We provide the first investigation into whether and how much genes explain having health insurance coverage or not and possible mechanisms for genetic variation. Using a twin-design that compares identical and non-identical twins from a national sample of US twins from the National Survey of Midlife Development in the United States, we find that genetic effects explain over 40% of the variation in whether a person has any health coverage versus not, and nearly 50% of the variation in whether individuals younger than 65 have private coverage versus whether they have no coverage at all. Nearly one third of the genetic variation in being uninsured versus having private coverage is explained by employment industry, self-employment status, and income, and together with education, they explain over 40% of the genetic influence. Marital status, number of children, and available measures of health status, risk preferences, and prevention effort do not appear to be important channels for genetic effects. That genes have meaningful effects on the insurance status suggests an important source of heterogeneity in insurance take up.
Importance The United States spends more on health care than any other country, with costs approaching 18% of the gross domestic product (GDP). Prior studies estimated that approximately 30% of health care spending may be considered waste. Despite efforts to reduce overtreatment, improve care, and address overpayment, it is likely that substantial waste in US health care spending remains. Objectives To estimate current levels of waste in the US health care system in 6 previously developed domains and to report estimates of potential savings for each domain. Evidence A search of peer-reviewed and “gray” literature from January 2012 to May 2019 focused on the 6 waste domains previously identified by the Institute of Medicine and Berwick and Hackbarth: failure of care delivery, failure of care coordination, overtreatment or low-value care, pricing failure, fraud and abuse, and administrative complexity. For each domain, available estimates of waste-related costs and data from interventions shown to reduce waste-related costs were recorded, converted to annual estimates in 2019 dollars for national populations when necessary, and combined into ranges or summed as appropriate. Findings The review yielded 71 estimates from 54 unique peer-reviewed publications, government-based reports, and reports from the gray literature. Computations yielded the following estimated ranges of total annual cost of waste: failure of care delivery, $102.4 billion to $165.7 billion; failure of care coordination, $27.2 billion to $78.2 billion; overtreatment or low-value care, $75.7 billion to $101.2 billion; pricing failure, $230.7 billion to $240.5 billion; fraud and abuse, $58.5 billion to $83.9 billion; and administrative complexity, $265.6 billion. The estimated annual savings from measures to eliminate waste were as follows: failure of care delivery, $44.4 billion to $93.3 billion; failure of care coordination, $29.6 billion to $38.2 billion; overtreatment or low-value care, $12.8 billion to $28.6 billion; pricing failure, $81.4 billion to $91.2 billion; and fraud and abuse, $22.8 billion to $30.8 billion. No studies were identified that focused on interventions targeting administrative complexity. The estimated total annual costs of waste were $760 billion to $935 billion and savings from interventions that address waste were $191 billion to $282 billion. Conclusions and Relevance In this review based on 6 previously identified domains of health care waste, the estimated cost of waste in the US health care system ranged from $760 billion to $935 billion, accounting for approximately 25% of total health care spending, and the projected potential savings from interventions that reduce waste, excluding savings from administrative complexity, ranged from $191 billion to $282 billion, representing a potential 25% reduction in the total cost of waste. Implementation of effective measures to eliminate waste represents an opportunity reduce the continued increases in US health care expenditures.Do you want to read t
In this paper, we analyze each of Warren’s proposals in detail. While some of Warren’s proposals would in fact succeed in raising taxes or reducing spending, others would not. All in all, while Warren and her advisors estimate that her proposals would fully fund “Medicare for All,” we estimate that, altogether, the Warren plan would increase the primary federal deficit by $15 trillion over ten years. (We did not calculate the cost of interest payments to service $15 trillion of additional borrowing.)
Warren’s financing plan has two parts. The first describes her approach to estimating the costs of Medicare-for-all. The second lays out the way she pays for the plan without, in her words, “one penny” of middle-class tax increases.As befits Warren’s wonkish, master-of-plans persona, she’s relied in both cases on top experts. Her cost estimate was conducted by Don Berwick, the former director of the Centers for Medicare and Medicaid Services; and Simon Johnson, the former chief economist at the World Bank. Her tax plan was developed by Betsey Stevenson, who served as chief economist at the Labor Department; Mark Zandi, the head economist at Moody’s Analytics; and Johnson. Helpfully, her plan is backed up by two detailed appendices laying bare, and arguing for, the assumptions Warren makes.
The French Press: Elizabeth Warren’s Fantastical Potpourri of Absurd Assumptions and Outright FalsehoodsNovember 6, 2019
What about Elizabeth Warren? She just insulted your intelligence. She just unveiled the most transparently absurd campaign pledge since, “I’ll build the wall, and Mexico will pay for it.” When I read her plan, which purports to deliver universal health care coverage without a middle class tax increase, it’s hard to believe intelligent people take it seriously. It’s simply fantastical. It’s a potpourri of absurd assumptions and outright falsehoods.
Senator Warren deserves enormous credit for abandoning her earlier dismissals of the $30 trillion financing question and producing a plan that spells out the required new taxes. However, promising to shield middle-class families from new taxes forces Sen. Warren to propose an unrealistic level of health care savings, as well as new taxes on businesses and investors that are nearly unprecedented in the modern economy. A more realistic accounting of this plan likely leaves a substantial funding hole, not to mention questions about how the economy would respond to this avalanche of taxes.
Why have so many young men withdrawn from the U.S. labor force since1965? This paper presents a model in which men invest time in employment to enhance their value as marriage partners. When the marriage market return on this investment declines, young men’s employment declines as well, in preparation for a less favorable marriage market. Taking this prediction to data, I show that fewer young men sought employment after 2 interventions that reduced the valueof gender-role-specialization within marriage: i) the adoption of unilateral divorce legislation, and ii) demand-driven improvements in women’s employment opportunities. I then show, using a structural estimation, that half of the employment effect of a labor market shock to men’s wages is determined by endogenous adjustment of the marriage market to the shock. These findings establish the changing marriage market as an important driver of decline in young men’s labor market involvement.
Although the decline in marriage has been cited as a possible contributor to the “despair” afflicting marginalized White communities, these studies have not directly considered mortality by marital status. This paper uses complete death certificate data from the Mortality Multiple Cause Files with American Community Survey data to examine age-specific mortality rates for married and non-married people from 2007 to 2017. The overall rise in White mortality is limited almost exclusively to those who are not married, for men and women. By comparison, mortality for Blacks and Hispanics has fallen or remained flat regardless of marital status (except for young, single Hispanic men). Analysis by education level shows death rates have risen most for Whites with the lowest education, but have also increased for those with high school or some college. Because mortality has risen faster for unmarried Whites at all but the lowest education levels, there has been an increase in the marriage mortality ratio. Mortality differentials are an increasingly important component of the social hierarchy associated with marital status.