y Is informality bad for business? By webfeeds.brookings.edu Published On :: Fri, 11 Oct 2019 20:14:54 +0000 Formal businesses in developing countries often complain about unfair competition from their peers in the informal sector. Their complaints are often well-founded: Growing formal companies must go through the hurdles of paying taxes and fees, waiting in line for permits, and even facing greater scrutiny from government agencies. Informal businesses, on the other hand, use minimal,… Full Article
y Detoxifying Colombia’s drug policy By webfeeds.brookings.edu Published On :: Mon, 06 Jan 2020 18:01:24 +0000 Colombia’s counternarcotics policy choices have profound impact on consolidating peace in the wake of the 2016 peace deal with the Revolutionary Armed Forces of Colombia — People’s Army (Fuerzas Armadas Revolucionarias de Colombia — Ejército del Pueblo, FARC) and on the building of an effective state. Strategies of forced or voluntary eradication of coca crops… Full Article
y 10 facts about Social Security and retirement saving By webfeeds.brookings.edu Published On :: Fri, 13 Nov 2015 15:27:00 -0500 “Social security is not going broke,” said Carolyn Colvin, acting commissioner of the Social Security Administration, at a Brookings Retirement Security Project event this week. She was joined by Consumer Financial Protection Bureau Director Richard Cordray to discuss retirement planning and to unveil a new retirement calculator. “Social Security is the only guaranteed monthly income for a majority of older consumers,” Cordray said. After their keynote addresses, a panel of retirement security experts moderated by Guest Scholar Joshua Gotbaum discussed efforts to improve retirement planning and what knowledge the average American needs to make retirement planning achievable. Ted Gayer, VP and director of Economic Studies at Brookings, introduced the event. Here are 10 facts about Social Security and retirement planning mentioned during the event. Full video is available below and on the event’s page. 1/3 of U.S. households spend all of their available resources in every pay period 60 million people received Social Security benefits in September 2015 For the average worker, Social Security replaces only about 40 percent of pre-retirement earnings 45 million people are already 65 or order, and 10,000 people are turning 65 each day The average American now spends about 20 years in retirement (in 1950, the average was about 4 years) 4 in 10 Americans aged 51-59 are reaching retirement with limited or no savings, and are projected to face a saving shortfall ~2/3 of the 40 million Americans 65 and older who receive Social Security benefits depend on those benefits for ½ or more of their retirement income It’s about 70 percent or more of income for those 80 or older Only 60 percent of people who retire claim to have done any retirement planning at all Delaying claiming Social Security “buys” people 6-8 percent more real benefits per year once they do take it Olivia Mitchell, a professor at the Wharton School, University of Pennsylvania, explained this last point, noting that if a person stopped working at 62 but waited to claim benefits until 70, he or she would receive a benefit 76 percent higher in (real) dollars per month for life. “When to claim Social Security is many older Americans’ most important financial decision they will ever make in their lifetimes,” according to Mitchell. Learn more about the event here and watch the video: Helping America plan for retirement: Keynote remarks Video Helping America plan for retirement: Keynote remarks Authors Fred Dews Full Article
y Life expectancy and the Republican candidates' Social Security proposals By webfeeds.brookings.edu Published On :: Fri, 29 Jan 2016 12:00:00 -0500 In last Thursday’s GOP debate, Marco Rubio, Ted Cruz, Jeb Bush and Chris Christie managed to avoid mentioning their common proposal to “reform entitlements” by raising the Social Security retirement age from 67 to 70. That was probably a good idea. Their proposal only demonstrates their lack of understanding about the demographics of older Americans, especially the dramatic disparities in their life expectancy associated with education and race. Recent research on life expectancy indicates that their proposed change would effectively nullify Social Security for millions of Americans and sharply limit benefits for many millions more.. While many people in their 30s and 40s today can look forward to living into their 80s, the average life expectancy for the majority of Americans who do not hold a college degree hovers closer to 70, or the average life expectancy for all Americans in 1950. The Widening Inequalities in the Life Spans of Americans This research, summarized recently in a study published in Health Affairs, found that life expectancy for various age cohorts of Americans is closely associated with both educational achievement and race. For example, the average life expectancy for college-educated American men who were age 25 in 2008, or age 33 today, is 81.7 years for whites and 78.2 years for blacks. (Table 1, below) By contrast, the projected, average life span of high-school educated males, also age 25 in 2008 or 33 today, is 73.2 years for whites and 69.3 years for blacks. Women on average live longer than men; but similar disparities based on education and race are evident. The average life expectancy of women age 25 in 2008, or 33 years old today, was 79 years for whites and 75.4 years for blacks for those with a high school diploma, and 84.7 years for whites and 81.6 years for blacks with college degrees. Most disturbing, the average life expectancy of Americans age 25 in 2008 without a high school diploma is just 68.6 years for white men, 68.2 years for black men, 74.2 years for white women, and 74.9 years for black women. Surprisingly, the researchers found that Hispanics in this age group have the longest life expectancies, even though they also have the lowest average levels of education. Since these data are anomalous and may reflect sampling problems, we will focus mainly on the life-expectancy gaps between African American and white Americans. Tallying How Many People Are Adversely Affected Census data on the distribution by education of people age 25 to 34 in 2010 (ages 30 to 39 in 2015) provide a good estimate of how many Americans are adversely affected by these growing differences. Overall, 56.3 percent of all Americans currently in their 30s fall are high school graduates or left school without a high school diploma, educational groups with much lower average life expectancies. (Table 2, below) More precisely, 10.1 percent or almost 4.8 million Americans in their 30s today lack a high school diploma, and 46.2 percent or 18.9 million thirty-somethings have high school diplomas and no further degrees. All told, they account for 23,702,000 Americans in their 30s; and among older Americans, the numbers and percentages are even higher. Since race as well as education are major factors associated with differences in life expectancy, we turn next to education by race (Table 3, below). The totals differ modestly from Table 2, because Census data on education by race cover ages 30-39 in 2014, while Table 2 covers age 30-39 in 2015 (ages 25-34 in 2010). Among people in their 30s today, 45.4 percent of whites or 10,613,000 Americans have a high school degree or less – and their average life expectancy is 9.4 years less than whites in their 30s with a college or associate degree. Among people in their 30s todays, 64.4 percent of blacks or 3,436,000 Americans have a high school degree or less – and their life expectancy is 8.6 years less than blacks in their 30s with an B.A. or associate degree, and 11.6 years less than whites with a college or associate degree.. Among people in their 30s today, 75.6 percent of Hispanics or 6,243,000 Americans have a high school degree or less – and their life expectancy is 5.0 years less than Hispanics in their 30s with a college or associate degree. As a policy matter, these data tell us that across all communities—white, black, Hispanic—improvements in secondary education to prepare everyone for higher education, and lower-cost access to higher education, can add years to the lives of millions of Americans. Preserving Meaningful Access to Social Security Benefits The widening inequalities in average life expectancy associated with race and education have more direct policy implications for Social Security, because the number of years that people can claim its benefits depends on their life spans. The growing inequalities in life expectancy translate directly into growing disparities in the years people can claim Social Security benefits, based on their education and race. Assuming that Americans in their 30s today retire at age 67 (the age for full benefits for this age group), they can expect to claim retirement benefits, on average, ranging from 1.2 years to 19.3 years, based on their education and race. (Table 4, below) The most pressing issues of life expectancy and Social Security involve white males, black males, and black females without college degrees: Among Americans age 33 today, white and black men without high school diplomas and black males with high school degrees, on average, can expect to live long enough to collect benefits for less than three years. Similarly, white and black women without high school diplomas and black women with high school degrees, on average, can expect to collect benefits for less than eight years. Together, they account for 25.2 percent of whites and 64.4 percent of blacks in their 30s today. By contrast, male and female white college graduates age 33 today, on average, can expect to collect Social Security for between 14.7 and 17.7 years, respectively; and 33-year old black men and women with college degrees, on average, will claim benefits for 11.2 to 14.6 years, respectively. These findings dictate that proposals to raise the Social Security retirement age should be rejected as a matter of basic fairness. Among this year’s presidential hopefuls, as noted earlier, Ted Cruz, Marco Rubio, Jeb Bush and Chris Christie all have called for raising the retirement age to 70 years. Under this policy, black men in their 30s today without a college degree and white men now in their 30s without a high school diploma, on average, would not live long enough to collect any Social Security. The change would reduce the average number of years of Social Security for Americans in their 30s today, From 1.6 years to -1.4 years for white men with no high school diploma, From 1.2 years to -1.8 years for black men with no high school diploma, and From 2.3 years to – 0.7 years for black, male high-school graduates. Furthermore, among Americans in their 30s today, white and black women without a high school diploma, white male high school graduates, and black female high school graduates, would live long enough, on average, to collect Social Security for just 3.2 to 5.4 years. The GOP change reduce the average number of years of Social Security for Americans in their 30s today, From 6.2 years to 3.2 years for white, male high school graduates, From 7.2 years to 4.2 years for white women with no high school diploma, From 7.9 years to 4.9 years for black women with no high school diploma, and From 8.4 years to 5.4 years for black, female high-school graduates. All told, proposals to raise the retirement age to 70 years old would mean, based on the average life expectancy of Americans in their 30s today, that 25.2 percent of whites in their 30s and 64.4 percent of blacks of comparable age, after working for 35 years or more, would receive Social Security benefits for 5.4 years or less. Authors Robert Shapiro Image Source: © Jim Young / Reuters Full Article
y What growing life expectancy gaps mean for the promise of Social Security By webfeeds.brookings.edu Published On :: Fri, 12 Feb 2016 00:00:00 -0500 Full Article
