CSED Working Paper No. 33: Physician Social Networks and Geographic Variation in Medical Care

Forty-two million Americans, or one in every eight, have student loans, and they owe a total of $1.6 trillion, the second largest pool of consumer credit after mortgages. According to the Federal Reserve, 20 percent of adult borrowers who borrowed for their own educations were behind on their payments in 2018. Of those who are…

Studies in this week’s Hutchins Roundup find that collecting payments from insurers is highly costly for health care providers, superstar firms account for less of productivity growth than previously thought, and more. Want to receive the Hutchins Roundup as an email? Sign up here to get it in your inbox every Thursday. Costly billing hassles…

In an extraordinary response to an extraordinary public health challenge, the U.S. government has forced much of the economy to shut down. We now face the challenge of deciding when and how to reopen it. This is both vital and complicated. Wait too long—maintain the lockdown until we have a vaccine, for instance—and we’ll have another Great Depression. Move too soon, and we…

The Hutchins Center Fiscal Impact Measure shows how much local, state, and federal tax and spending policy adds to or subtracts from overall economic growth, and provides a near-term forecast of fiscal policies’ effects on economic activity. Editor’s Note: Due to significant uncertainty about the effect of the COVID-19 pandemic on the outlook for GDP…

Studies in this week’s Hutchins Roundup find that consumer spending has fallen sharply because of COVID-19, salary history bans have increased women’s earnings relative to men’s, and more. Want to receive the Hutchins Roundup as an email? Sign up here to get it in your inbox every Thursday. Consumer spending falls sharply because of COVID-19…

The coronavirus crisis in the United States—and the associated business closures, event cancellations, and work-from-home policies—has triggered a deep economic downturn of uncertain duration. The Federal Reserve has stepped in with a broad array of actions to limit the economic damage from the pandemic, including up to $2.3 trillion in lending to support households, employers, financial…

The COVID-19 pandemic—in addition to posing a severe threat to public health—has disrupted the economy and financial markets, and prompted a strong desire among investors for safe and liquid securities. In that environment, one might expect U.S. Treasury securities to be the investment of choice, but for a while in March, the $18 trillion market…

The economic activity of the U.S. has plummeted in the wake of the coronavirus pandemic and unemployment has soared—largely the result of social distancing policies designed to slow the spread of the virus. The depth and speed of the decline will rival that of the Great Depression. But will the aftermath be as painful? Or…

The monthly jobs report—the unemployment rate from one survey and the change in employer payrolls from another survey—is one of the most closely watched economic indicators, particularly at a time of an economic crisis like today. Here’s a look at how these data are collected and how to interpret them during the COVID-19 pandemic. What…

Studies in this week’s Hutchins Roundup find that households with low liquidity are more likely to spend their stimulus checks, social skills predict group performance as well as IQ, and more. Want to receive the Hutchins Roundup as an email? Sign up here to get it in your inbox every Thursday. Households with low liquidity…

It is not news that, for all its promised benefits, artificial intelligence has a bias problem. Concerns regarding racial or gender bias in AI have arisen in applications as varied as hiring, policing, judicial sentencing, and financial services. If this extraordinary technology is going to reach its full potential, addressing bias will need to be…

Deepfakes are videos that have been constructed to make a person appear to say or do something that they never said or did. With artificial intelligence-based methods for creating deepfakes becoming increasingly sophisticated and accessible, deepfakes are raising a set of challenging policy, technology, and legal issues. Deepfakes can be used in ways that are…

There are significant potential benefits to using data-driven risk assessments in criminal sentencing. For example, risk assessments have rightly been endorsed as a mechanism to enable courts to reduce or waive prison sentences for offenders who are very unlikely to reoffend. Multiple states have recently enacted laws requiring the use of risk assessment instruments. And…

What happens when you mix easy access to increasingly sophisticated technology for producing deepfake videos, a high-stakes election, and a social media ecosystem built on maximizing views, likes, and shares? America is about to find out. As I explained in a TechTank post in February 2019, “deepfakes are videos that have been constructed to make…

