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8451. Health Care Rationing: What it Means

Author:
Henry J. Aaron
Publication Date:
12-2005
Content Type:
Policy Brief
Institution:
The Brookings Institution
Abstract:
The United States spends more on health care than any other nation. In 2003, medical spending made up more than 15 percent of U.S. GDP, and if historical trends persist, this share will climb to more than one-third of GDP by 2040. With medical technology advancing at an ever-increasing rate, the potential for spending on procedures not worth their costs is growing. But there are few good ideas for reining in medical costs without hurting patients.
Topic:
Economics, Health, and Human Welfare
Political Geography:
United States

8452. Block Grants: Flexibility vs. Stability in Social Services

Author:
Margy Waller
Publication Date:
12-2005
Content Type:
Policy Brief
Institution:
The Brookings Institution
Abstract:
Since the 1940s, federal officials, commissions, and scholars all have suggested that local governments receive their federal funds in the form of so-called block grants. Supporters say block grant sallow local governments more freedom to design programs, simplify administration of funds, and improve consumer access to social services. The biggest challenge to wholesale support for block grants is simple: How can we ensure accountability for spending and outcomes? Policymakers face a dilemma: keep block grant funding flexible to ensure its success or protect programs from potential cuts that threaten the stability of services. This policy brief reviews the history of federal block grants for social services, the academic literature examining block grant outcomes, and recent federal proposals.
Topic:
Development, Economics, Government, and Human Welfare

8453. Why Federalism Matters

Author:
Pietro S. Nivola
Publication Date:
10-2005
Content Type:
Policy Brief
Institution:
The Brookings Institution
Abstract:
What do we want from federalism?” asked the late Martin Diamond in a famous essay written thirty years ago. His answer was that federalism—a political system permitting a large measure of regional selfrule—presumably gives the rulers and the ruled a “school of their citizenship,” “a preserver of their liberties,” and “a vehicle for flexible response to their problems.” These features, broadly construed, are said to reduce conflict between diverse communities, even as a federated polity affords inter-jurisdictional competition that encourages innovations and constrains the overall growth of government.
Topic:
Development, Government, and Politics
Political Geography:
United States

8454. Nigeria's Paris Club Debt Problem

Publication Date:
08-2005
Content Type:
Policy Brief
Institution:
The Brookings Institution
Abstract:
Intense domestic pressure has convinced Nigerian President Olusegun Obasanjo to seek a deal that would eliminate the country's $31 billion of debt owed to the governments of the U.K., France, and other aid-giving countries that use the Paris Club process to restructure debt that countries cannot repay. The Paris Club creditors have proposed an unprecedented operation—its first-ever buyback at a discount—that would cancel all of Nigeria's debt to them in exchange for a cash payment of roughly $12 billion.
Topic:
Conflict Resolution, International Relations, and Debt
Political Geography:
Africa, United Kingdom, Paris, France, and Nigeria

8455. Moving Toward Smarter Aid

Publication Date:
08-2005
Content Type:
Policy Brief
Institution:
The Brookings Institution
Abstract:
The Millennium Challenge Corporation (MCC) is seriously wounded. Unveiled by President Bush in March 2002 as a promising new bilateral aid instrument for tackling global poverty, the most prominent sign of the MCC's distress was the mid-summer resignation of Paul Applegarth, its first CEO. More disturbing are the cuts imposed by the Congressional committees marking up next year's budget. The MCC's original concept was to award $5 billion annually to low-income countries based on objective criteria measuring their performance in ruling justly, investing in people, and promoting economic freedom. Appropriations for the MCC in its third year of funding, however, appear to be stuck below $2 billion. Criticism of the MCC for getting off to a slow start misses the point. Creating a new agency takes time and the original concept remains valid. To enable the MCC to live up to its potential, its newly nominated CEO will have to sell the MCC vision to a skeptical Congress and gain the flexibility required to avoid drifting toward "more of the same."
Topic:
International Relations, Debt, Economics, and Poverty