y What America’s retirees really deserve By webfeeds.brookings.edu Published On :: Thu, 18 Feb 2016 12:11:00 -0500 Social Security faces a financial shortfall. If Congress does nothing about it, current projections indicate that benefits will be cut automatically by 21 percent in 2034. Congress could close the gap by raising revenues, lowering benefits, or doing some of both. If benefits seem generous, Congress is likely to lean toward benefit cuts more than revenue increases. If they seem stingy, then the reverse. Given the split between the two parties on whether to cut benefits or to raise them, evidence on the adequacy of benefits is central to this key policy debate. Those perceptions will help determine whether Social Security continues to provide basic retirement income for workers with comparatively low earnings histories and a foundation of retirement income for most others or it will become just a minimal safety-net backstop against extreme destitution? Down-in-the-weeds disagreements among analysts often seem too arcane for anyone other than specialists. But sometimes they are too important to ignore. A current debate about the adequacy of Social Security benefits is an example. The not-so-simple question is this: are Social Security benefits ‘generous’ or ‘stingy’? To answer this question, people long looked to the Office of the Social Security Actuary. For many years that office published estimates of something called the ‘replacement rate’—that is, how high are benefits paid to retirees and the disabled relative what they earned during their working years. A 2014 retiree with median earnings had average lifetime earnings of about $46,000. That worker qualified for a benefit at age 66 of about $19,000, a replacement rate of about 41%. Replacement rates vary with earnings. Dollar benefits rise with earnings, but they rise less than proportionately. As a result, replacement rates of low earners are higher than replacement rates of high earners. As you might suppose, there are many ways in which to compute such ‘replacement rates. Because of analytical disputes on which method is best, the Social Security trustees in 2014 decided to stop including replacement rate estimates in their annual reports. In December 2015, the Congressional Budget Office (CBO) offered what it considered a better measure of the generosity of Social Security. It estimated that replacement rates for middle income recipients were about 60%–dramatically higher than the 41% that the Social Security Trustees had estimated. The gap between the estimates of CBO and those of Social Security is even larger than it seems. To see why, one needs to recognize that to sustain living standards retirees on average need only about 75% to 80% as much income as they did when working. Retirees need less income because they are spared some work-related expenses, such as transportation to and from work. Those are only average of course; some need more, some less. If one believed the SSA actuaries, Social Security provides median earners barely more than half of what they need to be as well off as they were when working. Benefit cuts from that modest level would threaten the well-being for the majority of retirees who are entirely or mostly dependent on Social Security benefits—and especially for those with large medical expenses uncovered by Medicare. On the other hand, if one accepted CBO’s estimates, Social Security provids more than three-quarters of the retirement income target. Against that baseline, benefit cuts would still sting, but they would pose less of a threat, and not much of a threat at all for most retirees who have some income from private pensions or personal savings. When the CBO estimates came out, conservative commentators welcomed the findings and cited CBO’s well-established and well-earned reputation for objectivity. They correctly noted that many retirees have additional income from private pensions, 401ks, or other personal savings, and asserted that there was no general retirement income shortage. By inference, cutting benefits a bit to help close the long-term funding gap would be no big deal. Social Security advocates were put on the defensive, hard-pressed to challenge the estimates of the widely-respected Congressional Budget Office. But earlier this year, CBO acknowledged that it had made mistakes in its Decameter estimates and revised them. The new CBO estimate put the replacement rate for middle-level earners at around 42%, almost the same as the estimate of the Social Security actuaries, not the much higher level that had sent ripples through the policy community. One conservative analyst, Andrew Biggs, who had trumpeted the initial CBO finding in The Wall Street Journal, promptly and honorably retracted his article. Two aspects of this green-eyeshade kerfuffle stand out. The first is that policy debates often depend on obscure technical analyses that are, in turn, remarkably sensitive to ‘black-box’ methods to which few or no outsiders have ready access. The second is that CBO burnished its reputation for honesty by owning up to its own mistakes — in this case, a whopping overestimate of a key number. Such candor is all too rare; it merits notice and praise. But there is a broader lesson as well. Technical issues of comparable complexity surround numerous current political disputes. Is Bernie Sanders’ single-payer plan affordable? Will Marco Rubio’s tax plan cause deficits to balloon? To vote rationally, people must struggle to see through the rhetorical chaff that surrounds candidates’ favorite claims. There is, alas, no substitute for paying close attention to the data, even if they are ‘down in the weeds.’ Editor's note: This piece originally appeared in Fortune. Authors Henry J. Aaron Publication: Fortune Image Source: Ho New Full Article
y The rich-poor life expectancy gap By webfeeds.brookings.edu Published On :: Fri, 19 Feb 2016 10:41:00 -0500 Gary Burtless, a senior fellow in Economic Studies, explains new research on the growing longevity gap between high-income and low-income Americans, especially among the aged. “Life expectancy difference of low income workers, middle income workers, and high income workers has been increasing over time,” Burtless says. “For people born in 1920 their life expectancy was not as long typically as the life expectancy of people who were born in 1940. But those gains between those two birth years were very unequally distributed if we compare people with low mid-career earnings and people with high mid-career earnings.” Burtless also discusses retirement trends among the educated and non-educated, income inequality among different age groups, and how these trends affect early or late retirement rates. Also stay tuned for our regular economic update with David Wessel, who also looks at the new research and offers his thoughts on what it means for Social Security. Show Notes Later retirement, inequality and old age, and the growing gap in longevity between rich and poor Disparity in Life Spans of the Rich and the Poor Is Growing Subscribe to the Brookings Cafeteria on iTunes, listen on Stitcher, and send feedback email to BCP@Brookings.edu. Authors Gary BurtlessFred Dews Image Source: © Scott Morgan / Reuters Full Article
y The growing life-expectancy gap between rich and poor By webfeeds.brookings.edu Published On :: Mon, 22 Feb 2016 13:38:00 -0500 Researchers have long known that the rich live longer than the poor. Evidence now suggests that the life expectancy gap is increasing, at least here the United States, which raises troubling questions about the fairness of current efforts to protect Social Security. There's nothing particularly mysterious about the life expectancy gap. People in ill health, who are at risk of dying relatively young, face limits on the kind and amount of work they can do. By contrast, the rich can afford to live in better and safer neighborhoods, can eat more nutritious diets and can obtain access to first-rate healthcare. People who have higher incomes, moreover, tend to have more schooling, which means they may also have better information about the benefits of exercise and good diet. Although none of the above should come as a surprise, it's still disturbing that, just as income inequality is growing, so is life-span inequality. Over the last three decades, Americans with a high perch in the income distribution have enjoyed outsized gains. Using two large-scale surveys, my Brookings colleagues and I calculated the average mid-career earnings of each interviewed family; then we estimated the statistical relationship between respondents' age at death and their incomes when they were in their 40s. We found a startling spreading out of mortality differences between older people at the top and bottom of the income distribution. For example, we estimated that a woman who turned 50 in 1970 and whose mid-career income placed her in the bottom one-tenth of earners had a life expectancy of about 80.4. A woman born in the same year but with income in the top tenth of earners had a life expectancy of 84.1. The gap in life expectancy was about 3½ years. For women who reached age 50 two decades later, in 1990, we found no improvement at all in the life expectancy of low earners. Among women in the top tenth of earners, however, life expectancy rose 6.4 years, from 84.1 to 90.5. In those two decades, the gap in life expectancy between women in the bottom tenth and the top tenth of earners increased from a little over 3½ years to more than 10 years. Our findings for men were similar. The gap in life expectancy between men in the bottom tenth and top tenth of the income distribution increased from 5 years to 12 years over the same two decades. Rising longevity inequality has important implications for reforming Social Security. Currently, the program takes in too little money to pay for all benefits promised after 2030. A common proposal to eliminate the funding shortfall is to increase the full retirement age, currently 66. Increasing the age for full benefits by one year has the effect of lowering workers' monthly checks by 6% to 7.5%, depending on the age when a worker first claims a pension. For affluent workers, any benefit cut will be partially offset by gains in life expectancy. Additional years of life after age 65 increase the number years these workers collect pensions. Workers at the bottom of the wage distribution, however, are not living much longer, so the percentage cut in their lifetime pensions will be about the same as the percentage reduction in their monthly benefit check. Our results and other researchers' findings suggest that low-income workers have not shared in the improvements in life expectancy that have contributed to Social Security's funding problem. It therefore seems unfair to preserve Social Security by cutting future benefits across the board. Any reform in the program to keep it affordable should make special provision to protect the benefits of low-wage workers. Editor's note: This piece originally appeared in The Los Angeles Times. Authors Gary Burtless Publication: The Los Angeles Times Image Source: © Brian Snyder / Reuters Full Article
y Retirement planning isn’t really about how you invest By webfeeds.brookings.edu Published On :: Wed, 24 Feb 2016 10:44:00 -0500 Open any magazine aimed at the upper middle class and you’ll find lots of ads about retirement planning: financial firms fighting over which one will ‘advise’ you and get you to invest your money with them. But, for most people, that isn’t the most important part of retirement planning. In fact, most people don’t have significant retirement savings, so arguing about who or how to invest them is irrelevant. Their “financial planning” is more likely to be about whether and when to pay the credit card bill. So what kind of retirement planning really matters? There are lots of answers, but here are two of the most important: How long you work and when you apply for Social Security. For most people, these matter far more than whether your savings are invested in stocks or bonds. Working Longer Requires More than Wishful Thinking. One of the great blessings of modern medicine is that people are living longer. But one of the consequences of that blessing is that unless people work longer and/or save more while they’re working, they’re more likely to run out of money in retirement than ever before. (The decline of traditional pensions, which paid lifetime income benefits, hasn’t helped either.) Most folks know this and are responding. According to a recent survey, 65 percent of baby boomers expect to work past 65. But those expectations may not be met. Currently, about half of workers stop working before age 65: some are wealthy enough; more often they’re just not healthy enough. Flexible retirement is more slogan than fact. Moreover, the job market isn’t as flexible as some may hope. Yes, an increasing percentage of seniors are working at least occasionally (~35 percent of men over 60, ~25 percent of women), but that doesn’t mean they’re doing their dream job on their chosen schedule. Increasingly, most of those who do work past 65 work full-time. Twenty