Deepfakes are videos that make a person appear to say or do something they did not say or do, and they are coming to an election near you. With the 2020 election contests coming up, how can we guard ourselves against deep fakes and prevent them from changing the outcome of an election? To address…

Artificial intelligence (AI) is a transformative technology that will have a profound impact on manufacturing, robotics, transportation, agriculture, modeling and forecasting, education, cybersecurity, and many other applications. The positive benefits of AI are enormous. For example, AI-based systems can lead to improved safety by reducing the risks of injuries arising from human error. AI-based systems…

The world is experiencing extraordinary advances in artificial intelligence, with applications being deployed in finance, health care, education, e-commerce, criminal justice, and national defense, among other areas. As AI technology advances across industries and into everyday use around the world, important questions must be addressed regarding transparency, fairness, privacy, ethics, and human safety. What are…

Much has been written, and rightly so, about the potential that artificial intelligence (AI) can be used to create and promote misinformation. But there is a less well-recognized but equally important application for AI in helping to detect misinformation and limit its spread. This dual role will be particularly important in geopolitics, which is closely…

In 2019, an innocent man was jailed in New York City after the complaining witness showed police screenshots of harassing text messages and recordings of threatening voicemails that the man allegedly sent in violation of a protective order. The man’s Legal Aid Society defense attorney subpoenaed records from SpoofCard, a company that lets people send…

In 1968 Congress passed and President Lyndon B. Johnson then signed into law the Fair Housing Act (FHA), which prohibits housing-related discrimination on the basis of race, color, religion, sex, disability, familial status, and national origin. Administrative rulemaking and court cases in the decades since the FHA’s enactment have helped shape a framework that, for…

In the first installment of the Brookings-Tsinghua Center Policy Series, Nonresident Senior Fellow Tao Ran explores how China’s growth model since the mid-1990’s has led to a series of distortions in the country’s urban land use, housing price and migration patterns.The report further argues for a coordinated reform package in China’s land, household registration and…

After continuous confrontation between villagers and local officials for almost four months, the land grab in the fishing village of Wukan, in Guandong province, China, has now led to the death of one of the elected village leaders in police custody, and further escalated into a violent "mass incident" with tens of thousands of farmers…

On March 26 the Brookings-Tsinghua Center, a joint venture of Tsinghua University and the Brookings Institution, hosted a public forum exploring the challenges and opportunities that China will face in the next five years.In the first panel, speakers discussed the opportunities and challenges that China faces in its continued economic growth and social transformations. In…

After a peaceful power transition in the 18th Party Congress, the new leadership in China is again under the limelight. The world is watching how it tackles the many challenges facing the nation: rising inequality, worsening pollution, rampant corruption, restless society, to name just a few. Most policy analysts therefore, believe that the top priority…

Almost a year and a half after the Communist Party of China’s 18th Party Congress and one year into the term of the new government, China and the world are waiting for the new leadership’s plans to further transform China’s economy and to improve governance. What new reform measures should be the focus? Why are…

Douglas J. Elliott, fellow in Economic Studies at the Brookings Institution, delivered a public speech at Brookings-Tsinghua Center (BTC) on December 11, moderated by Tao Ran, nonresident senior fellow of the BTC. International Monetary Fund resident representative to Hong Kong Shaun Roache also joined as a guest commentator. The discussion was warmly received by students,…

