Providing all beneficial care to those who need it is rapidly becoming unaffordable, even for a nation as rich as the United States. The highly decentralized U.S. payment system is unique in its lack of effective levers for limiting health care spending, and managed care has largely been ineffective. A different solution, considered extreme by many in the United States, is rationing.
The United States spends more on health care than any other nation. In 2003, medical spending made up more than 15 percent of U.S. GDP, and if historical trends persist, this share will climb to more than one-third of GDP by 2040. With medical technology advancing at an ever-increasing rate, the potential for spending on procedures not worth their costs is growing. But there are few good ideas for reining in medical costs without hurting patients.
Robert E. Litan, Nicholas Warren, and Lael Brainard
Publication Date:
07-2005
Content Type:
Policy Brief
Institution:
The Brookings Institution
Abstract:
With a new wave of white-collar offshoring coming fast on the heels of accelerated job losses in manufacturing, an ever-broader pool of American workers is finding that the nation's safety net has more holes than netting. The nation can and must do more to help insure the livelihoods of American workers in the face of structural shifts of whatever form, while preserving the benefits of an open and innovative economy. With technological change and offshoring accelerating job turnover and the pace at which workers' job-specific skills lose value, the time has come for the federal government to strengthen the existing safety net.
When George W. Bush leaves office in 2009, the federal government will owe at least $15,000 more for every American than it did when he became president eight years earlier. This unprecedented build-up of public debt will result from budget deficits projected to average more than $250 billion a year during the Bush presidency, plus more than one trillion dollars borrowed from social security trust funds. Although this budget projection may be high, there is far greater risk that actual deficits will exceed current estimates than that they will be lower.
Topic:
International Relations, Economics, and Government
In Washington, politicians and pundits have settled on a single magical solution for the country's economic ills: getting China to revalue its currency, the RMB. By any reasonable economic measure, however, the RMB is not undervalued. China does have a trade surplus with the United States, but it has a trade deficit with the rest of the world. And China's accumulation of dollar reserves is not the result of trade surpluses, but of large investment inflows caused in part by speculators' betting that China will yield to U.S. pressure. Focusing on China's currency is a distraction. If the United States wants to improve its economy for the long haul, it had best look elsewhere beginning with raising the productivity of American workers.
Topic:
Economics and Government
Political Geography:
United States, China, America, Washington, and Asia
A UNIQUE AND SUCCESSFUL INTERNATIONAL POLICY EXPERIMENT has been under way in Cambodia for the last six years. In the country's export apparel factories, working conditions and labor rights are monitored by inspectors from the International Labor Organization (ILO), an international public organization. The results of the inspections are published in credible, highly transparent reports that describe in detail whether the factories are in compliance with national labor laws and internationally agreed basic labor rights. These reports are published on the Internet, and a range of Cambodian and international actors use them. The U.S. government uses the reports as a key input for decisions under an innovative scheme that allows Cambodian firms to sell more apparel in the U.S. market if they improve working conditions and respect workers' rights. Private retail apparel firms that buy from Cambodian factories also use the reports. These buyers, conscious of their brand reputations, use the reliable information they find in the reports to steer orders toward compliant factories and away from noncompliant ones.
Topic:
Foreign Policy, Development, Economics, and Government
With President Bush's call for comprehensive Social Security reform bogged down in the morass of partisan politics, many reform advocates have suggested starting the process with smaller steps. Recently, Sen. Jim DeMint (R-SC), Rep. Jim McCrery (R-LA), Rep. Paul Ryan (R-WI), Rep. Sam Johnson (R-TX), and others have proposed legislation to rebate Social Security surpluses to workers in the form of contributions to personal accounts.
Seventy-seven million aging baby boomers will sink America's retirement security system if we don't take action soon. A few years ago, the problem went unrecognized by most Americans. Today, the prospect of a fiscal crisis has forced policymakers to focus on solutions.
Medicaid occupies a special place among government programs for the poor. Public support for Medicaid is broader and deeper than for other safety net programs because the consequences of inadequate medical care can be much more immediate and severe than those of a lack of money or even food.
One of the most frequently voiced objections to school choice is that the free market lacks the "accountability" that governs public education. Public schools are constantly monitored by district administrators, state officials, federal officials, school board members, and throngs of other people tasked with making sure that the schools follow all the rules and regulations governing them. That level of bureaucratic oversight does not exist in the free market, and critics fear choice-based education will be plagued by corruption, poor-quality schools, and failure.