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Prefunding Medicare

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  • Martin Feldstein

Abstract

The Medicare program of health care for the aged now costs more than $5,000 per enrollee, a national cost of more than $200 billion a year. The official projections that these costs will rise rapidly from 2.5% of GDP now to 5.5% of GDP in 2030 and 7% of GDP in 2070 assume that structural changes in health care will prevent the even more rapid growth of spending that would occur if past trends continue. These GDP shares are equivalent to increasing the payroll tax rates that rise from 5% of total wages now to 14% of total wages by 2070. Alternatively, if the increased Medicare spending is financed by an across-the-board increase in income tax rates, all tax rates would rise by 46 percent (e.g., from 28% to 41%). If Medicare costs continue to be tax financed, the sharp increase in Medicare costs would cause a substantial increase in the deadweight loss of the tax system. Even with quite favorable assumptions, the increased deadweight loss is likely to be almost as large as the direct increase in the health care costs themselves. This paper analyzes an alternative life cycle approach to paying for the cost of health care of the aged: a system of investment-based individual Retiree Health Accounts (RHAs) to which the government deposits funds during individuals' working years. At retirement the individual could use the accumulated fund to purchase a fee-for-service plan like the current Medicare package, to pay for membership in an HMO, or to establish a medical savings account with a high deductible insurance policy. Using data from the Social Security administration, I estimate that annual RHA deposits equal to about 1.4% of total payroll would eventually be enough to pay for the full increase in the cost of Medicare, obviating a nine percentage point payroll tax increase.

Suggested Citation

  • Martin Feldstein, 1999. "Prefunding Medicare," NBER Working Papers 6917, National Bureau of Economic Research, Inc.
  • Handle: RePEc:nbr:nberwo:6917
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    References listed on IDEAS

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    1. Martin Feldstein, 1998. "Privatizing Social Security," NBER Books, National Bureau of Economic Research, Inc, number feld98-1.
    2. Martin Feldstein & Andrew Samwick, 1998. "The Transition Path in Privatizing Social Security," NBER Chapters, in: Privatizing Social Security, pages 215-264, National Bureau of Economic Research, Inc.
    3. Martin Feldstein & Elena Ranguelova, 1998. "Individual Risk and Intergenerational Risk Sharing in an Investment-Based Social Security Program," NBER Working Papers 6839, National Bureau of Economic Research, Inc.
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    Cited by:

    1. Yasushi Iwamoto & Tadashi Fukui, 2009. "Prefunding Health and Long-term Care Insurance," Public Policy Review, Policy Research Institute, Ministry of Finance Japan, vol. 5(2), pages 255-286, November.
    2. van Groezen, B.J.A.M. & Meijdam, A.C. & Verbon, H.A.A., 2002. "Social Security Reform and Population Ageing in a Two-Sector Growth Model," Discussion Paper 2002-25, Tilburg University, Center for Economic Research.
    3. Tadashi Fukui & Yasushi Iwamoto, 2007. "Policy Options for Financing Future Health and Long-Term Care Costs in Japan," NBER Chapters, in: Fiscal Policy and Management in East Asia, pages 415-442, National Bureau of Economic Research, Inc.
    4. Jeffrey R. Brown & Olivia S. Mitchell & James M. Poterba, 2001. "The Role of Real Annuities and Indexed Bonds in an Individual Accounts Retirement Program," NBER Chapters, in: Risk Aspects of Investment-Based Social Security Reform, pages 321-370, National Bureau of Economic Research, Inc.
    5. Tadashi Fukui & Yasushi Iwamoto, 2006. "Policy Options for Financing the Future Health and Long-term Care Costs in Japan (Subsequently published in "Fiscal Policy and Management in East Asia", Takatoshi Ito and Andrew Rose eds., U," CARF F-Series CARF-F-071, Center for Advanced Research in Finance, Faculty of Economics, The University of Tokyo.
    6. Marcelin Joanis & David Boisclair & Claude Montmarquette, 2004. "La santé au Québec : des options pour financer la croissance," CIRANO Project Reports 2004rp-04, CIRANO.
    7. Charles Yuji Horioka, 2014. "The Life and Work Of Martin Stuart (“Marty”) Feldstein," UP School of Economics Discussion Papers 201410, University of the Philippines School of Economics.
    8. Epictetus Patalinghug, 2007. "Comment on "Policy Options for Financing Future Health and Long-Term Care Costs in Japan"," NBER Chapters, in: Fiscal Policy and Management in East Asia, pages 442-444, National Bureau of Economic Research, Inc.
    9. repec:dpr:wpaper:0905 is not listed on IDEAS

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    JEL classification:

    • H5 - Public Economics - - National Government Expenditures and Related Policies

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