中国的经济改革一直纠结于稳增长和去杠杆、调结构，那么当前宏观调控的方式是否具有可持续性？为何经济的杠杆率不断增加，而需要推动的结构调整却进展甚微？本文希望从当前中国政治经济结构的内在矛盾来对做出解释，并提出本轮要有效去杠杆和调结构所需满足的一系列政治条件。   “不刺激、去杠杆、调结构”的理念与现实 新一届政府的施政理念曾经被总结为“不刺激、去杠杆、调结构”，希望通过与“去杠杆”相配合的“调结构”的“活乱循环”。 但现实的情况，却是一旦经济开始出现了下行苗头，央行就会在各方的压力之下选择一次次放水，各部委也开始加速项目审批。多次“微刺激”累积成“中刺激”、“大刺激”，“去杠杆”反而变成了“加杠杆”，“调结构”所需的关键领域改革却难以实现有效的突破。 可以不夸张地说，从过去两年中国的宏观政策与改革实际进展来看，既有体制运行的逻辑要远远压过正确施政理念的逻辑，而原有利益格局的惯性更是远远强于政府去杠杆、调结构的力度。 甚至早在计划经济时期，中国“条块分割”体制中作为“块块”的地方政府就有不断“加杠杆”的冲动，而作为“条条”的各个中央部委，其天然职责就是作为中央政府代表相互配合来实现经济紧缩。无论是在1980年代，还是在1990年代，国务院相关部委的一个主要责任，就是在宏观紧缩期配合压产能和去杠杆。当然，与这个责任对应的是党中央对国务院在相当程度上的授权，才最终较为成功地完成了历次去杠杆的任务。 由于当前中国经济的杠杆率过高、房地产行业风险日益增大的情况下，如果用传统去杠杆的办法简单地去“收”，就很容易带来“死”的局面。如何在本轮去杠杆的过程中确保经济不出现硬着陆，已成为中国经济当前必须面对的重大挑战。 而当前体制下要实现去杠杆与调结构的目标，面临以下三方面的重大障碍：首先是产业垄断和资源控制方面的集权，尤其是央企的“尾大不掉”，已经成为当前宏观紧缩、产业结构转型与技术升级的重大障碍；其次是当前财政集权及其带来的支出刚性在未来财政收入下行的情况下很容易导致体制内、体制外不稳定；最后是经济管制上的中央集权，比如土地管理体制的集权，很容易在去杠杆过程中调控缺乏弹性，甚至带来经济的硬着陆，未来必须想办法通过渐进式的调整逐步走向更为分权与市场化的经济管理体制。 尤其需要强调的是，在本轮经济紧缩中，央企的尾大不掉和中央财政支出刚性潜在的巨大维稳风险，都是中国历次去杠杆中从来没有出现过的情况。因此，本轮去杠杆必须要采取针对性的策略，利用“双轨制”推动经济分权与更市场化的去杠杆。也只有如此，才能防止“一收就死”的系统性经济风险。   集权式去杠杆的负面效应 从中国宏观经济调控政策的历史经验看，去杠杆要在短期内真正奏效，必须在中央层面采取一系列的集权化措施，包括金融、财政和行政方面的集权。但这种去杠杆过程中的“中国特色”，也会带来多方面的负面效应。 首先，作为一个可置信的紧缩政策，“一刀切”式的压产能、砍泡沫虽有助于快速去杠杆，但也会带来非常高昂的经济代价，往往出现的结果是“孩子和洗澡水一起倒掉”，无效供给和有效供给都被压缩，调控的经济成本非常之大。 其次，中央的财政、行政集权本身可能与市场化改革之间出现巨大的矛盾。尽管各种集权的措施有助于在短期内紧缩宏观需求，但却不可避免地带来“活乱循环”的经济周期：往往是一收就死，之后只好再放，但再放又会再乱。 第三，集权化的紧缩政策也会与中央“调结构”这个政策目标本身产生尖锐矛盾。要实现有效的结构调整与产业技术升级，必须依靠市场的力量，而市场化又需要推动经济分权。只有市场化和经济分权才可以充分调动地方政府与企业的积极性，发挥后者的信息与激励优势去培育新增长点，并最终推动结构转型与技术创新。