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Begin New Search Topic Health Content Type Working Paper Publishing Institution The Cato Institute

1. Disease Mix and How Economic Freedom Matters for Health Outcomes

Author:
Vincent Geloso, Kelly Hyde, and Ilia Murtazashvili
Publication Date:
03-2023
Content Type:
Working Paper
Institution:
The Cato Institute
Abstract:
We investigate the institutional foundations of public health. We argue that a key distinction in analysis of disease is between diseases of commerce (diseases associated with movement of people and with affluence) and diseases of poverty (primarily noncommunicable diseases that depend on wealth and income). We show that the mix of disease – the ratio of communicable diseases and those associated with longevity to diseases of poverty – increases in economically free countries. We argue that increasing burdens of diseases of commerce reflects the quality of institutions, as those diseases are better than living shorter, brutish lives where diseases of poverty claim many lives. This analysis also highlights an institutional trade‐​off: economically free institutions reduce certain types of disease while contributing to others.
Topic:
Health, Infectious Diseases, Economy, Institutions, and Public Health
Political Geography:
Global Focus

2. The Use of Public Assistance Benefits by Citizens and Non-citizen Immigrants in the United States

Author:
Leighton Ku and Brian Bruen
Publication Date:
02-2013
Content Type:
Working Paper
Institution:
The Cato Institute
Abstract:
Claims are sometimes made that immigrants use public benefits, such as Medicaid, the Supplemental Nutrition Assistance Program, or the Temporary Assistance for Needy Families programs, more often than those who are born in the United States. This report provides analyses, using the most recent data from the Census Bureau, that counter these claims. In reality, low-income non-citizen immigrants, including adults and children, are generally less likely to receive public benefits than those who are native-born. Moreover, when non-citizen immigrants receive benefits, the value of benefits they receive is usually lower than the value of benefits received by those born in the United States. The combination of lower average utilization and smaller average benefits indicates that the overall cost of public benefits is substantially less for low-income non-citizen immigrants than for comparable native-born adults and children. The report also explains that the lower use of public benefits by non-citizen immigrants is not surprising, since federal rules restrict immigrants' eligibility for these public benefit programs.
Topic:
Economics, Health, Humanitarian Aid, Markets, and Immigration
Political Geography:
United States

3. Fiscal and Generational Imbalances and Generational Accounts: A 2012 Update

Author:
Jagadeesh Gokhale
Publication Date:
11-2012
Content Type:
Working Paper
Institution:
The Cato Institute
Abstract:
Official federal budget accounts are constructed exclusively in terms of current cash flows – receipts from taxes and fees and outlays on purchases and transfers. But cash-flows do not reveal economically relevant information about who benefits and who loses from government policies. Cash flows also do not reveal how changes in government's policies redistribute resources within and across generations, including reducing the tax burden on today's generations and increasing it on future ones. Because most government transact ions are targeted by age and gender, the federal government can bring about large resource transfers across generations. Intergenerational resource transfers will grow larger as the composition of budget receipts and expenditures changes with relatively faster growth of age-and-gender-related social insurance program. Intergenerational redistributions across generations through federal government operations could substantially affect different generations' economic expectations and choices and exert powerful long-term effects on economic outcomes.
Topic:
Economics, Government, Health, Human Welfare, Markets, and Monetary Policy
Political Geography:
United States

4. Estimating ObamaCare's Effect on State Medicaid Expenditure Growth

Author:
Jagadeesh Gokhale
Publication Date:
01-2011
Content Type:
Working Paper
Institution:
The Cato Institute
Abstract:
Unless repeal attempts succeed, the Patient Protection and Affordable Care Act of 2010 (ObamaCare) promises to increase state government obligations on account of Medicaid by expanding Medicaid eligibility and introducing an individual health insurance mandate for all US citizens and legal permanent residents. Once ObamaCare becomes fully effective in 2014, the cost of newly eligible Medicaid enrollees will be almost fully covered by the federal government through 2019, with federal financial support expected to be extended thereafter. But ObamaCare provides states with zero additional federal financial support for new enrollees among those eligible for Medicaid under the old laws. That makes increased state Medicaid costs from higher enrollments by "old-eligibles" virtually certain as they enroll into Medicaid to comply with the mandate to purchase health insurance. This study estimates and compares potential increases in Medicaid costs from ObamaCare for the five most populous states: California, Florida, Illinois, New York, and Texas.
Topic:
Government, Health, Markets, and Health Care Policy
Political Geography:
United States, New York, California, and Florida

