The Value of Human Capital and Health Behavior by Alexander Skorobogatov :: SSRN

January 31, 2013

The paper examines an effect of the return to human capital on health behavior. An approach is assumed in the paper which implies that health is an investment good complimentary for human capital. The latter is treated as actual skills and knowledge yielding a bonus above earnings. We propose a model relating health demand to human capital. According to the model, human capital determines health behavior via the expected effect of health on the return to human capital. The main implication of the model is that the educated people will not much differ from those lacking any education with regard to health behavior if their education does not generate the bonus.

via The Value of Human Capital and Health Behavior by Alexander Skorobogatov :: SSRN.


Workplace Characteristics and Employment of Older Workers by Chinhui Juhn, Kristin McCue :: SSRN

January 31, 2013

As aging of the U.S. population places increased demands on public programs such as Social Security, an important question is how long older Americans are willing and able to work before they retire from the labor force. While studies based on household surveys have provided information on the role of savings, health status, pension and health insurance coverage, there is relatively little information on how workplace and employer characteristics affect the employment of older workers. In this study we use linked employer-employee data to explore the relationship between the characteristics of jobs held at age 55 and early retirement. We focus on a sample of 63-year-olds drawn from the 2005-2008 American Community Survey. We match this sample to information on their earnings, employment, employers and coworkers drawn from the Longitudinal Employer-Household Dynamics data for the years in which they age from 55 to 63. We use employment status as reported in the ACS to split the sample into those who have retired by age 63 and those who continue to work. We then examine differences between early retirees and continuing workers in the characteristics of their employment at age 55, and at how these characteristics change as they approach age 63. We find that early retirees are more likely to be employed by larger employers at age 55 than are continuers. They work for employers with somewhat higher pay than do continuers, and are less likely to have young coworkers.

via Workplace Characteristics and Employment of Older Workers by Chinhui Juhn, Kristin McCue :: SSRN.


Food Insecurity Among Households with Working-Age Adults with Disabilities by Alisha Coleman-Jensen, Mark Nord :: SSRN

January 31, 2013

Prior research has shown that food insecurity is more common among U.S households with an adult who has a work-limiting disability than among other households. To provide more detail on the prevalence of food insecurity by a range of types of disabilities, we analyzed data from the Current Population Survey Food Security Supplement (2009 and 2010). We focused on two groups of households that include adults with disabilities: (1) households with a working-age adult with a disability that prevented work (not in labor force-disabled); and (2) those with a working-age adult with a specified disability (hearing, vision, mental, physical, self-care, or going-outside-home disability) and no indication that their disability prevented them from working (other reported disabilities). Food insecurity was most prevalent among households with an adult who was not in labor force-disabled (33.5 percent), followed by those with a working-age adult with other reported disabilities (24.8 percent). Households with no working-age adult with a disability had a much lower prevalence of food insecurity (12.0 percent). Close to two in five households with very low food security included an adult with a disability. The study findings demonstrate the importance of disabilities as a determinant of food insecurity.

via Food Insecurity Among Households with Working-Age Adults with Disabilities by Alisha Coleman-Jensen, Mark Nord :: SSRN.


Artificial Sweetness: A Survey of the Harmful Effects Caused by the U.S. Sugar Program and Possibilities for Reform by Cameron Stokes :: SSRN

January 31, 2013

The U.S. sugar industry is one of the most heavily protected in the world. This protection comes from the regulatory aspects of the farm bills passed by Congress every five or six years, most recently in 2008. The current sugar program consists of price supports to maintain a “price floor” for raw and refined sugar in the U.S., marketing controls to regulate the amount of sugar each state and individual producer can sell into the market, and import quotas to limit the influx of foreign sugar into the attractively-priced U.S. market. Because the program includes a “no cost” mandate, quotas are strictly enforced to prevent overproduction, which results in a deflated cost. As a result, those who are allotted a share of the market stand to gain big, while those who are outside the system suffer the consequences.