这样，集权化的紧缩政策就会不利于结构转型和产业升级。 一般而言，去杠杆的最关键措施是紧缩信贷政策，尤其是给那些不具备可持续性的企业和地方政府断奶。应该说，仅仅就信贷紧缩本身而言，并不一定就不利于向地方、企业与市场分权。但中国的情况却有所不同，主要表现在那些加了过高杠杆的实体，往往就是如国企、地方投融资平台这类存在严重预算软约束，不怕高息借贷、也没打算自己还钱的实体。因此，要有效去杠杆，中央政府就不得不采取一定的行政措施去压缩国企过剩产能，同时停掉地方政府大量的低回报基建项目。 在中国，如果不采取上述行政性措施，而只是推动紧缩的信贷政策，就会很快带来“钱荒”的问题。一旦“钱荒”出现，地方政府、国企、乃至银行本身就会倒逼央行继续提供更多的流动性。换句话说，由于“软预算约束”的存在，地方政府、国企能在金融市场上不惜代价去借钱，金融市场也因存在大量此类主体而出现严重的道德风险与逆向选择问题。在这种情况下，中央只靠信贷紧缩来推动去杠杆就必然难以成功。只要地方党、政领导、大型国企官员对信贷紧缩持反对态度，并在“钱荒”出现后逼迫央行放水，同时游说相关部委降低压产能的政策压力，那时各部委就很难顶得住压力。   中央的行政集权曾是去杠杆的支撑点 不妨回顾一下1990年代朱镕基总理主导的宏观紧缩政策。当时除央行大幅收缩银根之外，国家计委也必须硬性压缩各类基建项目，而负责各产业的其他部委则负责分头压缩相关产业的过剩产能，其中强势的国家经贸委也发挥了巨大作用。换句话说，只有在中央各部委集体行动的前提下，才能有效地实现去杠杆的目标。 显然，当前这一轮去杠杆也必须考虑各部委自身是否有激励去配合中央的行动。1990年代中后期的紧缩实际上伴随着中央财政、行政审批等多方面集权的措施，而这就给了国务院各部委相应的资源与政治权力，并成为各部委配合中央推动“紧缩”的强大激励。 需要指出，新中国历史上曾经出现过多次的宏观经济紧缩，而在不同历史阶段，中央集权的内涵也随时而变。例如，在1980年代的宏观紧缩中，中央虽然上收了投资审批权限，但并未大幅集中财税收入和国企管理权限。相比之下，1990年代紧缩期中央则推动了财政、金融、土地管理、国企管控等多方面集权。 更为不利的是，本轮去杠杆还面临着一些新出现的严峻挑战，首先，央企的“尾大不掉”让各个中央部委在压缩产能上力不从心；其次，中央财政的支出刚性增加了去杠杆的维稳风险；最后，中央集权与结构调整之间的矛盾比历史各个时期都更加突出。   央企“尾大不掉”是最近10多年新出现的问题 在中国现实政治与经济环境中，有效去杠杆必须给中央各部委足够的激励，尤其是赋予其相应的行政权力来推动他们形成集体行动。1990年代各行业主管部委压缩地方国企过剩产能的一个重要激励，就是为自己直接管理的央企来腾出市场空间。当然，那时候各个部委很难只是单方面压缩地方国企的产能。通常他们采用的策略是也要求央企产能有所压缩，但同时却利用自己掌握的资源去推动央企的设备改造与技术升级，从而降低产能压缩对央企的负面影响。1990年代推出的国企技改贴息政策就是此种类型的博弈。 但中央部委上述压产能的方式，势必与市场化、分权化的改革大方向背道而驰：一旦部委与央企集权导致经济活力不足后，经济又开始出现“一收就死”的情况，“一死再放”，陷入“活乱循环”的历史周期。 更为糟糕的，是1990年代紧缩期中央部委对央企的有意保护却带来了央企的经济实力与政治地位的不断上升，结果是“抓大放小”导致了央企的“尾大不掉”。而当央企的经济规模和政治地位不断提升后，各部委就基本丧失了对央企的有效管控权。 应该说，现在国资委等相关部委对央企的管控能力远远不能与1990年代的国家经贸委相比。