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1. Disease Mix and How Economic Freedom Matters for Health Outcomes

Author:
Vincent Geloso, Kelly Hyde, and Ilia Murtazashvili
Publication Date:
03-2023
Content Type:
Working Paper
Institution:
The Cato Institute
Abstract:
We investigate the institutional foundations of public health. We argue that a key distinction in analysis of disease is between diseases of commerce (diseases associated with movement of people and with affluence) and diseases of poverty (primarily noncommunicable diseases that depend on wealth and income). We show that the mix of disease – the ratio of communicable diseases and those associated with longevity to diseases of poverty – increases in economically free countries. We argue that increasing burdens of diseases of commerce reflects the quality of institutions, as those diseases are better than living shorter, brutish lives where diseases of poverty claim many lives. This analysis also highlights an institutional trade‐​off: economically free institutions reduce certain types of disease while contributing to others.
Topic:
Health, Infectious Diseases, Economy, Institutions, and Public Health
Political Geography:
Global Focus

2. Trade Is Good for Your Health

Author:
James Bacchus
Publication Date:
06-2021
Content Type:
Policy Brief
Institution:
The Cato Institute
Abstract:
There is increasing need to free up medical trade to help end the COVID-19 pandemic and secure global health. Yet import tariffs, export restrictions, and other limitations on international trade in medicines and medical goods continue to confound the hopes for fulfilling this need. Indeed, added restrictions have been imposed on medical trade during the pandemic. Meanwhile, governments have accomplished little at the World Trade Organization (WTO) to help meet this need. Using trade to help fight the COVID-19 pandemic and to otherwise support global health must move to the top of the WTO agenda, with the aim of finalizing new rules to support trading for health care goods by the time of the next WTO ministerial conference in Geneva in late November 2021 — and ideally, sooner.
Topic:
Health, Trade, and COVID-19
Political Geography:
Global Focus

3. Fed Policy: Good Intentions, Risky Consequences

Author:
Charles I. Plosser
Publication Date:
10-2013
Content Type:
Journal Article
Journal:
The Cato Journal
Institution:
The Cato Institute
Abstract:
The last five years have been an extraordinary time for the global economy and monetary policymakers. The financial crisis and the severe global recession that followed have tested our resolve, our patience, and our economic theories. To restore the health of ailing financial markets and economies, central banks have driven shortterm interest rates to essentially zero, expanded their balance sheets to unprecedented levels, and engaged in market interventions that have blurred the lines between monetary policy and fiscal policy.
Topic:
Economics and Health

4. The Use of Public Assistance Benefits by Citizens and Non-citizen Immigrants in the United States

Author:
Leighton Ku and Brian Bruen
Publication Date:
02-2013
Content Type:
Working Paper
Institution:
The Cato Institute
Abstract:
Claims are sometimes made that immigrants use public benefits, such as Medicaid, the Supplemental Nutrition Assistance Program, or the Temporary Assistance for Needy Families programs, more often than those who are born in the United States. This report provides analyses, using the most recent data from the Census Bureau, that counter these claims. In reality, low-income non-citizen immigrants, including adults and children, are generally less likely to receive public benefits than those who are native-born. Moreover, when non-citizen immigrants receive benefits, the value of benefits they receive is usually lower than the value of benefits received by those born in the United States. The combination of lower average utilization and smaller average benefits indicates that the overall cost of public benefits is substantially less for low-income non-citizen immigrants than for comparable native-born adults and children. The report also explains that the lower use of public benefits by non-citizen immigrants is not surprising, since federal rules restrict immigrants' eligibility for these public benefit programs.
Topic:
Economics, Health, Humanitarian Aid, Markets, and Immigration
Political Geography:
United States

5. Fiscal and Generational Imbalances and Generational Accounts: A 2012 Update

Author:
Jagadeesh Gokhale
Publication Date:
11-2012
Content Type:
Working Paper
Institution:
The Cato Institute
Abstract:
Official federal budget accounts are constructed exclusively in terms of current cash flows – receipts from taxes and fees and outlays on purchases and transfers. But cash-flows do not reveal economically relevant information about who benefits and who loses from government policies. Cash flows also do not reveal how changes in government's policies redistribute resources within and across generations, including reducing the tax burden on today's generations and increasing it on future ones. Because most government transact ions are targeted by age and gender, the federal government can bring about large resource transfers across generations. Intergenerational resource transfers will grow larger as the composition of budget receipts and expenditures changes with relatively faster growth of age-and-gender-related social insurance program. Intergenerational redistributions across generations through federal government operations could substantially affect different generations' economic expectations and choices and exert powerful long-term effects on economic outcomes.
Topic:
Economics, Government, Health, Human Welfare, Markets, and Monetary Policy
Political Geography:
United States

