Author: Don Taylor

Don Taylor is an Associate Professor of Public Policy at Duke University, where his teaching and research focuses on health policy, with a focus on Medicare generally, and on hospice and palliative care, specifically. He increasingly works at the intersection of health policy and the federal budget. Past research topics have included health workforce and the economics of smoking. He began blogging in June 2009 and wrote columns on health reform for the Raleigh, (N.C.) News and Observer. He blogged at The Incidental Economist from March 2011 to March 2012. He is the author of a book, Balancing the Budget is a Progressive Priority that will be published by Springer in May 2012.

Why I Voted Against North Carolina Amendment One

(cross posted at freeforall)

I voted against North Carolina’s Amendment One last week during early voting, and did so for the following basic reasons:

I think amendments to a state Constitution should be undertaken sparingly, and believe further that they should secure rights for persons and not limit them.
Because N.C. already has a law that bans same-sex marriage, I consider Amendment One to be mean spirited, piling on, and an attempt to introduce yet another wedge issue into the campaign.
Amendment One is broadly written, and its passage would likely do more than limit marriage options. For example, it could invalidate certain domestic partner unions that enable persons to get health insurance, etc. Duke University has been a leader in providing such benefits for its employees, and has taken a stand against the Amendment. The passage of Amendment One would likely have unintended consequences beyond the stated goal of proponents-to ban gay marriage-a goal that is already secured by state law as I noted (there are dueling commercials in the State saying this point is either true, or false).

I voted against the amendment for all these reasons.

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Health reform and the election

Greg Sargent noting that in spite of the Affordable Care Act not being overly popular as a whole, focus on health reform during the election could be helpful to the President.

I would agree and go even a bit further, and say that avoiding health reform discussion since passage of the law has enabled Republicans to get away with only being clear about what they are against, and let them off the hook from offering a coherent alternative. The more discussion about health reform during the election the better. If Republicans move toward a plan that attempts to substantially address coverage, cost and quality, it will start to look an awful lot like what they have been against. If they don’t offer a comprehensive plan, then they will have no answer to one of the key issues facing our country.

The Affordable Care Act was a good step because it was a step; we desperately need to take the next one and find some set of health reform policies that we will actually TRY. It will take both sides to do this, and an important step is to smoke Republicans out on what they are really for (if anything). This is a time where the Rove playbook-go on offense around a presumed weakness-should be co-opted by the President, both for policy and political reasons.

Medicare’s funding future: income v. payroll taxes

(cross posted at freeforall)

The 2012 Medicare Trustees report is out (h/t @sarahkliff), and one graph jumped out at me: the historical and projected financing components of Medicare (payroll taxes, income taxes, premiums, and the much smaller items of taxes on benefits for higher income persons and state contributions for Part D).

Historically, payroll taxes have been the primary funding mechanism, but the further in the future we go, income taxes become increasingly important (general revenue transfers) for financing Medicare. As the report says on p. 25

The Trustees expect growth in SMI Part B and Part D premiums and general fund transfers to continue to outpace GDP growth and HI payroll tax growth in the future. This phenomenon occurs primarily because, under current law, SMI revenue increases at the same rate as expenditures, whereas HI revenue does not. Accordingly, as the HI sources of revenue become increasingly inadequate to cover HI costs, SMI revenues would represent a growing share of total Medicare revenues.

There are obviously many moving parts to such a projection, and there is great policy uncertainty about what we might do in the future. With that proviso I note two points:

Shifting more Medicare financing burden to income taxes is an increase in the use of a more progressive form of taxation (income taxes given current tax code) to fund Medicare
Payroll taxes and history of beneficiaries having paid payroll taxes have been a key part of the popularity of Medicare, and reinforced the (incorrect) notion that beneficiaries had pre-funded their Medicare costs (it is a pay as you go system). If income taxes are used to pay a larger portion of Medicare in the future, it may help to end the perception that beneficiaries already paid for the cost of their care. This post shows that payroll taxes by beneficiaries do not cover the cost of their care; they weren’t designed to do so, but the perception lingers to powerful effect that makes addressing the cost side of the program very hard

The next bubble, college tuition edition

David Brooks makes several good points while asking the basic question of whether the cost of college is worth it. Money quote:

This is an unstable situation. At some point, parents are going to decide that $160,000 is too high a price if all you get is an empty credential and a fancy car-window sticker.

Of course, if you are pricing Duke University for little Johnny, you recognize $160,000 as a bargain (the cost of attendance for Duke is $59,343 for 2012-13; our expansive financial aid policies are contained in the link).

I think the practical definition of a bubble is people are rushing to desperately spend their money on something up until the moment where almost no one is willing (or able) to do so. You don’t really know it was a bubble until it pops, but you can likely get some hints. This chart from mymoneyblog may be a hint of sorts.

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The Blahous dust up

(cross posted at freeforall)

Jonathan Bernstein with a post decrying the poor job the WaPo Ombudsman did in describing the controversy around the piece put out last week by Charles Blahous that said the ACA will increase the deficit (contro to CBO’s longstanding estimates). I was with my family in a car heading South on I-95 reading about the unfolding controversy on twitter last week, and so I didn’t post on it. However, even now, it is mostly being described as a dust up over double counting (how can something help the deficit and Medicare). Jonathan Chait has a good piece debunking this claim, Kevin Drum has a nice illustration of why this is not a valid claim, and Josh Barro adds a bit more on how this interpretation undermines one of the conservative charges leveled against the President. This is an old argument, rehashed.

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The most important tax reform decision

(This is cross posted at Don Taylorâ€™s freeforall blog).

The most important tax reform decision is deciding to collect enough revenue to pay for the spending that the nation plans to undertake.

This basic decision is often lost in the discussion of other (important) issues: marginal rates, tax expenditures, the Buffet rule/fairness, changes in the mix of taxes used to collect revenue, impact on the economy, etc. There are many key decisions to be made if we are to transition toward a sustainable federal budget, but most fundamentally, we must decide what proportion of GDP will be redistributed via government expenditure, and then develop a tax code that can collect the amount of revenue necessary to pay for such spending.

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