This Note will analyze the U.S. sugar program as it has developed and currently exists. The main focus will be on the program’s effect on various parties in the marketplace, including domestic sugar producers, domestic end-consumers and industries that use sugar, and international sugar producers. On balance, it will be shown that the impact of the sugar program is overwhelmingly negative on all but a very few parties. This paper will also explore various methods for reducing the harms created by the program, both domestically and internationally. Though in the near future, skepticism of any changes seems to remain the safest bet, the goal of this Note is to show that reform is needed and long overdue and that positive changes are possible down the road, even if they are politically difficult.

via Artificial Sweetness: A Survey of the Harmful Effects Caused by the U.S. Sugar Program and Possibilities for Reform by Cameron Stokes :: SSRN.


Policy and Regulation of Long-Term Care – Exploration of an Uncultivated Field by Günter Roth :: SSRN

January 31, 2013

The article deals with the scarcely examined question as to how welfare state policy and regulation are related to the quantity and quality of long-term care services. The analysis carried out here supports evidence of a positive influence of social democratic welfare state regimes on the public spending and supply rates of care services. Beside that and a path dependent development recently also a trend towards the convergence of welfare state regimes began, mostly with the conservative regimes catching up. In general there is a trend towards strengthening home care and regulated markets with private for profit suppliers.

The importance of regulation and supervision by the state is emphasized through comparative studies from the USA, showing the positive influence of the intensity of controls on the quality of care services. However, despite supervision, (similar to Europe) the number of serious deficiencies remains high and defects often occur without effective consequences. As background it should be emphasized that there is no sufficient, decisive long-term care policy – also in the USA, where relatively strong age-related organizations are reported. Nevertheless, the political background and effects of welfare state regulation in its various forms remain unclear. In this respect, more research into care policy and the effects of welfare state regulation on the quality of care services is necessary.

via Policy and Regulation of Long-Term Care – Exploration of an Uncultivated Field by Günter Roth :: SSRN.


Revitalizing Informed Consent and Protecting Patient Autonomy: An Appeal to Abandon Objective Causation by Evelyn Tenenbaum :: SSRN

January 31, 2013

Due to advances in medicine, patients now have a wide-array of treatment options. Legal and ethical principles favoring patient autonomy theoretically give patients the right to choose among these options based on their personal values and preferences. But the right to choose is only meaningful if the patient is given sufficient information to make an intelligent decision. This article explains why informed consent laws fail to perform their function of protecting patients’ interests in receiving the information they need to exercise their personal preferences. In all but four states, a patient cannot prevail on an informed consent claim without proving objective causation. That standard forces the courts to focus on the hypothetical preferences of a reasonable person, rather than on the values and priorities of the individual patient.

The medical information patients receive from physicians reflects this focus on the hypothetical reasonable patient. The informed consent process often consists of a formalistic recitation of risks and alternatives intended to protect the physician against liability, rather than a joint process during which the physician and patient coordinate to ensure that the patient’s decisions are based on individual preferences and concerns. The Affordable Care Act recognizes this deficiency and includes a program to “facilitate the incorporation of patient preferences and values into the medical plan.”

This article argues that courts and state legislatures must also do their part by abandoning objective causation so informed consent laws can perform their essential role of protecting patients’ informational interests. The article traces the history of informed consent and shows why the doctrine is ripe for change. It recommends adopting a subjective causation standard and explains why this standard is an attractive option. The article also proposes using new computer systems to help make the informed consent process easy, effective, and relatively inexpensive.

via Revitalizing Informed Consent and Protecting Patient Autonomy: An Appeal to Abandon Objective Causation by Evelyn Tenenbaum :: SSRN.


Life, Liberty, and the Pursuit of Genetic Information by Sapna Kumar :: SSRN

January 31, 2013

Over the past few decades, scientists have made breakthroughs in understanding how genetic mutations contribute to disease in the human body. This has led to the availability of genetic testing, allowing patients to know whether they carry a particular mutation and allowing doctors to provide appropriate medical treatment based on test results. Thus, knowledge of one’s genetic information can help people make informed decisions regarding medical treatment.

