Reading list

Several of the papers included below are from many years ago. Check the dates before you read or you may be very confused by what the authors write. The policy and political context is not static.

What can Massachusetts teach us about national health insurance reform? (Journal of Policy Analysis and Management). This is a debate between Douglas Holtz-Eakin and Jon Gruber about lessons from Massachusetts health reform.

Risk adjustment in health care markets: concepts and applications, by Randall P. Ellis (Institute of Health Economics)

This chapter summarizes the recent literature on risk adjustment, synthesizing the theoretical and empirical literatures, emphasizing areas of current research and policy interest. The paper relates optimal risk adjustment to the previous theory and empirical work. The empirical estimation section covers choice of an objective function, different types of information that can be used, conceptual issues, estimation, and validation. The paper concludes with detailed discussion of risk adjustment applications in Canada, US, Netherlands, and Germany.

The Medicare reform debate: what is the next step?  by H J Aaron and R D Reischauer (Health Affairs)

Medicare costs are rising faster than projected revenues. Action to close the emerging deficit is inescapable. We propose converting Medicare from a “service reimbursement” system to a “premium support” system. These changes would resemble many that are now reshaping private employer-based insurance. Our reform would encompass not just the “public” Medicare program but also the “real” Medicare, which includes the supplemental plans to which most Medicare beneficiaries have access. Approved plans would have to offer stipulated services. We review numerous technical issues in moving to a new system that cannot be solved quickly and that preclude quick budget savings.

Is premium support the right medicine for Medicare? by J Oberlander (Health Affairs)

This paper assesses the desirability of transforming Medicare into a premium-support system. I focus on three areas crucial to the future of Medicare: cost savings, beneficiary choice, and the stability of traditional Medicare. Based on my analysis of the Bipartisan Commission on the Future of Medicare plan, I find substantial problems with adopting premium support for Medicare. In particular, projections of premium-support savings are based on questionable assumptions that the slowdown in health spending during 1993-1997 can be sustained and extrapolated to future Medicare performance. Consequently, premium support may inadvertently destabilize public Medicare and erode beneficiary choice without achieving substantial savings.

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