years ago about 60 percent of workers over the age of 65 worked part-time; today about 60 percent work full-time. It’s not clear why part-time work has declined, but one reason may be that employers still haven’t adjusted to the idea. A recent Transamerica Survey found that 66 percent of age 55+ US workers expect they will enter retirement flexibly -- but only 25 percent report that their employer offers the opportunity to move from full-time to part-time. However, the best way for employers to change is for their employees to ask (or have a union that does). Retirement planning involves more than wishful thinking. If you want a flexible or a phased retirement, you need to know what your options really are – and the time to find out is long before you’re on the verge of retirement. Defer Applying for Social Security? The other step that matters for most people is when they choose to apply for Social Security. Many apply as soon as they legally can do so, generally at age 62. For most people, that’s a mistake, because it means they will get reduced payments for the rest of their lives. Most others claim their Social Security benefits by the time they reach the “normal retirement age”, which for baby boomers is 66 years. (The normal retirement age is gradually being raised; for those born after 1959 it’s age 67.) For many people, that’s a mistake, too, because your lifetime benefit increases each year that you delay from 62 up to age 70. How much more will your Social Security be if you start taking it at 70 instead of claiming benefits at the earliest possible age? A lot. For baby boomers, waiting till 70 increases the annual benefit by about 8% or each year of delay. That means instead of taking an annual payment at 62 of $10,000 a year, waiting 8 years means your annual payment will rise to $17,600 – inflation indexed for life. (If you keep working after age 62, then the math can be even more compelling, because Social Security is based on your highest 35 years of earnings.) If you are married, delaying also increases payments to your spouse after you die. Of course, lots of folks have justifications for taking the lower payment at 62. Some say, “I won’t live long enough to make up the difference” – but in fact most people do live that long and many live longer. Others say, “I need the money to pay my bills.” But if you have savings or home equity, it’s worth using those first and taking Social Security later. So the next time someone approaches you about moving your 401k money over to them, consider the option they won’t tell you about: spending it first and deferring Social Security. After all, Social Security gives you a guaranteed 8% return for waiting – and an 8% guaranteed return is hard to beat. (But they probably won’t tell you that, either.) Editor's note: This piece originally appeared in Inside Sources. Authors Joshua Gotbaum Publication: Inside Sources Full Article
y How to fix the backlog of disability claims By webfeeds.brookings.edu Published On :: Tue, 01 Mar 2016 08:31:00 -0500 The American people deserve to have a federal government that is both responsive and effective. That simply isn’t the case for more than 1 million people who are awaiting the adjudication of their applications for disability benefits from the Social Security Administration. Washington can and must do better. This gridlock harms applicants either by depriving them of much-needed support or effectively barring them from work while their cases are resolved because having any significant earnings would immediately render them ineligible. This is unacceptable. Within the next month, the Government Accountability Office, the nonpartisan congressional watchdog, will launch a study on the issue. More policymakers should follow GAO’s lead. A solution to this problem is long overdue. Here’s how the government can do it. Congress does not need to look far for an example of how to reduce the SSA backlog. In 2013, the Veterans Administration cut its 600,000-case backlog by 84 percent and reduced waiting times by nearly two-thirds, all within two years. It’s an impressive result. Why have federal officials dealt aggressively and effectively with that backlog, but not the one at SSA? One obvious answer is that the American people and their representatives recognize a debt to those who served in the armed forces. Allowing veterans to languish while a sluggish bureaucracy dithers is unconscionable. Public and congressional outrage helped light a fire under the bureaucracy. Administrators improved services the old-fashioned way — more staff time. VA employees had to work at least 20 hours overtime per month. Things are a bit more complicated at SSA, unfortunately. Roughly three quarters of applicants for disability benefits have their cases decided within about nine months and, if denied, decide not to appeal. But those whose applications are denied are legally entitled to ask for a hearing before an administrative law judge — and that is where the real bottleneck begins. There are too few ALJs to hear the cases. Even in the best of times, maintaining an adequate cadre of ALJs is difficult because normal attrition means that SSA has to hire at least 100 ALJs a year to stay even. When unemployment increases, however, so does the number of applications for disability benefits. After exhausting unemployment benefits, people who believe they are impaired often turn to the disability programs. So, when the Great Recession hit, SSA knew it had to hire many more ALJs. It tried to do so, but SSA cannot act without the help of the Office of Personnel Management, which must provide lists of qualified candidates before agencies can hire them. SSA employs 85 percent of all ALJs and for several years has paid OPM approximately $2 million annually to administer the requisite tests and interviews to establish a register of qualified candidates. Nonetheless, OPM has persistently refused to employ legally trained people to vet ALJ candidates or to update registers. And when SSA sought to ramp up ALJ hiring to cope with the recession challenge, OPM was slow to respond. In 2009, for example, OPM promised to supply a new register containing names of ALJ candidates. Five years passed before it actually delivered the new list of names. For a time, the number of ALJs deciding cases actually fell. The situation got so bad that the president’s January 2015 budget created a work group headed by the Office of Management and Budget and the Administrative Conference of the United States to try to break the logjam. OPM promised a list for 2015, but insisted it could not change procedures. Not trusting OPM to mend its ways, Congress in October 2015 enacted legislation that explicitly required OPM to administer a new round of tests within the succeeding six months. These stopgap measures are inadequate to the challenge. Both applicants and taxpayers deserve prompt adjudication of the merits of claims. The million-person backlog and the two-year average waits are bad enough. Many applicants wait far longer. Meanwhile, they are strongly discouraged from working, as anything more than minimal earnings will cause their applications automatically to be denied. Throughout this waiting period, applicants have no means of self-support. Any skills applicants retain atrophy. The shortage of ALJs is not the only problem. The quality and consistency of adjudication by some ALJs has been called into question. For example, differences in approval rates are so large that differences among applicants cannot plausibly explain them. Some ALJs have processed so many cases that they could not possibly have applied proper standards. In recognition of both problems, SSA has increased oversight and beefed up training. The numbers have improved. But large and troubling variations in workloads and approval rates persist. For now, political polarization blocks agreement on whether and how to modify eligibility rules and improve incentives to encourage work by those able to work. But there is bipartisan agreement that dragging out the application process benefits no one. While completely eliminating hearing delays is impossible, adequate administrative funding and more, better trained hearing officers would help reduce them. Even if OPM’s past record were better than it is, OPM is now a beleaguered agency, struggling to cope with the fallout from a security breach that jeopardizes the security of the nation and the privacy of millions of current and past federal employees and federal contractors. Mending this breach and establishing new procedures will — and should — be OPM’s top priority. That’s why, for the sake of everyone concerned, responsibility for screening candidates for administrative law judge positions should be moved, at least temporarily, to another agency, such as the Administrative Conference of the United States. Shortening the period that applicants for disability benefits now spend waiting for a final answer is an achievable goal that can and should be addressed. Our nation’s disabled and its taxpayers deserve better. Editor's note: This piece originally appeared in Politico. Authors Henry J. AaronLanhee Chen Publication: Politico Full Article
y Let's put a retirement savings plan in every workplace By webfeeds.brookings.edu Published On :: Wed, 09 Mar 2016 09:43:00 -0500 Critics of the nation's retirement system regularly complain that the system is in crisis. Too many private companies fail to offer their employees a retirement plan. Many employees who are covered by a plan fail to make contributions to it. Those who do make contributions may contribute too little or invest their savings unwisely. The end result: Many of us will reach retirement age with miniscule pensions or too little savings to enjoy a comfortable old age. The argument that our retirement system has gaping holes is well founded. The notion that it faces an imminent "crisis" is nonsense. If the system currently faces a crisis, it has faced the same one for the past 40 years. While elderly Americans have seen their incomes and living standards improve in recent decades, the median working-age family has experienced little improvement in its real income. Nonelderly families that depend solely on the earnings of breadwinners who have below-average schooling saw a drop in their incomes. In recent research with Brookings colleagues, I tracked the real incomes of families headed by aged and nonaged Americans. In the 34 years ending in 2012, the median real income of working-age families climbed a little more than 2 percent (in other words, by less than one-tenth of a percentage point per year). The median real income of families headed by someone past 62 increased a little more than 40 percent. The numbers suggest our retirement system is doing a decent job improving the living standards of the aged. Unfortunately, the labor market is doing a much worse job boosting the living standards of middle-class wage earners. Critics of the retirement system might worry that it succeeds in protecting the incomes of the middle class elderly but fails to protect the incomes of the poor -- a concern not supported by the evidence. Income inequality has gone up among the elderly as it has among the nonelderly. But older low-income Americans have fared much better than low-income working-age adults. In the late 1950s, by far the highest poverty rate of any age group was that for people over 65. Even in the late 1980s, the elderly had a higher poverty rate than adults between 18-64. Since the middle of the last decade, however, the elderly have had the lowest poverty rate of any age group. People who warn us of a retirement "crisis" are nonetheless correct in pointing to sizeable holes in the current system. Too few companies, especially small ones, offer their workers a retirement plan. According to recent government estimates, only about half of workers in companies with fewer than 100 employees are offered a retirement plan. Offer rates are higher in bigger companies and in government agencies, but about 30 percent of all employees are not offered any pension or retirement savings plan where they work. When retirement plans are offered, however, workers are very likely to participate in them -- even if they must make a voluntary contribution out of their pretax wages. What is crucial for a retirement savings plan's success is automatic payroll withholding. Dollars that are withheld from workers' paychecks are harder for workers to spend on something other than retirement savings. A crucial improvement