6. Estimating ObamaCare's Effect on State Medicaid Expenditure Growth

Author:
Jagadeesh Gokhale
Publication Date:
01-2011
Content Type:
Working Paper
Institution:
The Cato Institute
Abstract:
Unless repeal attempts succeed, the Patient Protection and Affordable Care Act of 2010 (ObamaCare) promises to increase state government obligations on account of Medicaid by expanding Medicaid eligibility and introducing an individual health insurance mandate for all US citizens and legal permanent residents. Once ObamaCare becomes fully effective in 2014, the cost of newly eligible Medicaid enrollees will be almost fully covered by the federal government through 2019, with federal financial support expected to be extended thereafter. But ObamaCare provides states with zero additional federal financial support for new enrollees among those eligible for Medicaid under the old laws. That makes increased state Medicaid costs from higher enrollments by "old-eligibles" virtually certain as they enroll into Medicaid to comply with the mandate to purchase health insurance. This study estimates and compares potential increases in Medicaid costs from ObamaCare for the five most populous states: California, Florida, Illinois, New York, and Texas.
Topic:
Government, Health, Markets, and Health Care Policy
Political Geography:
United States, New York, California, and Florida

7. Scientific Misconduct: The Manipulation of Evidence for Political Advocacy in Health Care and Climate Policy

Author:
George Avery
Publication Date:
02-2010
Content Type:
Policy Brief
Institution:
The Cato Institute
Abstract:
Science is increasingly being manipulated by those who try to use it to justify political choices based on their ethical preferences and who are willing to suppress evidence of conflict between those preferences and the underlying reality. This problem is clearly seen in two policy domains, health care and climate policy.
Topic:
Climate Change, Health, Politics, and Science and Technology

8. The Massachusetts Health Plan: Much Pain, Little Gain

Author:
Michael F. Cannon and Aaron Yelowitz
Publication Date:
01-2010
Content Type:
Working Paper
Institution:
The Cato Institute
Abstract:
In 2006, Massachusetts enacted a sweeping health insurance law that mirrors the legislation currently before Congress. After signing the measure, Gov. Mitt Romney (R) wrote, "Every uninsured citizen in Massachusetts will soon have affordable health insurance and the costs of health care will be reduced." But did the legislation achieve these goals? And what other effects has it had? This paper is the first to use Current Population Survey data for 2008 to evaluate the Massachusetts law, and the first to examine its effects on the accuracy of the CPS's uninsured estimates, self-reported health, the extent of "crowd-out" of private insurance for both children and adults, and in-migration of new Massachusetts residents.
Topic:
Government, Health, and Privatization
Political Geography:
United States

9. Obama's Prescription for Low-Wage Workers: High Implicit Taxes, Higher Premiums

Author:
Michael F. Cannon
Publication Date:
01-2010
Content Type:
Working Paper
Institution:
The Cato Institute
Abstract:
House and Senate Democrats have produced health care legislation whose mandates, subsidies, tax penalties, and health insurance regulations would penalize work and reward Americans who refuse to purchase health insurance. As a result, the legislation could trap many Americans in low-wage jobs and cause even higher health-insurance premiums, government spending, and taxes than are envisioned in the legislation.
Topic:
Government, Health, and Privatization
Political Geography:
United States and America

10. Reforming Medical Malpractice Liability through Contract

Author:
Michael F. Cannon
Publication Date:
11-2010
Content Type:
Working Paper
Institution:
The Cato Institute
Abstract:
This paper discusses the medical malpractice "crisis" and the potential of contract liability to reduce overall malpractice costs as well as improve the quality of and access to care. First, the paper describes the current medical malpractice liability "system" and some of the more common reforms offered. It then discusses the economic rationale of allowing patients and providers to agree in advance of treatment on how the patient will be compensated in the event of simple negligence on the part of providers, explaining how contract liability may offer improvements in the areas of costs, patient preferences, the pursuit of more efficient liability rules, and quality of care. The paper then critiques select objections to contract liability – those based on the superior bargaining power of providers, the lack of information available to patients, and possible reductions in quality – and forwards possible limitations on the right to contract that may allay such concerns.
Topic:
Health, Law, and Health Care Policy
Political Geography:
United States

11. Massachusetts Miracle or Massachusetts Miserable: What the Failure of the "Massachusetts Model" Tells Us about Health Care Reform

