obtain health insurance, either through tax or
spending subsidies.

Although most of us think our health care system is
predominantly a private system, government is heavily involved. Close to one in every two health care dollars is spent by government. And even spending that counts as private is heavily
subsidized.

Despite appearances to the contrary, this year’s presidential follies have managed to feature at least a few policy discussions amid all the name-calling.