Henry J. Aaron

Values and Public Policy

This work presents six essays that seek answers to some particular questions. What role can, or should, a democratic government play in shaping values? And, how do values shape the effects of public policy? The contributors identify trends and public policy tools through and by which some of these values might be changed.

Is Health Spending Excessive? If So, What Can We Do About It?

The case that the United States spends more than is optimal on health care is overwhelming. But identifying reasons for excessive spending is not the same as showing how to wring it out in ways that increase welfare. To lower spending without lowering net welfare, it is necessary to identify what procedures are effective at reasonable cost, to develop protocols that enable providers to identify in advance patients in whom expected benefits of treatment are lower than costs, to design incentives that encourage providers to act on those protocols, and to provide research support to maintain the flow of beneficial innovations.

Demographic Effects on the Equity of Social Security Benefits

This paper examines the impact on social security benefits and taxes of (a) differential mortality by race, income, education, sex, and marital status; (b) differing ages of entry into the labour force; and (c) different lifetime earnings profiles.

Extending Medicare Reimbursement in Clinical Trials

Thats it, a book to wait for in this month. Even you have wanted for long time for releasing this book extending medicare reimbursement in clinical trials; you may not be able to get in some stress. Should you go around and seek fro the book until you really get it? Are you sure? Are you that free? This condition will force you to always end up to get a book. But now, we are coming to give you excellent solution.

The Independent Payment Advisory Board — Congress's “Good Deed”

In establishing the Independent Payment Advisory Board (IPAB), Congress may have shown a rare willingness to abstain from meddling in matters it is poorly equipped to manage. It is too early to be sure, however, and the board must surmount major challenges.

Should Public Policy Seek To Control The Growth Of Health Care Spending

Debate about whether to restrain health care spending is intensifying. Much of the debate revolves around efficient research allocation. The possible impact of cost control on the advance of medical technology merits more attention. Public and private efforts to slow growth of health spending have not enjoyed much success. Most recently, managed care failed because administrators lacked political legitimacy. Politically established budget limits can hold down spending, but the United States seems unwilling to adopt them; even if it were, the technology to administer them rationally does not exist. In this situation, efforts to hold down cost growth carry grave risks.

Why Now Is Not the Time for Premium Support

The idea of a premium-support system for Medicare dates from 1995, but current proposals do not contain appropriate safeguards, and the circumstances of the U.S. health care system have changed in ways that would make the approach unwise today.

Three Cheers for Logrolling — The Demise of the SGR

Thanks to old-fashioned vote trading, Congress has finally scrapped the sustainable growth rate formula for calculating Medicares physician fees, replacing it with new but promising incentives that could catalyze increased efficiency and greater cost control.

Presidential address— Seeing through the fog

All public policies have two things in common. They deal with the future and, as a result, they are based on forecasts or projections. The forecasts or projections may be implicit or based on naive extrapolation or ad hoc assumptions. They may be explicit and based on elaborate extrapolations or on behavioral models. In either case, unfortunately, they are notoriously unreliable. In fact, they almost always are wrong-sometimes just a bit wrong, but often massively wrong. Nonetheless, forecasts are what distinguishes reasoned planning from blind action. Without forecasts, we would be totally at sea. That we have to use forecasts or projections, that we know they will be wrong, and that they usually are wrong raise some difficult questions for policy analysis and policymaking. Regrettably, in my view, they receive too little attention.2 My purpose today is to urge that they receive more. My comments are intended to make four points. First, it is important for policymakers to appreciate how errorprone forecasts and projections actually are. Second, it is important not to permit the availability of projections or forecasts to obscure fundamental policy questions that are important in any plausible scenario. Third, uncertainty means that, where possible, it is prudent to design policies with builtin flexibility that respond automatically to diverse possible outcomes. Fourth, where builtin flexibility is impossible, complete analyses should take into account the consequences if forecasts prove wrong, and weigh those consequences against the results of postponing action until information improves or against other policies under the plausible range of possible outcomes.

The Central Question for Health Policy in Deficit Reduction

Health policy debates will bulk large in deliberations of the super committee tasked with proposing deficit reductions. But the importance of specific spending cuts for overall health policy pales beside that of whether a deficit-reduction plan includes tax increases.