Author:
Michael Tanner
Publication Date:
06-2009
Content Type:
Policy Brief
Institution:
The Cato Institute
Abstract:
When Massachusetts passed its pioneering health care reforms in 2006, critics warned that they would result in a slow but steady spiral downward toward a government-run health care system. Three years later, those predictions appear to be coming true: Although the state has reduced the number of residents without health insurance, 200,000people remain uninsured. Moreover, the increase in the number of insured is primarily due to the state's generous subsidies, not the celebrated individual mandate. Health care costs continue to rise much faster than the national average. Since 2006, total state health care spending has increased by28 percent. Insurance premiums have increased by 8–10 percent per year, nearly double the national average. New regulations and bureaucracy are limiting consumer choice and adding to healthcare costs. Program costs have skyrocketed. Despite tax increases, the program faces huge deficits. The state is considering caps on insurance premiums, cuts in reimbursements to providers, and even the possibility of a “global budget” on health care spending—with its attendant rationing. A shortage of providers, combined with increased demand, is increasing waiting times to see a physician. With the “Massachusetts model” frequently cited as a blueprint for health care reform, it is important to recognize that giving the government greater control over our health care system will have grave consequences for taxpayers, providers, and health care consumers. That is the lesson of the Massachusetts model.
Topic:
Health, Human Welfare, Markets, and Governance
Political Geography:
United States

12. Halfway to Where? Answering the Key Questions of Health Care Reform

Author:
Michael Tanner
Publication Date:
09-2009
Content Type:
Working Paper
Institution:
The Cato Institute
Abstract:
Although neither the House nor the Senate passed a health care bill by President Obama's August deadline, various pieces of legislation have made it through committee, and they provide a concrete basis for analyzing what the proposed health care reform would and would not do. Looking at the various bills that are moving on Capitol Hill, we can determine the following: Contrary to the Obama administration's repeated assurances, millions of Americans who are happy with their current health insurance will not be able to keep it. As many as 89.5 million people may be dumped into a government-run plan. Some Americans may find themselves forced into a new insurance plan that no longer includes their current doctor. Americans will pay more than $820 billion in additional taxes over the next 10 years, and could see their insurance premiums rise as much as 95 percent. The current health care bills will increase the budget deficit by at least $239 billion over the next 10 years, and far more in the years beyond that. If the new health care entitlement were subject to the same 75-year actuarial standards as Social Security or Medicare, its unfunded liabilities would exceed $9.2 trillion. While the bills contain no direct provisions for rationing care, they nonetheless increase the likelihood of government rationing and interference with how doctors practice medicine. Contrary to assertions of some opponents, the bills contain no provision for euthanasia or mandatory end-of-life counseling. The bills' provisions on abortion coverage are far murkier.
Topic:
Government, Health, Human Welfare, and Markets
Political Geography:
United States and America

13. Yes, Mr. President: A Free Market Can Fix Health Care

Author:
Michael F. Cannon
Publication Date:
10-2009
Content Type:
Working Paper
Institution:
The Cato Institute
Abstract:
In March 2009, President Barack Obama said, “If there is a way of getting this done where we're driving down costs and people are getting health insurance at an affordable rate, and have choice of doctor, have flexibility in terms of their plans, and we could do that entirely through the market, I'd be happy to do it that way.” This paper explains how letting workers control their health care dollars and tearing down regulatory barriers to competition would control costs, expand choice, improve health care quality, and make health coverage more secure.
Topic:
Economics, Health, and Markets
Political Geography:
United States

14. All the President's Mandates: Compulsory Health Insurance Is a Government Takeover

Author:
Michael F. Cannon
Publication Date:
09-2009
Content Type:
Policy Brief
Institution:
The Cato Institute
Abstract:
The most hazardous health reform measure before Congress is not the so-called "public option," but proposals to make health insurance compulsory via an individual or employer mandate. Compulsory health insurance could require nearly 100 million Americans to switch to a more expensive health plan and would therefore violate President Barack Obama's pledge to let people keep their current health insurance. In particular, the legislation before Congress could eliminate many or all health savings account plans. Making health insurance compulsory would also spark an unnecessary fight over abortion and would enable government to ration care to those with private health insurance.
Topic:
Government, Health, and Markets
Political Geography:
United States and America