in our current system would be to require all employers to establish automatic payroll withholding for voluntary retirement savings in an IRA (individual retirement account). Companies that already offer a qualified pension or retirement savings plan should be exempt from any extra obligation. The harshest critics of the current retirement system would go much further than this. Many want to bring back traditional retirement plans that guaranteed workers a specific monthly pension linked to their job tenure, final pay, and age at retirement. The advantages of such a plan for workers are that their employer is typically responsible for funding the plan and for ensuring that pensions are paid, regardless of the ups and downs of financial markets. A big disadvantage is that the promised benefits are not worth much if the worker's career with a company is cut short, either because of a layoff or quitting. People who are nostalgic for old-fashioned pensions may be right that workers would prefer to be covered by such a plan, despite their disadvantages for short-tenure workers. I'm less persuaded that traditional pensions offer better protection to typical workers than modern 401(k)-type plans. Regardless of the pros and cons of the two kinds of plan, it is wildly unrealistic to think small employers or new employers will want to take on the risks and administrative burdens connected with an old-fashioned pension plan. All U.S. workers are covered by a traditional, defined-benefit pension: it's called Social Security. It has worked well over the past four decades in protecting and even lifting the incomes of the retired elderly. It may not work as well in the future if benefits are cut substantially to keep the program solvent. Boosting workplace retirement savings is a sensible way to insure future retirees will have adequate incomes, even if Social Security benefits have to be trimmed. An essential first step to boosting savings is to require companies to put a retirement savings plan in every workplace. Editor's note: This piece originally appeared in Real Clear Markets. Authors Gary Burtless Publication: Real Clear Markets Image Source: © Max Whittaker / Reuters Full Article
y What Trump and the rest get wrong about Social Security By webfeeds.brookings.edu Published On :: Tue, 15 Mar 2016 09:03:00 -0400 Ahead of Tuesday’s primary elections in Ohio, Florida and other states, the 2016 presidential candidates have been talking about the future of Social Security and its funding shortfalls. Over the next two decades, the money flowing into Social Security will be too little to pay for all promised benefits. The reserve fund will be exhausted soon after 2030, and the only money available to pay for benefits will be from taxes earmarked for the program. Unless Congress and the President change the law before the reserve is depleted, monthly benefits will have to be cut about 21%. Needless to say, office holders, who must face voters, are unlikely to allow such a cut. Before the Trust Fund is depleted, lawmakers will agree to some combination of revenue increase and future benefit reduction, eliminating the need for a sudden 21% pension cut. The question is: what combination of revenue increases and benefit cuts does each candidate favor? The candidate offering the most straightforward but least credible answer is Donald Trump. During the GOP presidential debate last week, he pledged to do everything within his power to leave Social Security “the way it is.” He says he can do this by making the nation rich again, by eliminating budget deficits, and by ridding government programs of waste, fraud, and abuse. In other words, he proposed to do nothing specifically to improve Social Security’s finances. Should Trump’s deal-making fail to make us rich again, he offered no back-up plan for funding benefits after 2034. The other three GOP candidates proposed to repair Social Security by cutting future pensions. No one in the debate, except U.S. Sen. Marco Rubio from Florida, mentioned a specific way to accomplish this. Rubio’s plan is to raise the age for full retirement benefits. For many years, the full retirement age was 65. In a reform passed in 1983, the retirement age was gradually raised to 66 for people nearing retirement today and to 67 for people born after 1960. Rubio proposes to raise the retirement age to 68 for people who are now in their mid-40s and to 70 for workers who are his children’s age (all currently under 18 years old). In his campaign literature, Rubio also proposes slowing the future rate of increase in monthly pensions for high-income seniors. However, by increasing the full retirement age, Rubio’s plan will cut monthly pensions for any worker who claims benefits at 62 years old. This is the earliest age at which workers can claim a reduced pension. Also, it is by far the most common age at which low-income seniors claim benefits. Recent research suggests that low-income workers have not shared the gains in life expectancy enjoyed by middle- and especially high-income workers, so Rubio’s proposed cut could seriously harm many low-income workers. Though he didn’t advertise it in the debate, Sen. Ted Cruz favors raising the normal retirement age and trimming the annual cost-of-living adjustment in Social Security. In the long run, the latter reform will disproportionately cut the monthly pensions of the longest-living seniors. Many people, including me, think this is a questionable plan, because the oldest retirees are also the most likely to have used up their non-Social-Security savings. Finally, Cruz favors allowing workers to fund personal-account pensions with part of their Social Security contributions. Although the details of his plan are murky, if it is designed like earlier GOP privatization plans, it will have the effect of depriving Social Security of needed future revenues, making the funding gap even bigger than it is today. The most revolutionary part of Cruz’s plan is his proposal to eliminate the payroll tax. For many decades, this has been the main source of Social Security revenue. Presumably, Cruz plans to fund pensions out of revenue from his proposed 10% flat tax and 16% value-added tax (VAT). This would represent a revolutionary change because up to now, Social Security has been largely financed out of its own dedicated revenue stream. By eliminating the independent funding stream, Cruz will sever the perceived link between workers’ contributions and the benefits they ultimately receive. Most observers agree with Franklin Roosevelt that the strong link between contributions and benefits is a vital source of the enduring popularity of the program. Social Security is an earned benefit for retirees rather than a welfare check. Gov. John Kasich does not propose to boost the retirement age, but he does suggest slowing the growth in future pensions by linking workers’ initial pensions to price changes instead of wage changes. He hints he will impose a means test in calculating pensions, reducing the monthly pensions payable to retirees who have high current incomes. Many students of Social Security think this a bad idea, because it can discourage workers from saving for retirement. All of the Republican candidates, except Trump, think Social Security’s salvation lies in lower benefit payouts. Nobody mentions higher contributions as part of the solution. In contrast, both Democratic candidates propose raising payroll or other taxes on workers who have incomes above the maximum earnings now subject to Social Security contributions. This reform enjoys broad support among voters, most of whom do not expect to pay higher taxes if the income limit on contributions is lifted. Sen. Bernie Sanders would immediately spend some of the extra revenue on benefit increases for current beneficiaries, but his proposed tax hike on high-income contributors would raise enough money to postpone the year of Trust Fund depletion by about 40 years. Hillary Clinton is less specific about the tax increases and benefit improvements she favors. Like Sanders, however, she would vigorously oppose benefit cuts. None of the candidates has given us a detailed plan to eliminate Social Security’s funding imbalance. At this stage, it’s not obvious such a plan would be helpful, since the legislative debate to overhaul Social Security won’t begin anytime soon. Sanders has provided the most details about his policy intentions, but his actual plan is unlikely to receive much Congressional support without a massive political realignment. Cruz’s proposal, which calls for eliminating the Social Security payroll tax, also seems far outside the range of the politically feasible. What we have learned from the GOP presidential debates so far is that Republican candidates, with the exception of Trump, favor balancing Social Security through future benefit cuts, possibly targeted on higher income workers, while Democratic candidates want to protect current benefit promises and will do so with tax hikes on high-income workers. There is no overlap in the two parties’ proposals, and this accounts for Washington’s failure to close Social Security’s funding gap. Editor’s note: This piece originally appeared in Fortune. Authors Gary Burtless Publication: Fortune Image Source: © Scott Morgan / Reuters Full Article
y It's time to end Social Security for the rich By webfeeds.brookings.edu Published On :: Tue, 05 Apr 2016 12:02:00 -0400 The long-term finances of Social Security are in bad shape. Its reserves are expected to run out in less than 20 years, and under current law that will force cuts in benefits. Some experts argue that the best way to get the system’s finances back in shape would be to raise the full retirement age above the scheduled 67. That would bolster the program’s finances in two ways. First, by increasing payroll tax revenues, because people would work longer. And second, by reducing the period each American would collect benefits. That approach might seem fair, since on average Americans are living longer. Life expectancy is more than 15 years higher than when Social Security began in 1937. But we are not all average. Lower-income Americans have not seen much increase in life expectancy, while more affluent people have. Thus raising the retirement age would cut total lifetime benefits proportionately more for those on the bottom rungs of the income ladder. But let’s think differently about Social Security. Right now, monthly checks are linked to a person’s earnings during their working years. So, better-paid workers get bigger checks. True, lower-paid workers pay much less in Social Security payroll taxes and usually get back much more than they paid in taxes – even counting in interest on their tax contributions. Upper-income workers typically get back a lot less than they paid in, despite larger checks. But low-wage workers still get smaller Social Security checks to try to meet their monthly needs in retirement. Many end up falling below the poverty line and have to apply for means-tested assistance from Supplementary Security Income (SSI), another part of the Social Security system. What if we were to recast regular Social Security as true insurance? Insurance is something that pays out only when things go wrong. If you don’t have a car crash, or your house doesn’t burn down, you don’t get your premiums back later in life. What you do get is protection and peace of mind. So imagine Social Security as insurance protection against being financially insecure in retirement. If it were that, it would be very different from today. For one thing, we would want the lowest-income retirees to get the largest regular check – assuming they had dutifully paid their payroll tax “premiums” when working – and also enough to keep them comfortably out of poverty without having to rely on SSI. Some retirees with a modest income from, say, an IRA, might still need a small Social Security “insurance payout” to maintain a reasonable standard of living. In a true insurance model like this, retired Americans with healthy income from assets would get no Social Security check at all, rather than getting the largest checks as they do today. If Social Security is seen as insurance against financial insecurity then Warren Buffet clearly doesn’t need a check. Nor do other older Americans for whom a monthly Social Security check is just a little bit more icing on an already rich cake. If we reformed Social Security to make it more like real insurance, we’d need to do it gradually so people could plan, with the changes only fully affecting workers who are perhaps in their early 40s today. There would be a significantly higher basic benefit check for the least well-off. For retired singles with retiree income over, say, $25,000 in today’s dollars, the check would be reduced according to income until for a retiree with, say, $100,000 in other income there would be no check at all. With this reform, regular Social Security would more efficiently protect the elderly against economic insecurity and from poverty without the stigma of applying for SSI “welfare.” And it would help put the program on a more secure footing. To be sure, some would say it’s not fair that many Americans would pay Social Security taxes and get nothing in return. But that misses the point that Social Security should be insurance. And what’s really not fair is that many today pay high payroll taxes for a check that doesn’t keep them out of poverty. Some other critics might argue that without checks for all, the coalition needed to preserve Social Security would unravel. I doubt that very much. Social Security has an iconic status in America and there is no public support for ending it. So let’s not allow Social Security’s deteriorating finances to make it a steadily worse deal for those who need it most. It’s time instead to look at a reform that refocuses its mission on insuring financial security for seniors. Editor's note: This piece originally appeared in Real Clear Markets. Authors Stuart M. Butler Publication: Real Clear Markets Image Source: © Fred Prouser / Reuters Full Article