5. The Massachusetts Health Plan: Much Pain, Little Gain

Author:
Michael F. Cannon and Aaron Yelowitz
Publication Date:
01-2010
Content Type:
Working Paper
Institution:
The Cato Institute
Abstract:
In 2006, Massachusetts enacted a sweeping health insurance law that mirrors the legislation currently before Congress. After signing the measure, Gov. Mitt Romney (R) wrote, "Every uninsured citizen in Massachusetts will soon have affordable health insurance and the costs of health care will be reduced." But did the legislation achieve these goals? And what other effects has it had? This paper is the first to use Current Population Survey data for 2008 to evaluate the Massachusetts law, and the first to examine its effects on the accuracy of the CPS's uninsured estimates, self-reported health, the extent of "crowd-out" of private insurance for both children and adults, and in-migration of new Massachusetts residents.
Topic:
Government, Health, and Privatization
Political Geography:
United States

6. Obama's Prescription for Low-Wage Workers: High Implicit Taxes, Higher Premiums

Author:
Michael F. Cannon
Publication Date:
01-2010
Content Type:
Working Paper
Institution:
The Cato Institute
Abstract:
House and Senate Democrats have produced health care legislation whose mandates, subsidies, tax penalties, and health insurance regulations would penalize work and reward Americans who refuse to purchase health insurance. As a result, the legislation could trap many Americans in low-wage jobs and cause even higher health-insurance premiums, government spending, and taxes than are envisioned in the legislation.
Topic:
Government, Health, and Privatization
Political Geography:
United States and America

7. Reforming Medical Malpractice Liability through Contract

Author:
Michael F. Cannon
Publication Date:
11-2010
Content Type:
Working Paper
Institution:
The Cato Institute
Abstract:
This paper discusses the medical malpractice "crisis" and the potential of contract liability to reduce overall malpractice costs as well as improve the quality of and access to care. First, the paper describes the current medical malpractice liability "system" and some of the more common reforms offered. It then discusses the economic rationale of allowing patients and providers to agree in advance of treatment on how the patient will be compensated in the event of simple negligence on the part of providers, explaining how contract liability may offer improvements in the areas of costs, patient preferences, the pursuit of more efficient liability rules, and quality of care. The paper then critiques select objections to contract liability – those based on the superior bargaining power of providers, the lack of information available to patients, and possible reductions in quality – and forwards possible limitations on the right to contract that may allay such concerns.
Topic:
Health, Law, and Health Care Policy
Political Geography:
United States

8. A Better Way to Generate and Use Comparative-Effectiveness Research

Author:
Michael F. Cannon
Publication Date:
02-2009
Content Type:
Working Paper
Institution:
The Cato Institute
Abstract:
President Barack Obama, former U.S. Senate majority leader Tom Daschle, and others propose a new government agency that would evaluate the relative effectiveness of medical treatments. The need for “comparative-effectiveness research” is great. Evidence suggests Americans spend $700 billion annually on medical care that provides no value. Yet patients, providers, and purchasers typically lack the necessary information to distinguish between high- and low-value services.
Topic:
Economics, Government, Health, and Privatization
Political Geography:
United States

9. Health-Status Insurance: How Markets Can Provide Health Security

Author:
John H. Cochrane
Publication Date:
02-2009
Content Type:
Working Paper
Institution:
The Cato Institute
Abstract:
None of us has health insurance, really. If you develop a long-term condition such as heart disease or cancer, and if you then lose your job or are divorced, you can lose your health insurance. You now have a preexisting condition, and insurance will be enormously expensive—if it's available at all. Free markets can solve this problem, and provide life-long, portable health security, while enhancing consumer choice and competition. “Heath-status insurance” is the key. If you are diagnosed with a long-term, expensive condition, a health-status insurance policy will give you the resources to pay higher medical insurance premiums. Health-status insurance covers the risk of premium reclassification, just as medical insurance covers the risk of medical expenses. With health-status insurance, you can always obtain medical insurance, no matter how sick you get, with no change in out-of-pocket costs.
Topic:
Economics, Health, Markets, and Privatization
Political Geography:
United States

10. Obamacare to Come: Seven Bad Ideas for Health Care Reform

Author:
Michael Tanner
Publication Date:
05-2009
Content Type:
Working Paper
Institution:
The Cato Institute
Abstract:
President Obama has made it clear that reforming the American health care system will be one of his top priorities. In response, congressional leaders have promised to introduce legislation by this summer, and they hope for an initial vote in the Senate before the Labor Day recess.
Topic:
Government and Health
Political Geography:
United States