结果是在目前这轮压缩过剩产能的行动中，央企本身就成为去杠杆的巨大障碍，各中央部委压缩地方产能的政治动力也不仅因进一步集权的空间不足而大幅下降，反而出现了地方与部委合谋扩产能的情况。 考察新中国的各个历史时期，宏观紧缩政策未必一定就带来国企管理的中央集权乃至央企的“尾大不掉”。虽然1958年大跃进后，中央进行宏观调控的同时也将大量的地方国企管辖权上收到中央部委手里，但在1980年代的紧缩期，中央并未大量上收国企。此外，虽然央企在1950-1960年代间在国有工业体系中占据了绝对优势，但当时央企的政治地位并不高，基本都归各部委直接管理。换句话说，光有经济地位， 央企也未必成为宏观紧缩的必然障碍。 实际上，央企的“尾大不掉”并变成宏观紧缩的障碍，主要还是最近10多年才开始出现的新现象，其根本原因，是此时央企已开始逐步摆脱了中央部委的管控。央企不仅在经济上，而且在政治地位上都有迅速提升，并成为本轮宏观紧缩一个前所未有的挑战。   财政集权带来的支出刚性与去杠杆也存在矛盾 在讨论财税改革时，我们提到1990年代分税制改革后中央加大了对地方的转移支付力度。在现行财政体制下，中央财政转移支付中完全授予地方政府自主支配权的资金（即所谓均衡性转移支付）占比仍然较低（大约20%）。转移支付主要是由地方没有自主权的部分构成，包括专项转移支付和指定用途的“一般性转移支付”（如增发工资补助）。 转移支付比重上升强化了地方政府的预算软约束，其中一个主要机制就是它削弱了部委控制地方支出膨胀的政治激励：为强化对地方对口部门的控制，各部委都会尽量争取扩大自己控制的专项支付。如此带来的结果，就是部委联合地方一起向财政部施压要求多给钱。与此同时，地方政府也可借机联合各部委去倒逼中央给地方财力补缺口。当中央部委与地方开始“共谋”后，就出现了转移支付资金规模越庞大，部委压缩地方投资规模的动力越弱的情况，加大了地方政府的预算软约束问题。 当然，上述转移支付模式未必就直接带来宏观经济过热。毕竟相对于政府的总体基建规模而言，这些由转移支付资金所支持的基建项目总量还不太大。但上述财政“共谋”机制还是会让地方和各个部委不断要求增加各类转移支付，而且一旦增加就难以砍掉，结果是中央财政的支出刚性不断上升，而这有进一步逼迫中央不得不继续去集中财力。当经济过热出现时，中央财政收入和支出都会快速增长，而各部委都有动力扩大刚性支出以固化本位利益。 于是，中央财政支出刚性本身成为了去杠杆的障碍：如果强行去杠杆带来了中央财政收入下滑，这种支出上刚性将会直接影响体制内、体制外的政治稳定。而中央为了保稳定必须再去加杠杆来刺激经济。 1950-60年代中国的财政体制也高度集权，但当时中央对地方基本没有转移支付，中央拿到的钱直接用于满足各个部委及其下属单位的支出。所以，即使当时中央财政高度集权，但其财政支出也主要是生产性的（国有单位基建投资大部分直接通过预算内支出），不会出现因转移支付下降带来地方财政困难后很容易引致的社会稳定问题。因此，计划经济时期经济紧缩伴随的支出压缩带来的社会风险要小得多。 在1970-80年代，财政体制一直都比较分权，但中央照样可以通过收缩信贷进行宏观调控。当时的宏观紧缩并不带来财政集权，正如1950-60年代的财政集权本身也并不阻碍经济紧缩政策的执行。而本轮去杠杆中央财政集权所导致的“吃饭刚性”及其所蕴含的维稳风险是过去从未遇到的挑战。 因此对转移支付体制的改革，就是希望由此降低中央财政的支出刚性，降低“吃饭财政”下压缩支出必然带来的“保稳定”压力，进而降低紧缩政策的政治阻力。   产业升级与财政集权之间的矛盾 …

