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Tag Archives: entitlements

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At the beginning of The Intouchables, we meet an unemployed French worker awaiting a job interview. Uninterested in being hired, he needs a third signature for his benefits form to prove he is looking. Inexplicably, he gets the job and the result is a great movie.

While The Intouchables is not really about entitlements, it took me to Denmark’s dilemma. Long thought to be the ideal welfare state, Denmark’s entitlements include free college, free health care and universal child-care payments. Private businesses can run public institutions and, unlike the French, fire workers freely (which means they will hire more willingly). Still, some Danes are increasingly concerned that public sector perks are diminishing the work ethic.

As a result, during June 2010, Denmark halved the time that you could receive unemployment benefits from 4 years to 2. Displaying why, the following graph shows that the number of people who get jobs spikes just when fired or 4 years later (or 5 years during the 1990s) when they figure they better take any job because their benefits will soon expire. However, because it is tough to go back to work after 4 years, many do not.

Just before unemployment benefits expire, joblessness decreases.

Debating the merits of the welfare state, most researchers look at haves and have-nots inside countries. Instead, in this paper, 3 economists look at the impact of the Scandinavian welfare state on other nations. Fascinatingly, they conclude that the world would be less affluent and less innovative (see below) if we all adopted Denmark’s “cuddly form of capitalism.” As they tell us in their last sentence, “we cannot all be like the Scandinavians, because Scandinavian capitalism depends in part on the knowledge spillovers created by the more cutthroat American capitalism.”

From "Can't We All Be More Like Scandinavians?"

From “Can’t We All Be More Like Scandinavians?”

Sources and Resources: For more from those who totally agree with Denmark’s welfare state, I suggest reading this post from Dean Baker and The Economist’s series of articles on Scandinavia. Tilting toward the other side, are these articles (and my unemployment graph), here and here, from the NY Times. But, if you had to choose just one paper to read, I recommend the introduction and conclusion that frame the AceMoglu, Robinson, Verdier paper, “Can’t We All Be More Like the Scandinavians?”

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The ratio is 3 to 1. The “3″ is how much Medicare recipients are receiving. The “1″ is what they paid.

Still though, you can see from this NPR report why most people call Medicare an entitlement.

According to a study from the Urban Institute, an average worker starting Medicare in 2010 paid close to $55,000 in Medicare taxes. That same person’s lifetime Medicare benefit (from age 65 until death) is projected to total $161,000. You can see here how taxes and benefits for Medicare and Social Security vary between 1960 and 2030.

Rather similar to other pay-as-you go systems, taxes from current wage earners pay for current Medicare recipients. And therein lies the problem. Baby boomers, who far outnumber all other generations, have just started turning 65. Meanwhile, birth rates are falling and longevity is rising.

Solutions? Higher taxes? Lower benefits? Cost control? Privatization? More borrowing through U.S. bond sales to China and Japan?

The Economic Lesson

During 1965, President Lyndon Johnson called Wilbur Mills, chairman of the House Ways and Means Committee, and said, “Wilbur, I’ve just been looking through the polls here, and I’ve only got a few weaknesses, and the worst of them is that I’m not doing anything for the old folks. I need some help from you.
The result? Congress passes Medicare Parts A and B.

An Economic Question: Which new incentives would you suggest for the Congress, for Medicare recipients, and for healthcare providers to solve the Medicare problem?

 

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In October 1972, Congress decided that the federal government should pay for treating chronic kidney disease. Concerned that care went primarily to those who could afford it, Congress proclaimed dialysis and transplants an entitlement for almost all of us. They expected, though, that most patients would be younger than 54 and relatively healthy.

It did not work out that way.

Now, almost 40 years later, many more people, including the elderly, receive treatment. Accounting for 42% of the cost of the program, older patients on dialysis tend to have a plethora of other health problems including diabetes, heart disease, stroke, and dementia. For people with multiple chronic conditions, dialysis has been found not to be a life saver. Still though, treatment is provided for all who request it because it is an entitlement. And, as an entitilement, it is free.

Free???

The federal government pays between $40 and $50 billion dollars annually treating end-stage kidney disease.

The Economic Lesson

Here is where we have a dilemma. The cost for society to treat kidney disease is very different from the cost for the sick individual.

As a society, we have a limited supply of the land, labor, and capital that we use to make goods and services. For that reason, producing more of one good or service means less of another one. Allocating an unlimited supply of land, labor, and capital for treating kidney disease means having less elsewhere.

Our question: Would you support the current cost (defined as sacrifice) of treating kidney disease?

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Using data for 2009 from death certificates in all 50 states, the national Centers for Disease Control has concluded that we are living longer. A male infant’s projected life span has risen .2 years to 75.7 while a female infant’s life expectancy is up .1 years to 80.6. An interesting chart in the report notes projected longevity for ages 0-100. Females at age 100 are estimated as having 2.2 years left. 65-year old males have a projected life span of 82.3.

Living longer, though, means that Social Security will need more money unless changes are made. Proposals from the deficit commission appointed by President Obama include the following (pp. 48-53):

  • Gradually increase the age that we start to receive Social Security benefits.
  • Gradually increase Social Security taxes.
  • Decrease what higher earners receive.
  • Encourage more personal retirement saving.

The Economic Lesson

The future of Social Security takes us to two basic concerns.

  1. Life expectancy: When Social Security was created in 1935, the average lifespan was 64 and benefits could begin at age 65. Now, life expectancy can extend beyond 80.
  2. Ratio of workers to beneficiaries: Called pay-as-you-go, the Social Security system has current workers funding retirees’ benefits. Because of the baby boomers, the worker/retiree ratio is plunging. In 1950 there were 16 workers for every beneficiary and now it is 3:1. The projection for 2025 is a ratio of 2.3 workers for every retiree.

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On Amazon (“gift wrap available”), you can purchase the 1995 “Final Report to the President” of the “Bipartisan Commission on Entitlement and Tax Reform”. During February, President Obama announced the creation of the National Commission on Fiscal Responsibility and Reform. The old and new commissions have a lot in common.

I actually have a copy of the 1995 report on my bookshelf and just read its 269 pages. My conclusion? Nothing has substantially changed. In 1995, they said that Social Security expenditures would exceed Social Security tax revenue in 2013. The current projection is 2014. They said the system would have no trust fund money left in 2029. The current projection is 2037. Even one of the names is the same. Senator Alan Simpson was on the original commission and now is a co-chair of the current one.

Because many of the facts have not changed, their solutions remain viable. Reflecting timeless political realities, the 32 members of the commission could not agree. Consequently, the report included general conclusions, policy suggestions, and reports from committee members. In addition, the staff presented 3 policy packages ((pp. 169-175). 1) “No Tax Changes”  so benefits would decrease. 2) “Minimize Benefit Reductions” so taxes would rise. 3) A “Blended Approach” which combines benefit cuts and tax increases.

As was true 15 years ago, because discretionary items like education, space, and justice represent a small proportion of all federal spending, the 2010 commission will have to focus on mandatory spending which takes us to Social Security, Medicare, and Medicaid. Will the Congress and the President respond now as they did 15 years ago?

The Economic Lesson

Specifically defined, federal fiscal policy refers to taxing, spending, and borrowing. It involves the federal deficit which is the shortfall between annual spending and revenue. The federal debt is the total amount that the U.S. government owes.

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