A complicating factor, however, is gene patents. An inventor that determines the function of a gene and isolates it can get a patent, not just on the isolated gene itself, but also on tests detecting the presence of the gene. Consequently, gene patents have the potential to prevent people from learning about their own genetic information, and the potential to hinder doctors in treating their patients.

In this article, I argue that gene patents may violate the Fifth Amendment Due Process Clause. A strong argument can be made that individuals have a fundamental liberty interest in knowledge regarding their own genetic information, to the extent that such information will help them make informed decisions regarding medical treatment. Because gene patents are issued by the government and block individuals from obtaining this necessary information, the Patent Act is unconstitutional. I further discuss how the due process violation may extend beyond gene patents into other patents blocking diagnostic testing.

via Life, Liberty, and the Pursuit of Genetic Information by Sapna Kumar :: SSRN.


Essential Health Benefits and the Affordable Care Act: Law and Process by Nicholas Bagley, Helen Levy :: SSRN

January 31, 2013

Beginning in 2014, the Affordable Care Act (ACA) will require private insurance plans sold in the individual and small-group markets to cover a roster of “essential health benefits.” Precisely which benefits should count as essential, however, was left to the discretion of the Department of Health and Human Services (HHS). The matter was both important and controversial. HHS nonetheless announced its policy on essential health benefits by posting on its website a 13-page bulletin stating that it would allow each state to define essential benefits for itself by choosing a “benchmark” plan modeled on existing plans in the state. On both substance and procedure, the move was surprising. The benchmark approach departed from the uniform, federal standard that the statute appears to anticipate and that many informed observers expected HHS to adopt. And announcing the policy thorough an internet bulletin arguably allowed HHS to sidestep orthodox administrative procedures, including notice and comment, White House review, and preenforcement review in the courts.

What are we to make of this? This chapter explores two questions. First, is the benchmark approach a lawful exercise of HHS’s authority under the ACA? Although HHS may have brushed up against the limits of its discretionary authority, we conclude that the approach likely will (and, in our view, should) be upheld in the event of a challenge. Second, did HHS’s announcement of the benchmark approach through an internet bulletin allow the agency to avoid the very administrative procedures that typically serve to constrain the exercise of agency discretion? The answer here is a flat no. The agency’s adroit use of guidance documents instead resulted in a process that was more open to public scrutiny and external oversight than conventional rulemaking would have been.

via Essential Health Benefits and the Affordable Care Act: Law and Process by Nicholas Bagley, Helen Levy :: SSRN.


Can Medical Tourism Save Us From Obamacare? – Reason.com

January 31, 2013

If the double whammy of Obamacare, which will be fully up and running in 2014, and a rapidly aging population creates pronounced health-care shortages, more and more Americans may soon start looking abroad for fast, affordable, and effective treatments for all sorts of medical problems.

The global health-care industry is booming, which is creating new opportunities for medical travelers to purchase everything from discount dental work to state-of-the-art heart surgery. The international accreditation agency known as Joint Commission International evaluates the quality of hospitals around the world. It has given its stamp of approval to 546 hospitals worldwide and the list is growing faster than ever.

via Can Medical Tourism Save Us From Obamacare? – Reason.com.


Will ObamaCare Undermine Union Membership? – Hit & Run : Reason.com

January 31, 2013

One little-discussed side effect of ObamaCare is that it could undermine union membership by reducing the incentives for some unions to offer health benefits.

The issue here is how the law deals with multiemployer health plans, which cover as many as 26 million Americans, and are especially popular with unions whose members frequently work irregular hours for multiple customers. ObamaCare  requires these plans to comply with a number of regulations that are likely to drive up costs, but it doesn’t allow employers who provide benefits through multiemployer plans access to subsidies or tax credits. The only way for many of those union members currently covered by multiemployer plans to get subsidies would be for the unions to stop offering those plans.

via Will ObamaCare Undermine Union Membership? – Hit & Run : Reason.com.