Have Private Medicare Plans Bid Competitively – NYTimes.com

December 1, 2016

Yet the way that these private plans are paid today is extremely inefficient. While plans “bid” to offer coverage, actual payments to plans are based on administrative benchmarks. This is why the Medicare Payment Advisory Commission has routinely supported introducing “competitive bidding” into the program. While details vary by proposal, this would tie beneficiaries’ premiums to some plan in the market, be it a private plan or traditional Medicare itself. This would ensure financial neutrality between the two programs — incentivizing beneficiaries to seek out lower-cost plans — while also saving $275 billion over 10 years if it were structured similar to the Affordable Care Act’s exchanges.

Source: Have Private Medicare Plans Bid Competitively – NYTimes.com

Size and Development of the Shadow Economies of 157 Countries Worldwide: Updated and New Measures from 1999 to 2013 by Mai Hassan, Friedrich Schneider :: SSRN

November 13, 2016

This paper is a first attempt to study the size and development of the shadow economies of 157 countries over 1999 to 2013. Using a MIMIC model, we find that higher tax and regulatory burden, unemployment and self-employment rates are drivers of the shadow economy, meaning that an increase of these causal variables increases the shadow economy. Our result also confirms previous findings of Friedrich Schneider, Andreas Buehn and Claudia Montenegro (2010). The estimated average of informality of 157 countries around the world, including developing, eastern European, central Asian and high income OECD countries averaged over 1999 to 2013 is 33.77% of official GDP [the average value for the U.S. is 9.17%]. A critical discussion about the size of these macro-estimates comes to the conclusion that most likely the “true” shadow economy of these countries is only 69% of their estimated macro-MIMIC-values.

Source: Size and Development of the Shadow Economies of 157 Countries Worldwide: Updated and New Measures from 1999 to 2013 by Mai Hassan, Friedrich Schneider :: SSRN

Did Obamacare reduce un-insurance in 2015, or not? | TheHill

January 16, 2016

That total of $52.6 billion helped reduce the number of uninsured by 8.8 million on net in 2014, an average per capita cost of nearly $6,000.

Of course, the government incurred other costs in getting ObamaCare up and running—financing the creation of exchanges, launching its website, bankrolling star-crossed co-ops, promoting enrollment, and undertaking other efforts to implement and hype the law. Then there were the costs ObamaCare imposed on households and businesses—cancelled policies, premium hikes, higher deductibles, narrow physician networks, erroneous subsidy payments that resulted in loss of coverage among low-income households, a tax on the uninsured, and new levies on insurance premiums, drugs and medical devices—all of which have combined to make the law unpopular.

The eventual Democratic presidential nominee will nonetheless cite the reduction in the uninsurance rate as proof that ObamaCare has succeeded.  That is a mistake.  Though most Americans favor government intervention to make health insurance more widely available to people with low-incomes and pre-existing medical conditions, they chafe at the disruption the law has inflicted on their own coverage.  They will likely be as skeptical of presidential candidates who declare the law a success as they are of those who merely insist on its repeal.

Source: Did Obamacare reduce un-insurance in 2015, or not? | TheHill

Are Certificate-of-Need Laws Barriers to Entry? How They Affect Access to MRI, CT, and PET Scans | Mercatus

January 13, 2016


CON Regulations Have a Negative Effect on Nonhospital Providers

  • The association of a CON regulation with nonhospital providers is substantial, ranging from −34 percent to −65 percent utilization for MRI, CT, and PET scans.
  • Nonhospital providers in CON states experience significant decreases in the utilization of imaging services compared to hospital providers.

CON Regulations Have No Effect on Hospitals, Thus Increasing Their Market Share

  • CON regulation has no measurable effect on hospitals’ utilization of imaging services. The volume of services provided in hospitals is not affected by CON regulation.
  • This may explain why hospital providers have a stronger market presence in CON states than in non-CON states.

Consumers Are Driven to Seek Imaging Services in Non-CON States

  • CON regulations are associated with 3.93 percent more MRI scans, 3.52 percent more CT scans, and 8.13 percent more PET scans occurring out of state.
  • CON regulations may have a negative effect on consumers because patients living in CON states have to travel out of state more often than patients living in non-CON states. This propensity for traveling out of state to obtain medical services might be attributable to any of several factors: higher costs, a smaller selection of services, or restricted access to care.


CON laws act as barriers to entry for nonhospital providers and favor hospitals over other providers. In consequence, consumers of MRI, CT, and PET scanning services are driven to seek these services either out of state or in hospitals. More research is needed to determine whether additional costs and barriers in the healthcare industry restrict specific market providers and affect where procedures occur.

Source: Are Certificate-of-Need Laws Barriers to Entry? How They Affect Access to MRI, CT, and PET Scans | Mercatus

Yet Another Illegal ACA Tax Regulation, by Andy Grewal

October 14, 2015

I have previously written about various IRS regulations that contradict the clear language of tax code Section 36B. I recently re-examined the regulations and was only mildly surprised to find another provision that plainly exceeds the IRS’s rulemaking powers. Here, the IRS has simply discarded the statute’s joint return requirement for a segment of taxpayers (abused or abandoned spouses). Although one naturally pauses before criticizing the IRS for actually having a heart, the regulation presents an opportunity for tax avoidance and will lead to illegal penalty collections from employers.

Source: Yet Another Illegal ACA Tax Regulation, by Andy Grewal

33 Million Americans Still Don’t Have Health Insurance | FiveThirtyEight

October 14, 2015

Nearly 9 million people gained insurance last year, a win for “Obamacare” as the president’s signature health care law expanded Medicaid and opened health insurance exchanges. And yet, 33 million Americans, 10.4 percent of the U.S. population, still went without health insurance for the entirety of 2014. Millions more were uninsured for at least part of the year.1 New data released this month shows they were disproportionately poor, black and Hispanic; 4.5 million of them were children.

Source: 33 Million Americans Still Don’t Have Health Insurance | FiveThirtyEight

Health Care Compact States Choose Autocracy Over Democracy – US News

October 13, 2015

In a bold effort “to protect individual liberty and personal control over Health Care decisions,” nine states have approved a Health Care Compact to claim some autonomy from the Affordable Care Act, Medicare and Medicaid; two other states are considering joining them. The problem, however, is that in health care, most of the compact’s signatory states have poor records with respect to individual liberty and personal control over care.

The controls and strictures that these states place on patients and health care providers differ from the Affordable Care Act in style, but not in spirit. In both, the central guiding principles are paternalism and protectionism. The states, or their appointed medical boards, forbid patients and providers from using safe, effective modes of care and protect the finances and turfs of doctors, hospitals and others by shielding them from competition.

Source: Health Care Compact States Choose Autocracy Over Democracy – US News