y Recent Social Security blogs—some corrections By webfeeds.brookings.edu Published On :: Fri, 15 Apr 2016 12:00:00 -0400 Recently, Brookings has posted two articles commenting on proposals to raise the full retirement age for Social Security retirement benefits from 67 to 70. One revealed a fundamental misunderstanding of how the program actually works and what the effects of the policy change would be. The other proposes changes to the system that would subvert the fundamental purpose of the Social Security in the name of ‘reforming’ it. A number of Republican presidential candidates and others have proposed raising the full retirement age. In a recent blog, Robert Shapiro, a Democrat, opposed this move, a position I applaud. But he did so based on alleged effects the proposal would in fact not have, and misunderstanding about how the program actually works. In another blog, Stuart Butler, a conservative, noted correctly that increasing the full benefit age would ‘bolster the system’s finances,’ but misunderstood this proposal’s effects. He proposed instead to end Social Security as a universal pension based on past earnings and to replace it with income-related welfare for the elderly and disabled (which he calls insurance). Let’s start with the misunderstandings common to both authors and to many others. Each writes as if raising the ‘full retirement age’ from 67 to 70 would fall more heavily on those with comparatively low incomes and short life expectancies. In fact, raising the ‘full retirement age’ would cut Social Security Old-Age Insurance benefits by the same proportion for rich and poor alike, and for people whose life expectancies are long or short. To see why, one needs to understand how Social Security works and what ‘raising the full retirement age’ means. People may claim Social Security retirement benefits starting at age 62. If they wait, they get larger benefits—about 6-8 percent more for each year they delay claiming up to age 70. Those who don’t claim their benefits until age 70 qualify for benefits -- 77 percent higher than those with the same earnings history who claim at age 62. The increments approximately compensate the average person for waiting, so that the lifetime value of benefits is independent of the age at which they claim. Mechanically, the computation pivots on the benefit payable at the ‘full retirement age,’ now age 66, but set to increase to age 67 under current law. Raising the full retirement age still more, from 67 to 70, would mean that people age 70 would get the same benefit payable under current law at age 67. That is a benefit cut of 24 percent. Because the annual percentage adjustment for waiting to claim would be unchanged, people who claim benefits at any age, down to age 62, would also receive benefits reduced by 24 percent. In plain English, ‘raising the full benefit age from 67 to 70' is simply a 24 percent across-the-board cut in benefits for all new claimants, whatever their incomes and whatever their life-expectancies. Thus, Robert Shapiro mistakenly writes that boosting the full-benefit age would ‘effectively nullify Social Security for millions of Americans’ with comparatively low life expectancies. It wouldn’t. Anyone who wanted to claim benefits at age 62 still could. Their benefits would be reduced. But so would benefits of people who retire at older ages. Equally mistaken is Stuart Butler’s comment that increasing the full-benefit age from 67 to 70 would ‘cut total lifetime retirement benefits proportionately more for those on the bottom rungs of the income ladder.’ It wouldn’t. The cut would be proportionately the same for everyone, regardless of past earnings or life expectancy. Both Shapiro and Butler, along with many others including my other colleagues Barry Bosworth and Gary Burtless, have noted correctly that life expectancies of high earners have risen considerably, while those of low earners have risen little or not at all. As a result, the lifetime value of Social Security Old-Age Insurance benefits has grown more for high- than for low-earners. That development has been at least partly offset by trends in Social Security Disability Insurance, which goes disproportionately to those with comparatively low earnings and life expectancies and which has been growing far faster than Old-Age Insurance, the largest component of Social Security. But even if the lifetime value of all Social Security benefits has risen faster for high earners than for low earners, an across the board cut in benefits does nothing to offset that trend. In the name of lowering overall Social Security spending, it would cut benefits by the same proportion for those whose life expectancies have risen not at all because the life expectancy of others has risen. Such ‘evenhandeness’ calls to mind Anatole France’s comment that French law ‘in its majestic equality, ...forbids rich and poor alike to sleep under bridges, beg in streets, or steal loaves of bread.’ Faulty analyses, such as those of Shapiro and Butler, cannot conceal a genuine challenge to policy makers. Social Security does face a projected, long-term funding shortfall. Trends in life expectancies may well have made the system less progressive overall than it was in the past. What should be done? For starters, one needs to recognize that for those in successive age cohorts who retire at any given age, rising life expectancy does not lower, but rather increases their need for Social Security retirement benefits because whatever personal savings they may have accumulated gets stretched more thinly to cover more retirement years. For those who remain healthy, the best response to rising longevity may be to retire later. Later retirement means more time to save and fewer years to depend on savings. Here is where the wrong-headedness of Butler’s proposal, to phase down benefits for those with current incomes of $25,000 or more and eliminate them for those with incomes over $100,000, becomes apparent. The only source of income for full retirees is personal savings and, to an ever diminishing degree, employer-financed pensions. Converting Social Security from a program whose benefits are based on past earnings to one that is based on current income from savings would impose a tax-like penalty on such savings, just as would a direct tax on those savings. Conservatives and liberals alike should understand that taxing something is not the way to encourage it. Still, working longer by definition lowers retirement income needs. That is why some analysts have proposed raising the age at which retirement benefits may first be claimed from age 62 to some later age. But this proposal, like across-the-board benefit cuts, falls alike on those who can work longer without undue hardship and on those in physically demanding jobs they can no longer perform, those whose abilities are reduced, and those who have low life expectancies. This group includes not only blue-collar workers, but also many white-collar employees, as indicated by a recent study of the Boston College Retirement Center. If entitlement to Social Security retirement benefits is delayed, it is incumbent on policymakers to link that change to other ‘backstop’ policies that protect those for whom continued work poses a serious burden. It is also incumbent on private employers to design ways to make workplaces friendlier to an aging workforce. The challenge of adjusting Social Security in the face of unevenly distributed increases in longevity, growing income inequality, and the prospective shortfall in Social Security financing is real. The issues are difficult. But solutions are unlikely to emerge from confusion about the way Social Security operates and the actual effects of proposed changes to the program. And it will not be advanced by proposals that would bring to Social Security the failed Vietnam War strategy of destroying a village in order to save it. Authors Henry J. Aaron Image Source: © Sam Mircovich / Reuters Full Article
y Disability insurance: The Way Forward By webfeeds.brookings.edu Published On :: Wed, 27 Apr 2016 08:30:00 -0400 Editor’s note: The remarks below were delivered to the Committee for a Responsible Federal Budget on release of their report on the SSDI Solutions Initiative. I want to thank Marc Goldwein for inviting me to join you for today’s event. We all owe thanks to Jim McCrery and Earl Pomeroy for devoting themselves to the SSDI Solutions Initiative, to the staff of CFRB who backed them up, and most of all to the scholars and practitioners who wrote the many papers that comprise this effort. This is the sort of practical, problem-solving enterprise that this town needs more of. So, to all involved in this effort, ‘hats off’ and ‘please, don’t stop now.’ The challenge of improving how public policy helps people with disabilities seemed urgent last year. Depletion of the Social Security Disability Insurance trust loomed. Fears of exploding DI benefit rolls were widespread and intense. Congress has now taken steps that delay projected depletion until 2022. Meticulous work by Jeffrey Liebman suggests that Disability Insurance rolls have peaked and will start falling. The Technical Panel appointed by the Social Security Advisory Board, concurred in its 2015 report. With such ‘good’ news, it is all too easy to let attention drift to other seemingly more pressing items. But trust fund depletion and growing beneficiary rolls are not the most important reasons why policymakers should be focusing on these programs. The primary reason is that the design and administration of disability programs can be improved with benefit to taxpayers and to people with disabilities alike. And while 2022 seems a long time off, doing the research called for in the SSDI Solutions Initiative will take all of that time and more. So, it is time to get to work, not to relax. Before going any further, I must make a disclaimer. I was invited to talk here as chair of the Social Security Advisory Board. Everything I am going to say from now on will reflect only my personal views, not those of the other members or staff of the SSAB except where the Board has spoken as a group. The same disclaimer applies to the trustees, officers, and other staff of the Brookings Institution. Blame me, not them. Let me start with an analogy. We economists like indices. Years ago, the late Arthur Okun came up with an index to measure how much pain the economy was inflicting on people. It was a simple index, just the sum of inflation and the unemployment rate. Okun called it the ‘misery index.’ I suggest a ‘policy misery index’—a measure of the grief that a policy problem causes us. It is the sum of a problem’s importance and difficulty. Never mind that neither ‘importance’ nor ‘difficulty’ is quantifiable. Designing and administering interventions intended to improve the lives of people with disabilities has to be at or near the top of the policy misery index. Those who have worked on disability know what I mean. Programs for people with disabilities are hugely important and miserably hard to design and administer well. That would be true even if legislators were writing afresh on a blank legislative sheet. That they must cope with a deeply entrenched program about which analysts disagree and on which many people depend makes the problems many times more challenging. I’m going to run through some of the reasons why designing and administering benefits for people determined to be disabled is so difficult. Some may be obvious, even banal, to the highly informed group here today. And you will doubtless think of reasons I omit. First, the concept of disability, in the sense of a diminished capacity to work, has no clear meaning, the SSA definition of disability notwithstanding. We can define impairments. Some are so severe that work or, indeed, any other form of self-support seems impossible. But even among those with severe impairments, some people work for pay, and some don’t. That doesn’t mean that if someone with a given impairment works, everyone with that same impairment could work if they tried hard enough. It means that physical or mental impairments incompletely identify those for whom work is not a reasonable expectation. The possibility of work depends on the availability of jobs, of services to support work effort, and of a host of personal characteristics, including functional capacities, intelligence, and grit. That is not how the current disability determination process works. It considers the availability of jobs in the national, not the local, economy. It ignores the availability of work supports or accommodations by potential employers. Whatever eligibility criteria one may establish for benefits, some people who really can’t work, or can’t earn enough to support themselves, will be denied benefits. And some will be awarded benefits who could work. Good program design helps keep those numbers down. Good administration helps at least as much as, and maybe more than, program design. But there is no way to reduce the number of improper awards and improper denials to zero. Second, the causes of disability are many and varied. Again, this observation is obvious, almost banal. Genetic inheritance, accidents and injuries, wear and tear from hard physical labor, and normal aging all create different needs for assistance. These facts mean that people deemed unable to work have different needs. They constitute distinct interest groups, each seeking support, but not necessarily of the same kind. These groups sometimes compete with each other for always-limited resources. And that competition means that the politics of disability benefits are, shall we say, interesting. Third, the design of programs to help people deemed unable to work is important and difficult. Moral hazard is endemic. Providing needed support and services is an act of compassion and decency. The goal is to provide such support and services while preserving incentives to work and to controlling costs borne by taxpayers. But preserving work incentives is only part of the challenge. The capacity to work is continuous, not binary. Training and a wide and diverse range of services can help people perform activities of daily living and work. Because resources are scarce, policy makers and administrators have to sort out who should get those services. Should it be those who are neediest? Those who are most likely to recover full capacities? Triage is inescapable. It is technically difficult. And it is always ethically fraught. Designing disability benefit programs is hard. But administering them well is just as important and at least as difficult. These statements may also be obvious to those who here today. But recent legislation and administrative appropriations raise doubts about whether they are obvious to or accepted by some members of Congress. Let’s start with program design. We can all agree, I think, that incentives matter. If benefits ceased at the first dollar earned, few who come on the rolls would ever try to work. So, Congress, for many years, has allowed beneficiaries to earn any amount for a brief period and small amounts indefinitely without losing eligibility. Under current law, there is a benefit cliff. If—after a trial work period—beneficiaries earn even $1 more than what is called substantial gainful activity, $1,130 in 2016, their benefit checks stop. They retain eligibility for health coverage for a while even after they leave the rolls. And for an extended period they may regain cash and health benefits without delay if their earnings decline. Members of Congress have long been interested in whether a more gradual phase-out of benefits as earnings rise might encourage work. Various aspects of the current Disability Insurance program reflect Congress’s desire to encourage work. The so-called Benefit Offset National Demonstration—or BOND—was designed to test the impact on labor supply by DI beneficiaries of one formula—replacing the “cliff” with a gradual reduction in benefits: $1 of benefit last for each $2 of earnings above the Substantial Gainful Activity level. Alas, there were problems with that demonstration. It tested only one offset scenario – one starting point and one rate. So, there could be no way of knowing whether a 2-for-1 offset was the best way to encourage work. And then there was the uncomfortable fact that, at the time of the last evaluation, out of 79,440 study participants only 21 experienced the offset. So there was no way of telling much of anything, other than that few people had worked enough to experience the offset. Nor was the cause of non-response obvious. It is not clear how many demonstration participants even understood what was on offer. Unsurprisingly, members of Congress interested in promoting work among DI recipients asked SSA to revisit the issue. The 2015 DI legislation mandates a new demonstration, christened the Promoting Opportunity Demonstration, or POD. POD uses the same 2 for 1 offset rate that BOND did, but the offset starts at an earnings level at or below earnings of $810 a month in 2016—which is well below the earnings at which the BOND phase-out began. Unfortunately, as Kathleen Romig has pointed out in an excellent paper for the Center on Budget and Policy Priorities, this demonstration is unlikely to yield useful results. Only a very few atypical DI beneficiaries are likely to find it in their interest to participate in the demonstration, fewer even than in the BOND. That is because the POD offset begins at lower earnings than the BOND offset did. In addition, participants in POD sacrifice the right under current law that permits people receiving disability benefits to earn any amount for 9 months of working without losing any benefits. Furthermore, the 2015 law stipulated that no Disability Insurance beneficiary could be required to participate in the demonstration or, having agreed to participate, forced to remain in the demonstration. Thus, few people are likely to respond to the POD or to remain in it. There is a small group to whom POD will be very attractive—those few DI recipients who retain a lot of earning capacity. The POD will allow them to retain DI coverage until their earnings are quite high. For example, a person receiving a $2,000 monthly benefit—well above the average, to be sure, but well below the maximum—would remain eligible for some benefits until his or her annual earnings exceeded $57,700. I don’t know about you, but I doubt that Congress would favorably consider permanent law of this sort. Not only would those participating be a thin and quite unrepresentative sample of DI beneficiaries in general, or even of those with some earning capacity, but selection bias resulting from the opportunity to opt out at any time would destroy the external validity of any statistical results. Let me be clear. My comments on POD, the demonstration mandated in the 2015 legislation, are not meant to denigrate the need for, or the importance of, research on how to encourage work by DI recipients, especially those for whom financial independence is plausible. On the contrary, as I said at the outset, research is desperately needed on this issue, as well as many others. It is not yet too late to authorize a research design with a better chance of producing useful results. But it will be too late soon. Fielding demonstrations takes time: to solicit bids from contractors, for contractors to formulate bids, for government boards to select the best one, for contractors to enroll participants, for contractors to administer the demonstration, and for analysts to process the data generated by the demonstrations. That process will take all the time available between now and 2021 or 2022 when the DI trust fund will again demand attention. It will take a good deal more time than that to address the formidable and intriguing research agenda of SSDI Solutions Initiative. I should like to conclude with plugs for two initiatives to which the Social Security Advisory Board has been giving some attention. It takes too long for disability insurance applicants to have their cases decided. Perhaps the whole determination process should be redesigned. One of the CFRB papers proposes just that. But until that happens, it is vital to shorten the unconscionable delays separating initial denials and reconsideration from hearings before administrative law judges to which applicants are legally entitled. Procedural reforms in the hearing process might help. More ALJs surely will. The 2015 budget act requires the Office of Personnel Management to take steps that will help increase the number of ALJs hired. I believe that the new director, Beth Colbert, is committed to reforms. But it is very hard to change legal interpretations that have hampered hiring for years and the sluggish bureaucratic culture that fostered them. So, the jury is out on whether OPM can deliver. In a recent op-ed in Politico, Lanhee Chen, a Republican member of the SSAB, and I jointly endorsed urged Congress to be ready, if OPM fails to deliver on more and better lists of ALJ candidates and streamlined procedures for their appointment, to move the ALJ examination authority to another federal organization, such as the Administrative Conference of the United States. Lastly, there is a facet of income support policy that we on the SSAB all agree merits much more attention than it has received. Just last month, the SSAB released a paper entitled Representative Payees: A Call to Action. More than eight million beneficiaries have been deemed incapable of managing $77 billion in benefits that the Social Security Administration provided them in 2014. We believe that serious concern is warranted about all aspects of the representative payee program—how this infringement of personal autonomy is found to be necessary, how payees are selected, and how payee performance is monitored. Management of representative payees is a particular challenge for the Social Security Administration. Its primary job is to pay cash benefits in the right amount to the right person at the right time. SSA does that job at rock-bottom costs and with remarkable accuracy. It is handing rapidly rising workloads with budgets that have barely risen. SSA is neither designed nor staffed to provide social services. Yet determining the need for, selecting, and monitoring representative payees is a social service function. As the Baby Boom ages, the number of people needing help in administering cash benefits from the Social Security Administration—and from other agencies such as the Veterans Administration—will grow. So will the number needing help in making informed choices under Medicare and Medicaid. The SSAB is determined to look into this challenge and to make constructive suggestions. We are just beginning and invite others to join in studying what I have called “the most important problem the public has never heard of.” Living with disabilities today is markedly different from what it was in 1956 when the Disability Insurance program began. Yet, the DI program has changed little. Beneficiaries and taxpayers are pay heavily the failure of public policy to apply what has been learned over the past six decades about health, disability, function, and work. I hope that SSA and Congress will use well the time until it next must legislate on Disability Insurance. The DI rolls are stabilizing. The economy has grown steadily since the Great Recession. Congress has reinstated demonstration authority. With adequate funding for research and testing, the SSA can rebuild its research capability. Along with the external research community, it can identify what works and help Congress improve the DI program for beneficiaries and taxpayers alike. The SSDI Solutions Initiative is a fine roadmap. Authors Henry J. Aaron Publication: Committee for a Responsible Federal Budget Image Source: © Max Whittaker / Reuters Full Article