The high cost of prescription drugs has become an increasingly pressing concern for policymakers, insurers, and families. New drugs—like those now available for hepatitis C— offer tremendous medical benefits, but at a cost that puts them out of reach for many patients. In an effort to address the affordability dilemma, the Louisiana Department of Health…

In this week’s episode, John Page, a senior fellow in the Global Economy and Development Program, assesses the potential role of several economic strategies in transforming Africa’s industrial development for the global economy. “Between now and about 2030, the estimates are that as many as 85 million jobs at [the] bottom end of manufacturing will…

Why is there so little industry in Africa? Over the past forty years, industry and business interests have moved increasingly from the developed to the developing world, yet Africa’s share of global manufacturing has fallen from about 3 percent in 1970 to less than 2 percent in 2014. Industry is important to low-income countries. It…

The 2016 Spring Meetings of the International Monetary Fund (IMF) and World Bank occur during uncertain times for the “African Growth Miracle.” After more than two decades of sustained economic expansion, growth in sub-Saharan Africa slowed to 3.4 percent in 2015, the weakest performance since 2009. The growth slow-down reflects lower commodity prices, declining growth…

Since 1995, Africa’s explosive economic growth has taken place without the changes in economic structure that normally occur as incomes per person rise. In particular, Africa’s experience with industrialization has been disappointing, especially as, historically, industry has been a driving force behind structural change. The East Asian “Miracle” is a manufacturing success story, but sub-Saharan…

At his swearing in, the new African Development Bank President Akinwumi Adesina set out an agenda for the economic transformation of the continent. Among the five pillars of that agenda—popularly known as the “high fives”—is one that may have surprised many, especially in the donor community: Industrialize Africa. Why the surprise? Beyond supporting improvements in…

Editor’s Note: On September 21, the Department of Commerce and Bloomberg Philanthropies are hosting the second U.S.-Africa Business Forum. Building on the forum in 2014, this year’s meeting again hosts heads of state, U.S. CEOs, and African business leaders, but aims to go beyond past commitments and towards effective implementation. This year’s forum will focus on six sectors important…

Although African countries enjoyed fast economic growth based on high commodity prices over the past decade, this growth has not translated into the economic transformation the continent needs to eradicate extreme poverty and enjoy economic prosperity. Now, more than ever, the necessity for Africa to industrialize is being stressed at various international forums, ranging from…

Against a background of protracted decline in global commodity prices and renewed focus on the Africa rising narrative, Africa is proving resilient, underpinned by strong economic performance in non-commodity exporting countries. The rise of African cities contains the potential for new engines for the continent’s structural transformation, if harnessed properly. However, the susceptibility of Africa’s…

1.1 What's the issue? Incomes in developed and developing countries have been converging, especially since the turn of the century, but the unevenness of that trajectory merits further examination. Beginning in the early the 2000s, the average per capita income of developing countries (adjusted for purchasing power parity) has increased substantially relative to the average…

Sunday, November 20 marked another United Nations “Africa Industrialization Day.” If anything, the level of attention to industrializing Africa coming from regional organizations, the multilateral development banks, and national governments has increased since the last one. This year, the new president of the African Development Bank flagged industrial development as one of his “high five”…

Finally, three months after its elections, Italy has produced a new creature in the political biosphere: a “populist but technocratic” government. What we will be watching is not really the result of a Frankenstein experiment, rather something closer to a genetically modified organism. Such a pairing is probably something unheard of in history: Into a…

Rather than Italy leaving the euro, it’s now that the euros are leaving Italy. In the recent weeks, after doubts emerged about the government’s will to remain in the European monetary union, Italians have transferred dozens of billions of euros across the borders.  Only a few days after the formation of the new government, the financial situation almost slid out of control. Italy’s liabilities with the euro-area (as tracked by…

Welcome to the second edition of the Trans-Atlantic Scorecard, a quarterly evaluation of U.S.-European relations produced by Brookings’s Center on the United States and Europe (CUSE), as part of the Brookings – Robert Bosch Foundation Transatlantic Initiative. To produce the Scorecard, we poll Brookings scholars and other experts on the present state of U.S. relations…

Welcome to the third edition of the Trans-Atlantic Scorecard, a quarterly evaluation of U.S.-European relations produced by Brookings’s Center on the United States and Europe (CUSE), as part of the Brookings – Robert Bosch Foundation Transatlantic Initiative. To produce the Scorecard, we poll Brookings scholars and other experts on the present state of U.S. relations…

Executive summary The doctrine of nationalism will continue eroding Europe’s integration until its hidden cause is recognized and addressed. In order to do so, Europe’s policymakers must acknowledge a new, powerful, and pervasive factor of social and political change: divergence within countries, sectors, jobs, or local communities. The popularity of the nationalist rhetoric should not…