Daniel W. Sacks

The New Stylized Facts About Income and Subjective Well-Being

Economists in recent decades have turned their attention to data that asks people how happy or satisfied they are with their lives. Much of the early research concluded that the role of income in determining well-being was limited, and that only income relative to others was related to well-being. In this paper, we review the evidence to assess the importance of absolute and relative income in determining well-being. Our research suggests that absolute income plays a major role in determining well-being and that national comparisons offer little evidence to support theories of relative income. We find that well-being rises with income, whether we compare people in a single country and year, whether we look across countries, or whether we look at economic growth for a given country. Through these comparisons we show that richer people report higher well-being than poorer people; that people in richer countries, on average, experience greater well-being than people in poorer countries; and that economic growth and growth in well-being are clearly related. Moreover, the data show no evidence for a satiation point above which income and well-being are no longer related.

Why Do HMOs Spend Less? Patient Selection, Physician Price Sensitivity, and Prices

Cost-control incentives have become an important part of the health insurance landscape in the United States. These incentives are the strongest in capitated managed care organizations, especially HMOs, because such organizations are paid a fixed amount regardless of the spending they generate. Using a sample of insurance claims from about 500 plans, I find that in HMOs, spending on anti-cholesterol drugs is 19% lower than in other insurance plans. This spending difference could reflect the strong cost-control incentives generated by capitation, but it could also reflect the selection of healthy, price-sensitive patients into HMOs, or it could simply reflect lower prices. To understand the difference, I estimate a model of physician prescribing and patient refill decisions. Patients in HMOs are nearly twice as sensitive to copays as are other patients, consistent with selection of healthy patients into HMOs. Even after adjusting for this selection, however, HMO physicians remain highly sensitive to drug procurement costs. This high sensitivity explains about a 20% of the spending difference; combined with lower prices, it explains about 25–55% of the difference. I find no evidence that these spending reductions result in fewer patient refills or the prescribing of less effective statins.

The Health Insurance Marketplaces

When can I obtain it? Open Enrollment for health insurance plans on the Marketplace will take place from October 1, 2013 until March 31, 2014, with plans taking effect in January 2014. For more information about Open Enrollment on the Marketplace, please refer to www.healthcare.gov. 1) Visit www.healthcare.gov to create an account. You will need to provide some basic information. Then you can choose a user name, password, and security questions for your protection.