y The rising longevity gap between rich and poor Americans By webfeeds.brookings.edu Published On :: Tue, 03 May 2016 08:00:00 -0400 The past few months have seen a flurry of reports on discouraging trends in life expectancy among some of the nation’s struggling populations. Different researchers have emphasized different groups and have tracked longevity trends over different time spans, but all have documented conspicuous differences between trends among more advantaged Americans compared with those in worse circumstances. In a study published in April, Stanford economist Raj Chetty and his coauthors documented a striking rise in mortality rate differences between rich and poor. From 2001 to 2014, Americans who had incomes in the top 5 percent of the income distribution saw their life expectancy climb about 3 years. During the same 14-year span, people in the bottom 5 percent of the income distribution saw virtually no improvement at all. Using different sources of information about family income and mortality, my colleagues and I found similar trends in mortality when Americans were ranked by their Social-Security-covered earnings in the middle of their careers. Over the three decades covered by our data, we found sizeable differences between the life expectancy gains enjoyed by high- and low-income Americans. For 50-year old women in the top one-tenth of the income distribution, we found that women born in 1940 could expect to live almost 6.5 years longer than women in the same position in the income distribution who were born in 1920. For 50-year old women in the bottom one-tenth of the income distribution, we found no improvement at all in life expectancy. Longevity trends among low-income men were more encouraging: Men at the bottom saw a small improvement in their life expectancy. Still, the life-expectancy gap between low-income and high-income men increased just as fast as it did between low- and high-income women. One reason these studies should interest voters and policymakers is that they shed light on the fairness of programs that protect Americans’ living standards in old age. The new studies as well as some earlier ones show that mortality trends have tilted the returns that rich and poor contributors to Social Security can expect to obtain from their payroll tax contributions. If life expectancy were the same for rich and poor contributors, the lifetime benefits workers could expect to receive from their contributions would depend solely on the formula that determines a worker’s monthly pensions. Social Security’s monthly benefit formula has always been heavily tilted in favor of low-wage contributors. They receive monthly checks that are a high percentage of the monthly wages they earn during their careers. In contrast, workers who earn well above-average wages collect monthly pensions that are a much lower percentage of their average career earnings. The latest research findings suggest that growing mortality differences between rich and poor are partly or fully offsetting the redistributive tilt in Social Security’s benefit formula. Even though poorer workers still receive monthly pension checks that are a high percentage of their average career earnings, they can expect to receive benefits for a shorter period after they claim pensions compared with workers who earn higher wages. Because the gap between the life spans of rich and poor workers is increasing, affluent workers now enjoy a bigger advantage in the number of months they collect Social Security retirement benefits. This fact alone is enough to justify headlines about the growing life expectancy gap between rich and poor There is another reason to pay attention to the longevity trends. The past 35 years have provided ample evidence the income gap between America’s rich and poor has widened. To be sure, some of the most widely cited income series overstate the extent of widening and understate the improvement in income received by middle- and low-income families. Nonetheless, the most reliable statistics show that families at the top have enjoyed faster income gains than the gains enjoyed by families in the middle and at the bottom. Income disparities have gone up fastest among working-age people who depend on wages to pay their families’ bills. Retirees have been better protected against the income and wealth losses that have hurt the living standards of less educated workers. The recent finding that life expectancy among low-income Americans has failed to improve is a compelling reason to believe the trend toward wider inequality is having profound impacts on the distribution of well-being in addition to its direct effect on family income. Over the past century, we have become accustomed to seeing successive generations live longer than the generations that preceded them. This is not true every year, of course, nor is it always clear why the improvements in life expectancy have occurred. Still, it is reasonable to think that long-run improvements in average life spans have been linked to improvements in our income. With more money, we can afford more costly medical care, healthier diets, and better public health. Even Americans at the bottom of the income ladder have participated in these gains, as public health measures and broader access to health insurance permit them to benefit from improvements in knowledge. For the past three decades, however, improvements in average life spans at the bottom of the income distribution have been negligible. This finding suggests it is not just income that has grown starkly more unequal. Editor's note: This piece originally appeared in Real Clear Markets. Authors Gary Burtless Publication: Real Clear Markets Image Source: © Robert Galbraith / Reuters Full Article
y Stephen P. Cohen’s disciplinary contribution to political science By webfeeds.brookings.edu Published On :: Mon, 04 Nov 2019 16:47:14 +0000 There are people who influence you and there is the person who changes your life. For me, that person was Steve Cohen. From the first time I spoke with him on the phone in 1993 about a story I was writing for India Today (where I worked then), to my entry into the graduate program… Full Article
y Paying for education outcomes at scale in India By webfeeds.brookings.edu Published On :: Wed, 06 Nov 2019 12:28:37 +0000 India faces considerable education challenges: More than half of children are unable to read and understand a simple text by the age of 10, and disparities in learning levels persist between states and between the poorest and wealthiest children. But, with a flourishing social enterprise ecosystem and an appetite among NGOs and policymakers for testing… Full Article
y How do you measure happiness? Exploring the happiness curriculum in Delhi schools By webfeeds.brookings.edu Published On :: Wed, 13 Nov 2019 17:45:45 +0000 “Take a deep breath. Release. Take a deep breath. Release. Concentrate on the noises coming from the environment. What do you hear? Slowly, focus on your own breathing.” A grade 7 teacher at Rajkiya Pratibha Vikas Vidyalaya in Delhi, walks her students through a breathing exercise. After three minutes, she says, “When you are ready,… Full Article
y What Indian politicians, bureaucrats and military really think about each other By webfeeds.brookings.edu Published On :: Fri, 15 Nov 2019 06:58:11 +0000 Full Article
y How India should deal with Gotabaya’s Sri Lanka By webfeeds.brookings.edu Published On :: Tue, 19 Nov 2019 07:54:40 +0000 Full Article
y 20190722 NYT Zach Vertin By webfeeds.brookings.edu Published On :: Mon, 22 Jul 2019 19:15:34 +0000 Full Article
y Somalia’s path to stability By webfeeds.brookings.edu Published On :: Wed, 02 Oct 2019 16:10:24 +0000 Some years ago, a debate about the existence of poverty “traps” appeared to settle around the following tentative conclusion: poverty traps are rare and largely limited to remote or otherwise disadvantaged areas. The graph below takes the poorest 25 countries in 1960, and compares their per capita income in 1960 with that in 2016 (in… Full Article
y Africa in the news: Nagy visits Africa, locust outbreak threatens East Africa, and Burundi update By webfeeds.brookings.edu Published On :: Sat, 01 Feb 2020 12:30:12 +0000 Security and youth top agenda during US Assistant Secretary of State Nagy’s visit to Africa On January 15, U.S. Assistant Secretary of State for African Affairs Tibor Nagy headed to Africa for a six-nation tour that included stops in the Central African Republic, Ethiopia, Kenya, South Sudan, Sudan, and Somalia. Security was on the top of the agenda… Full Article
y The problem with militias in Somalia: Almost everyone wants them despite their dangers By webfeeds.brookings.edu Published On :: Introduction Militia groups have historically been a defining feature of Somalia’s conflict landscape, especially since the ongoing civil war began three decades ago. Communities create or join such groups as a primary response to conditions of insecurity, vulnerability and contestation. Somali powerbrokers, subfederal authorities, the national Government and external interveners have all turned to armed… Full Article
y Taiwan’s January 2020 elections: Prospects and implications for China and the United States By webfeeds.brookings.edu Published On :: EXECutive Summary Taiwan will hold its presidential and legislative elections on January 11, 2020. The incumbent president, Tsai Ing-wen of the Democratic Progressive Party (DPP), appears increasingly likely to prevail over her main challenger, Han Kuo-yu of the Kuomintang (KMT). In the legislative campaign, the DPP now has better than even odds to retain its… Full Article
y This US-China downturn may be difficult for Taiwan By webfeeds.brookings.edu Published On :: Mon, 24 Feb 2020 20:27:52 +0000 Many Taiwan policymakers hold the view that U.S.-China tensions create favorable conditions for closer U.S.-Taiwan relations. As the thinking goes, the less beholden Washington is to maintaining stable relations with Beijing, the more it will be willing to show support for its democratic friends in Taiwan. In the coming months, this proposition may be tested.… Full Article
y The South China Sea ruling and China’s grand strategy By webfeeds.brookings.edu Published On :: Wed, 13 Jul 2016 15:40:00 +0000 In the wake of the International Tribunal on the Law of the Sea's ruling this week, the question going forward is how China will respond. Will it double down on the aggressive and coercive activities of the past six years, behavior that has put most of its East Asian neighbors on guard? Will it continue to interpret the Law of the Sea in self-serving ways that very few countries accept? Or, might China recognize that its South China Sea strategy has been an utter failure and that its best response is to take a more restrained and neighborly approach? Full Article Uncategorized
y New York Times – Jul 14, 2016 By webfeeds.brookings.edu Published On :: Mon, 30 Nov -0001 00:00:00 +0000 Full Article
y U.S. South China Sea policy after the ruling: Opportunities and challenges By webfeeds.brookings.edu Published On :: Mon, 30 Nov -0001 00:00:00 +0000 In spite of the legal complexities of the South China Sea ruling, the verdict was widely seen as a victory of "right" over "might" and a boost for the rules-based international order that the United States has been championing. In reality, the ruling could also pose profound challenges for the future of U.S. South China Sea policy under the Obama administration and beyond. Full Article
y Taiwan must tread carefully on South China Sea ruling By webfeeds.brookings.edu Published On :: Mon, 30 Nov -0001 00:00:00 +0000 Taipei’s claims are similar to Beijing’s. How it responds to the tribunal’s decision could put it at odds with its U.S. ally. Full Article
y The day after: Enforcing The Hague verdict in the South China Sea By webfeeds.brookings.edu Published On :: Mon, 30 Nov -0001 00:00:00 +0000 The U.N. arbitral tribunal's decision was an unequivocal rebuke of China’s expansive maritime claims and increasingly assertive posturing in adjacent waters. But, as Richard Heydarian argues, despite the Philippines' landmark victory, what is at stake is no less than the future of the regional security architecture. Full Article