15. Mandatory Health Insurance: Lessons from Massachusetts

Author:
Craig J. Richardson
Publication Date:
10-2009
Content Type:
Journal Article
Journal:
The Cato Journal
Institution:
The Cato Institute
Abstract:
What lessons can be learned from the implementation of mandatory health insurance? As the Obama administration contemplates enacting far-reaching health care reforms that increase the role of government, the case of Massachusetts is worth serious study. Massachusetts' three-year experiment with mandatory health insurance (known as Chapter 58 legislation) has been judged by some health economists to be a qualified success, since it reached a primary goal of lowering the number of uninsured in the state (Gruber 2009, Long and Masi 2008). On the other hand, Tanner (2008: 5) argues that previously uninsured citizens signed up for health insurance because it was free or heavily subsidized, not because of the mandate itself. Official state statistics claim the number of uninsured in the state dropped from 11 percent in 2005 to less than 3 percent in 2009 (Massachusetts Health Connector 2009). Tanner (2009) disputes this number and suggests the number is closer to 5 percent, using Urban Institute and Census surveys as evidence. What supporters and foes of mandatory health insurance both seem to agree on is that the number of uninsured has fallen in the state since Chapter 58, and yet there remain between 150,000 and 200,000 uninsured citizens.
Topic:
Health
Political Geography:
United States

16. Bending the Productivity Curve: Why America Leads the World in Medical Innovation

Author:
Glen Whitman and Raymond Raad
Publication Date:
11-2009
Content Type:
Working Paper
Institution:
The Cato Institute
Abstract:
The health care issues commonly considered most important today — controlling costs and covering the uninsured — arguably should be regarded as secondary to innovation, inasmuch as a medical treatment must first be invented before its costs can be reduced and its use extended to everyone. To date, however, none of the most influential international comparisons have examined the contributions of various countries to the many advances that have improved the productivity of medicine over time. We hope this paper can help fill that void.
Topic:
Health, Human Welfare, and Markets
Political Geography:
America

17. Does the Doctor Need a Boss?

Author:
Michael F. Cannon and Arnold Kling
Publication Date:
01-2009
Content Type:
Policy Brief
Institution:
The Cato Institute
Abstract:
The traditional model of medical delivery, in which the doctor is trained, respected, and compensated as an independent craftsman, is anachronistic. When a patient has multiple ailments, there is no longer a simple doctor patient or doctor-patient-specialist relationship. Instead, there are multiple specialists who have an impact on the patient, each with a set of interdependencies and difficult coordination issues that increase exponentially with the number of ailments involved.
Topic:
Economics, Health, and Human Welfare
Political Geography:
United States

18. A Better Way to Generate and Use Comparative-Effectiveness Research

Author:
Michael F. Cannon
Publication Date:
02-2009
Content Type:
Working Paper
Institution:
The Cato Institute
Abstract:
President Barack Obama, former U.S. Senate majority leader Tom Daschle, and others propose a new government agency that would evaluate the relative effectiveness of medical treatments. The need for “comparative-effectiveness research” is great. Evidence suggests Americans spend $700 billion annually on medical care that provides no value. Yet patients, providers, and purchasers typically lack the necessary information to distinguish between high- and low-value services.
Topic:
Economics, Government, Health, and Privatization
Political Geography:
United States

19. Health-Status Insurance: How Markets Can Provide Health Security

Author:
John H. Cochrane
Publication Date:
02-2009
Content Type:
Working Paper
Institution:
The Cato Institute
Abstract:
None of us has health insurance, really. If you develop a long-term condition such as heart disease or cancer, and if you then lose your job or are divorced, you can lose your health insurance. You now have a preexisting condition, and insurance will be enormously expensive—if it's available at all. Free markets can solve this problem, and provide life-long, portable health security, while enhancing consumer choice and competition. “Heath-status insurance” is the key. If you are diagnosed with a long-term, expensive condition, a health-status insurance policy will give you the resources to pay higher medical insurance premiums. Health-status insurance covers the risk of premium reclassification, just as medical insurance covers the risk of medical expenses. With health-status insurance, you can always obtain medical insurance, no matter how sick you get, with no change in out-of-pocket costs.
Topic:
Economics, Health, Markets, and Privatization
Political Geography:
United States

20. Obamacare to Come: Seven Bad Ideas for Health Care Reform

Author:
Michael Tanner
Publication Date:
05-2009
Content Type:
Working Paper
Institution:
The Cato Institute
Abstract:
President Obama has made it clear that reforming the American health care system will be one of his top priorities. In response, congressional leaders have promised to introduce legislation by this summer, and they hope for an initial vote in the Senate before the Labor Day recess.
Topic:
Government and Health
Political Geography:
United States