Since a typical regulatory mandate can be equated in its economic effect to a combination of an expenditure program and a tax program, observers have often suggested that it would serve consistent public policy to bring regulatory decisions into the same budgetary framework. This paper concerns...

We evaluate several actual and hypothetical sustainable PAYGO pension structures, including: (1) versions of the US Social Security system with annual adjustments of taxes or benefits to maintain fiscal balance; (2) Sweden's Notional Defined Contribution system and several variants developed to...

The Medicare problem' is examined as part of the larger problem of providing for the overall financial needs of the elderly. Several myths about Medicare are discussed, and sources and uses of the elderly's full income' are estimated. The paper explores policy options to deal with...

State governments face the classic "make or buy" decision for the provision of Medicaid services. Over the past two decades, the majority of states have outsourced the provision of social health insurance through Medicaid Managed Care (MMC) programs. These programs have been extensively studied...

The Affordable Care Act (ACA) is one of the most important reforms of the US health insurance system since the introduction of Medicare. Since employment is a main source of health insurance for the working age population in the United States, this sweeping health insurance reform also has...

We use a natural experiment in China's health care reform, in which the government mandated zero markups for drugs sold in public hospitals, to study physician-induced demand for medical care. We develop a theoretical model that robustly predicts that the drug price zero markup policy (ZMP) will...

We study a 2008 policy reform in which Medicare revised its hospital payment system to better reflect patients' severity of illness. We construct a simulated instrument that predicts a hospital's policy-induced change in reimbursement using pre-reform patients and post-reform rules. The reform...

A mainstream motivation for decentralized government is to enable public service investments to better align with political preferences that may differ by geographical region. This paper examines how political preferences determine local government provision of hospital services. We find that...

The Affordable Care Act (ACA) authorized the largest expansion of public health insurance in the U.S. since the mid-1960s. We exploit ACA-induced changes in the discontinuity in coverage at age 65 using a regression discontinuity based design to examine effects of the expansion on health...

A large literature examines the effect of health insurance on mortality. We contribute by emphasizing two challenges in using the Affordable Care Act (ACA)'s quasi-experimental variation to study mortality. The first is non-parallel pretreatment trends. Rising mortality in Medicaid non-expansion...