y The fight for geopolitical supremacy in the Asia-Pacific By webfeeds.brookings.edu Published On :: Mon, 01 Aug 2016 14:01:07 +0000 Full Article
y Expectations for the Pope’s visit to Myanmar By webfeeds.brookings.edu Published On :: Mon, 27 Nov 2017 21:27:26 +0000 Full Article
y 20171128 NYT Lynn Kuok By webfeeds.brookings.edu Published On :: Tue, 28 Nov 2017 21:24:57 +0000 Full Article
y On the ground in Myanmar: The Rohingya crisis and a clash of values By webfeeds.brookings.edu Published On :: Wed, 29 Nov 2017 19:42:46 +0000 During my visit to Myanmar in mid-November, the latest of many since 2010, I witnessed new layers of complexity in the historical and political forces contributing to the Rohingya crisis. While the plight of the Rohingya population has galvanized international opinion, it has reinforced nationalist sentiment within a large segment of the Myanmar population and… Full Article
y Why Pope Francis is visiting Myanmar By webfeeds.brookings.edu Published On :: Thu, 30 Nov 2017 16:01:01 +0000 Full Article
y The year in failed conflict prevention By webfeeds.brookings.edu Published On :: Thu, 14 Dec 2017 20:58:11 +0000 In his first address to the United Nations Security Council in January 2017, the new Secretary-General António Guterres stated: “We spend far more time and resources responding to crises rather than preventing them. People are paying too high a price.” He stressed that a “whole new approach” to conflict prevention is necessary. Indeed, the world… Full Article
y Myanmar economy grows despite refugee crisis By webfeeds.brookings.edu Published On :: Thu, 18 Jan 2018 15:42:01 +0000 For people in the West, Myanmar appears to be a mess. Yet, for many in Asia, it still beckons as a land of opportunity. Western media remain focused on the ethnic cleansing operation against the Muslim Rohingya community launched by the government's armed forces in the wake of sporadic attacks from late 2015 by a… Full Article
y Myanmar’s stable leadership change belies Aung San Suu Kyi’s growing political vulnerability By webfeeds.brookings.edu Published On :: Thu, 05 Apr 2018 18:47:12 +0000 Myanmar stands at a critical crossroads in its democratic transition. In late March, the Union Parliament elected former Speaker of the Lower House U Win Myint as the country’s new president. U Win Myint is a longtime member of the ruling National League for Democracy (NLD) and a trusted partner of State Counselor Aung San… Full Article
y Facebook can’t resolve conflicts in Myanmar and Sri Lanka on its own By webfeeds.brookings.edu Published On :: Wed, 27 Jun 2018 19:42:37 +0000 Facebook CEO Mark Zuckerberg has been caught up in a whirlwind in recent months, giving congressional testimony and public statements defending Facebook against allegations that it has been too lax in combating online hate speech and disinformation. International criticism has rightly brought attention to the urgent need to address Facebook’s role in stoking ethnic and… Full Article
y Reviving BIMSTEC and the Bay of Bengal Community By webfeeds.brookings.edu Published On :: Fri, 17 Aug 2018 08:41:01 +0000 Blog: Revival of BIMSTEC at the Kathmandu Summit? On August 30 and 31, Nepal will host the fourth BIMSTEC Summit in Kathmandu with Prime Minister Narendra Modi and other heads of government expected to attend the summit. Founded in 1997, the Bay of Bengal Initiative for Multi-Sectoral Technical and Economic Cooperation (BIMSTEC) includes Bangladesh, Bhutan, India,… Full Article
y Leveling the playing field between inherited income and income from work through an inheritance tax By webfeeds.brookings.edu Published On :: Tue, 28 Jan 2020 05:08:58 +0000 The Problem The core objectives of tax policymaking should be to raise revenue in an efficient and equitable manner. Current taxation of estates and gifts (and nontaxation of inheritances) fails to meet these goals, perpetuating high levels of economic inequality and impeding intergenerational mobility. The current system also provides an intense incentive to delay realization of capital gains… Full Article
y The economics of federal tax policy By webfeeds.brookings.edu Published On :: Tue, 28 Jan 2020 15:08:08 +0000 Abstract The federal government faces increasing revenue needs driven by the aging of the population and emerging challenges. But the United States collects less revenue than it typically has in the past and less revenue than other governments do today. In addition, how the government raises revenue—not just how much it raises—has critical implications for… Full Article
y How a VAT could tax the rich and pay for universal basic income By webfeeds.brookings.edu Published On :: Thu, 30 Jan 2020 15:42:26 +0000 The Congressional Budget Office just projected a series of $1 trillion budget deficits—as far as the eye can see. Narrowing that deficit will require not only spending reductions and economic growth but also new taxes. One solution that I’ve laid out in a new Hamilton Project paper, "Raising Revenue with a Progressive Value-Added Tax,” is… Full Article
y Larry Summers on progressive tax reform By webfeeds.brookings.edu Published On :: Fri, 31 Jan 2020 10:00:03 +0000 On this episode: the Iowa caucuses, tax reform, and meet a scholar who studies global poverty reduction. First, a Brookings expert answers a student’s question about why the Iowa caucuses are so important. This is part of the Policy 2020 Initiative at Brookings. If you have a question for an expert, send a audio file… Full Article
y Did the 2017 tax cut—the Tax Cuts and Jobs Act—pay for itself? By webfeeds.brookings.edu Published On :: Fri, 14 Feb 2020 21:35:00 +0000 The Vitals Before and after passage of the Tax Cuts and Jobs Act (TCJA), several prominent conservatives, including Republicans in the House and Senate, former Reagan economist Art Laffer, and members of the Trump administration, claimed that the act would either increase revenues or at least pay for itself. In principle, a tax cut could… Full Article
y Brookings Papers on Economic Activity, Spring 2020 Edition By webfeeds.brookings.edu Published On :: Thu, 19 Mar 2020 01:01:54 +0000 The Brookings Papers on Economic Activity (BPEA) is an academic journal published twice a year by the Economic Studies program at Brookings. Each edition of the journal includes five or six new papers on macroeconomic topics currently impacting public policy. Below you’ll find five new papers submitted to the Spring 2020 journal and presented at… Full Article
y Priorities for India’s health policy By webfeeds.brookings.edu Published On :: Tue, 26 Jan 2016 15:50:00 -0500 India’s health care sector is poised at a crossroads, and the direction taken now will be critical in determining its trajectory for years to come. In a recent Brookings India paper on the Indian government’s health care policy, we argue that it should prioritize expanding and effectively delivering those aspects of health that fall under the definition of “public goods’” for example, vaccination, health education, sanitation, public health, primary care and screening, family planning through empowering women, and reproductive and child health. Reuters/Adnan Abidi - Doctors look at the ultrasound scan of a patient at Janakpuri Super Speciality Hospital in New Delhi, January 19, 2015 These are all aspects of health with significant externalities and thus cannot be efficiently provided by markets. Large gains in the nation’s health, and particularly the health of the poorest and most marginalized, can be made with this limited focus. As just one estimate, a 2010 World Bank study showed that India lost 53.8 billion USD annually in premature mortality, lost productivity, health care provision and other losses due to inadequate sanitation. Not about the money: Reforming India’s management systems Importantly, these gains can come very cost effectively, as demonstrated by India’s neighbors Bangladesh and Sri Lanka, which spend less as a percentage of GDP on health than India, but have better outcomes. It is not an expansion in spending that is critical for improving health outcomes. Instead, India needs to set appropriate goals and reform the public health care sector’s governance and management systems so that it is able to deliver on those goals. Evidence gathered globally and within India suggests that without good governance, additional spending would be worth little. One potential model to adopt is to set up publicly owned corporations at the state level that can take over the existing state health infrastructure and health delivery operations, thus permitting greater flexibility in management than the government’s notoriously inefficient and hidebound administrative systems. India needs to set appropriate goals and reform the public health care sector’s governance and management systems so that they are able to deliver against those goals. Where secondary and tertiary care are concerned, we believe that the government’s role should be to provide a different public good—sensible and responsive regulation that allows a health care market to develop. The government’s regulatory mechanism will need to address issues of information asymmetry between doctors and patients, for which we recommend government action to supplement market solutions for doctor discovery and quality appraisal that are already springing up. Hospital accreditation, increased importance for patient safety standards and guidelines, standardized, and, in time, mandated, Electronic Medical Records are all measures that will go toward ameliorating market failures that arise from information asymmetry in health care. Increased focus on patient safety in medical curriculums will help, but providing regulation that balances the twin objectives of improving monitoring, reporting and prevention of adverse events while disincentivizing the events themselves will be a key challenge for regulators. Addressing the shortage of qualified medical professionals Human resource expansion in health care is an area where transparent and responsive government regulation on the supply side is a public good of fundamental importance. The paucity of qualified health workers in India is well documented. The distribution, too, is skewed – the public health system, particularly in rural areas, is very short of qualified personnel. As many as 18 percent of government Primary Health Centers (PHCs) were entirely without doctors, and many others faced shortages. One promising way forward is offered by Indian state Chhattisgarh’s experience with a 3 year long medical training course. While the course was shut down in a few years after opposition from doctors, its graduates were hired as Rural Medical Assistants (RMAs) in PHCs. A Public Health Foundation of India (PHFI) study in 2010 evaluated PHCs across the state, focusing on diseases and conditions that PHCs most need to treat. They found that PHCs run by RMAs were just as good as those run by regular MBBS doctors in terms of provider competence, prescription practices and patient and community satisfaction. Practitioners with training in traditional medicine can also be potentially mainstreamed into such roles. Such avenues toward overcoming the shortage of medical personnel in rural areas must be explored. As many as 18 percent of government Primary Health Centers (PHCs) were entirely without doctors, and many others faced shortages. Health care financing is another area where government can play a large role. Medical insurance has proved to be a poor model for financing health care. It faces several theoretical pitfalls and has been one of the major factors behind the expensive and unsustainable healthcare system in the U.S. One approach that circumvents the adverse selection and moral hazard issues of medical insurance is that of introducing Medical Savings Accounts (MSAs). MSAs can be encouraged by tax deductions that would apply if the accounts were used to pay for medical expenses, and equity concerns can be alleviated by direct payments for those that cannot pay for themselves. Reuters/Babu - Pharmacists dispense free medication, provided by the government, to patients at Rajiv Gandhi Government General Hospital, July 12, 2012 These methods can help us accomplish the task of building a health care system that places its principal public spending focus on making and keeping large swathes of our population healthy, and its principal regulatory focus on creating an efficient market for health care. Authors Shamika RaviRahul Ahluwalia Image Source: © Babu Babu / Reuters Full Article