11. Halfway to Where? Answering the Key Questions of Health Care Reform

Author:
Michael Tanner
Publication Date:
09-2009
Content Type:
Working Paper
Institution:
The Cato Institute
Abstract:
Although neither the House nor the Senate passed a health care bill by President Obama's August deadline, various pieces of legislation have made it through committee, and they provide a concrete basis for analyzing what the proposed health care reform would and would not do. Looking at the various bills that are moving on Capitol Hill, we can determine the following: Contrary to the Obama administration's repeated assurances, millions of Americans who are happy with their current health insurance will not be able to keep it. As many as 89.5 million people may be dumped into a government-run plan. Some Americans may find themselves forced into a new insurance plan that no longer includes their current doctor. Americans will pay more than $820 billion in additional taxes over the next 10 years, and could see their insurance premiums rise as much as 95 percent. The current health care bills will increase the budget deficit by at least $239 billion over the next 10 years, and far more in the years beyond that. If the new health care entitlement were subject to the same 75-year actuarial standards as Social Security or Medicare, its unfunded liabilities would exceed $9.2 trillion. While the bills contain no direct provisions for rationing care, they nonetheless increase the likelihood of government rationing and interference with how doctors practice medicine. Contrary to assertions of some opponents, the bills contain no provision for euthanasia or mandatory end-of-life counseling. The bills' provisions on abortion coverage are far murkier.
Topic:
Government, Health, Human Welfare, and Markets
Political Geography:
United States and America

12. Yes, Mr. President: A Free Market Can Fix Health Care

Author:
Michael F. Cannon
Publication Date:
10-2009
Content Type:
Working Paper
Institution:
The Cato Institute
Abstract:
In March 2009, President Barack Obama said, “If there is a way of getting this done where we're driving down costs and people are getting health insurance at an affordable rate, and have choice of doctor, have flexibility in terms of their plans, and we could do that entirely through the market, I'd be happy to do it that way.” This paper explains how letting workers control their health care dollars and tearing down regulatory barriers to competition would control costs, expand choice, improve health care quality, and make health coverage more secure.
Topic:
Economics, Health, and Markets
Political Geography:
United States

13. Bending the Productivity Curve: Why America Leads the World in Medical Innovation

Author:
Glen Whitman and Raymond Raad
Publication Date:
11-2009
Content Type:
Working Paper
Institution:
The Cato Institute
Abstract:
The health care issues commonly considered most important today — controlling costs and covering the uninsured — arguably should be regarded as secondary to innovation, inasmuch as a medical treatment must first be invented before its costs can be reduced and its use extended to everyone. To date, however, none of the most influential international comparisons have examined the contributions of various countries to the many advances that have improved the productivity of medicine over time. We hope this paper can help fill that void.
Topic:
Health, Human Welfare, and Markets
Political Geography:
America

14. The Grass Is Not Always Greener: A Look at National Health Care Systems Around the World

Author:
Michael Tanner
Publication Date:
03-2008
Content Type:
Working Paper
Institution:
The Cato Institute
Abstract:
Critics of the U.S. health care system frequently point to other countries as models for reform. They point out that many countries spend far less on health care than the United States yet seem to enjoy better health outcomes. The United States should follow the lead of those countries, the critics say, and adopt a government- run, national health care system.
Topic:
Government and Health
Political Geography:
United States and Europe

15. Organ Sales and Moral Travails: Lessons from the Living Kidney Vendor Program in Iran

Author:
Benjamin E. Hippen
Publication Date:
03-2008
Content Type:
Working Paper
Institution:
The Cato Institute
Abstract:
Kidney transplantation in the United States is burdened by a terrible policy failure. The cost of this failure will be paid in the currency of years of human lives unnecessarily lost, as well as a massive increase in federal expenditures over the next decade and beyond. The number of patients with end-stage renal disease (ESRD) in the United States has grown, but the supply of kidneys—for the preferred treatment for ESRD, kidney transplantation— has not kept pace with the demand. Unfortunately, the issue is not simply one of supply and demand: in the United States the supply of kidneys for transplantation is kept artificially low by a prohibition on the sale of human organs.
Topic:
Health, Human Welfare, and Markets
Political Geography:
United States, Iran, and Middle East

16. Medical Licensing: An Obstacle to Affordable, Quality Care

Author:
Shirley Svorny
Publication Date:
09-2008
Content Type:
Working Paper
Institution:
The Cato Institute
Abstract:
In the United States, the authority to regulate medical professionals lies with the states. To practice within a state, clinicians must obtain a license from that state's government. State statutes dictate standards for licensing and disciplining medical professionals. They also list tasks clinicians are allowed to perform. One view is that state licensing of medical professionals assures quality. In contrast, I argue here that licensure not only fails to protect consumers from incompetent physicians, but, by raising barriers to entry, makes health care more expensive and less accessible. Institutional oversight and a sophisticated network of private accrediting and certification organizations, all motivated by the need to protect reputations and avoid legal liability, offer whatever consumer protections exist today. Consumers would benefit were states to eliminate professional licensing in medicine and leave education, credentialing, and scope-of-practice decisions entirely to the private sector and the courts. If eliminating licensing is politically infeasible, some preliminary steps might be generally acceptable. States could increase workforce mobility by recognizing licenses issued by other states. For mid-level clinicians, eliminating education requirements beyond an initial degree would allow employers and consumers to select the appropriate level of expertise. At the very least, state legislators should be alert to the self-interest of medical professional organizations that may lie behind the licensing proposals brought to the legislature for approval.
Topic:
Government and Health
Political Geography:
United States