8456. The Well-Being of Single-Mother Families After Welfare Reform

Author:
Bruce D. Meyer and James X. Sullivan
Publication Date:
08-2005
Content Type:
Policy Brief
Institution:
The Brookings Institution
Abstract:
Trends in income and consumption tell very different stories about the well-being of single mothers and their children in recent years. On the one hand, data suggest that income fell noticeably for single mothers well below the poverty line, while income grew significantly for single mothers with higher incomes. On the other hand, data on how much these two groups of mothers and children consumed suggest that the material circumstances of both groups improved during the 1990s. We argue that the consumption data better reflect well-being for several reasons. First, consumption is probably measured with less error than income for poor families, and is more strongly associated with other measures of well-being such as health and housing conditions. Second, there is overwhelming evidence that income is underreported by these mothers and that the underreporting, especially of income from welfare and other transfer programs, has increased in recent years.
Topic:
Demographics, Economics, Government, and Human Welfare

8457. Insuring America's Workers in a New Era of Offshoring

Author:
Robert E. Litan, Nicholas Warren, and Lael Brainard
Publication Date:
07-2005
Content Type:
Policy Brief
Institution:
The Brookings Institution
Abstract:
With a new wave of white-collar offshoring coming fast on the heels of accelerated job losses in manufacturing, an ever-broader pool of American workers is finding that the nation's safety net has more holes than netting. The nation can and must do more to help insure the livelihoods of American workers in the face of structural shifts of whatever form, while preserving the benefits of an open and innovative economy. With technological change and offshoring accelerating job turnover and the pace at which workers' job-specific skills lose value, the time has come for the federal government to strengthen the existing safety net.
Topic:
Economics, Government, and Human Welfare
Political Geography:
United States and America

8458. Rumsfeld's Revolution at Defense

Author:
Paul C. Light
Publication Date:
07-2005
Content Type:
Policy Brief
Institution:
The Brookings Institution
Abstract:
Whatever his legacy as an architect of the war in Iraq, Defense Secretary Donald Rumsfeld has already earned a place in American bureaucratic history as one of its most ambitious organizational reformers. Rumsfeld is determined to complete a top-to-bottom overhaul of his department before he leaves office. Rumsfeld may be one of history's most ambitious reformers, but his actual impact is far from assured. He still faces intense resistance from the armed services, especially the Army, which has the most to lose in the movement to a much lighter military. And many of his proposals are either still under consideration in Congress or only in the early stages of implementation in the department.
Topic:
Security, Defense Policy, and Government
Political Geography:
Iraq and Middle East

8459. Insuring America's Workers in a New Era of Offshoring

Author:
Robert E. Litan, Nicholas Warren, and Lael Brainard
Publication Date:
07-2005
Content Type:
Policy Brief
Institution:
The Brookings Institution
Abstract:
With a new wave of white-collar offshoring coming fast on the heels of accelerated job losses in manufacturing, an ever-broader pool of American workers is finding that the nation's safety net has more holes than netting. The nation can and must do more to help insure the livelihoods of American workers in the face of structural shifts of whatever form, while preserving the benefits of an open and innovative economy. With technological change and offshoring accelerating job turnover and the pace at which workers' job-specific skills lose value, the time has come for the federal government to strengthen the existing safety net.
Topic:
Economics, Government, Human Welfare, and Poverty
Political Geography:
America

8460. Can the U.S. Government Live Within Its Means? Lessons from Abroad

Author:
Allen Schick
Publication Date:
06-2005
Content Type:
Policy Brief
Institution:
The Brookings Institution
Abstract:
When George W. Bush leaves office in 2009, the federal government will owe at least $15,000 more for every American than it did when he became president eight years earlier. This unprecedented build-up of public debt will result from budget deficits projected to average more than $250 billion a year during the Bush presidency, plus more than one trillion dollars borrowed from social security trust funds. Although this budget projection may be high, there is far greater risk that actual deficits will exceed current estimates than that they will be lower.
Topic:
International Relations, Economics, and Government
Political Geography:
United States