The U.S. population is aging. Social Security projections suggest that between 2013 and 2050, the population aged 65 and over will almost double, from 45 million to 86 million. One key driver of population aging is ongoing increases in life expectancy. Average U.S. life expectancy was 67 years for males and 73 years for females five decades ago; the averages are now 76 and 81, respectively. It has long been the case that better-educated, higher-income people enjoy longer life expectancies than less-educated, lower-income people. The causes include early life conditions, behavioral factors (such as nutrition, exercise, and smoking behaviors), stress, and access to health care services, all of which can vary across education and income.
The Growing Gap in Life Expectancy by Income: Implications for Federal Programs and Policy Responses | The National Academies PressSeptember 27, 2015
Some reforms, however, might be especially worthwhile insofar as they would simply make it more likely that budget results conform to lawmakers’ manifest intent. This piece will describe one such concept. In essence, it would prohibit future double-counting of Medicare Hospital Insurance (HI) savings, to ensure that future fiscal outcomes are consistent with the longstanding intent that both Social Security and Medicare HI be operated as self-financing programs.
There is currently an enormously expensive loophole in the budget rules. By law, Social Security and Medicare HI are only permitted to spend when there are positive balances in their respective trust funds. They must constrain benefit spending if trust fund reserves are depleted. Despite this restriction of law, current scorekeeping rules instead assume the law governing these programs will be changed to permit full payment of all scheduled benefits irrespective of trust fund spending authority. This results in a scorekeeping baseline assuming much higher spending than permitted under current law.
It’s easy to see that this issue is almost entirely about the difficulty of obtaining generic drug approval in the United States because there are many suppliers in India and prices are incredibly cheap. The prices in this list are in India rupees. 7 rupees is about 10 cents so the list is telling us that a single pill costs about 5 cents in India compared to $750 in the United States!
Since 2011, state spending on Medicaid has grown rapidly as enrollment increases and healthcare costs escalate. Growing enrollment, even prior to enactment of the Patient Protection and Affordable Care Act (ACA), has precipitated increasing program costs, while the end of temporary increases in federal assistance for the program has put additional financial burdens on states. As these trends continue, state budget officials and other policymakers are becoming increasingly concerned that the growth in state Medicaid expenditures will displace other state budget priorities.
In a new study for the Mercatus Center at George Mason University, policy analyst Marc D. Joffe examines state financial data to better understand the effects these trends in Medicaid are having on state budgets. The study finds evidence that growth in state Medicaid spending is crowding out spending on other major state programs, most notably education and transportation infrastructure. However, there is little evidence that growing state Medicaid expenditure is increasing state debt burdens. As the ACA continues to drive increasing enrollment in all states, those states that have opted for the Medicaid expansion will experience a greater fiscal burden as federal assistance for the expansion gradually shrinks.
Compared to spending on doctors and hospitals, prescription drug therapy is a bargain. Generic drugs are especially cheap; accounting for 88 percent of prescriptions filled but only 28 percent of expenditures. Within a year after a brand drug faces competition from generics, the average price falls 80 percent or more. Whereas the average cost of a name-brand prescription was $268 in 2011, it was only about $33 for a generic drug. Intense competition usually holds generic drug prices in check. Oddly, during the past few years, many generic drugs that have been on the market for decades have suddenly become more expensive. The price of more than one-fourth of generic drugs rose 10 percent to 100 percent or more in 2014. In other cases, older generic drugs have become scarce and hard to procure. Some of the reasons for drug price increases fall within the supply chain — the path a drug follows from raw ingredients to the consumer — and are discussed below.
Interventions that alter population-level risk exposure have yielded a number of improvements in public health. Tobacco taxes are an example of such population-based approaches to disease prevention. In the case of tobacco, the harms of shifting total population exposure through taxation are minimal, because there is no safe level of consumption. However, other risk factors do not exhibit the same linear relationship between exposure and mortality—and therefore may introduce new complexities in communicating with individuals and the public. In particular, many risk factors, such as alcohol consumption, exhibit a J-shaped association when plotting health effects like mortality on the vertical axis against the magnitude of the risk factor on the horizontal axis
The gap between the life expectancy of the rich and the poor has been increasing over time and that has big implications for the best ways to fix Social Security, Medicare, Medicaid and other entitlement programs.