Showing posts with label Social. Show all posts
Showing posts with label Social. Show all posts

Tuesday, 16 July 2013

Social Security Reform: The Budget Debate All Over Again

library C. Eugene Steuerle

"Economic Perspective" column reprinted with permission.
Copyright 1998 TAX ANALYSTS

The nonpartisan Urban Institute publishes studies, reports, and books on timely topics worthy of public consideration. The views expressed are those of the authors and should not be attributed to the Urban Institute, its trustees, or its funders.

Social security and Medicare reform suffer from the same problem that for so long made budget reform difficult. They measure gains and losses, winners and losers, from a base of a system that is imbalanced and whose promises don't add up. If our elected representatives convert the system to one that is more sustainable, however, they are accused of creating only losers—those who get smaller increases in benefits or higher taxes than are currently scheduled. But this is simply bad political accounting.

In budget policy, reducing future deficits was never given any formal credit for creating winners. Little recognition was given for all those who would get to pay fewer taxes, or receive additional benefits, if future interest costs on the federal debt were lower. Instead, the politics of budget reform implied there were only losers: those who would pay more taxes or receive fewer expenditures to keep the deficit lower.

Sometimes the list of losers would show up on distributional or other tables. For example, the 1982, 1984, 1990, and 1993 budget agreements all had some tax increases attached to them. In each case, the Joint Committee on Taxation would dutifully produce distributional tables by income class showing who would pay the additional taxes under the new law. Similarly, in many of the Medicare and other expenditure reforms that were debated as part of these budget efforts, calculations would sometimes be made of the additional cash burden for those individuals who might face some increased premium or copayment or lose some other benefit.

The problem with these calculations was not so much that some "losers" were identified; it was that the corresponding set of winners were ignored. Half the balance sheet was never calculated.

Ignore for the moment whether any particular tax and expenditure policy is good or bad for the economy in terms of behavior, incentives, poverty reduction, and so forth. Those are vital economic issues, but not usually part of the presentation of winners and losers. Absent those particular economic effects, the sum of losses plus gains to taxpayers from government action is exactly zero. That is, for every dollar paid in tax, there is a dollar that is expended for some purpose. This is easiest to see in the case of a direct cash transfer. One person pays, another receives. One dollar of loss to one is a dollar of gain for the other. The sum of transfers paid equal the sum of transfers received. If the expenditure is some good or service rather than a cash transfer, then each dollar's worth of that good or service for some people still represents a dollar of cost to other people.

Debt only confuses the issue, but the calculation is the same. Spend one dollar today and pay for it tomorrow. The present value—the sum of all values over time, discounted to the present—of all losses still equals the present value of all gains. Deferred taxes are still taxes. Similarly, if taxes are in excess of expenditures, then losses to current taxpayers or beneficiaries is made up for by gains to future taxpayers and beneficiaries.

This is simply basic accounting. If one looks only at a point in time, then it's easy to miscalculate winners and losers. Suppose one tries to calculate who wins by paying off current interest on the debt. At first it may look as if there are only losers—those taxpayers who fork over the extra money each year. That's because the winners likely were in the past—those who avoided paying the taxes to cover the cost of the benefits or expenditures they received.

From a measurement standpoint, it is obvious why only half the balance sheet is usually presented. Although we know that they must exist, the eventual winners from deficit reduction or bringing a system into balance are hard to identify. For example, reducing expected deficits allows the country to sell less debt. The future interest and principal payments that eventually have to be paid are lower. Nobody has to pay these amounts, and just who is "nobody" is vague at best. So, winners are hard to identify, and this side of the balance sheet is hard to create. It's not filled in, and it is hard to introduce it into the debate.

In contrast, losers from deficit reduction appear easy to identify. They are the ones who bear the lower benefits or higher taxes (the losses) from changing items already scheduled into the law. So, this side of the balance sheet is easy to fill in. It is the one that likely will be presented to the public and debated by the politicians because it is filled in.

That brings us back to taxes and expenditures in social security and Medicare. These systems promise higher and higher levels of benefits in the future, much more than current taxes can reasonably support. If one assumed that social security taxes were to support all of the promised increase in social security and Medicare benefits, those tax rates would almost have to double. Whether done through increased taxes or reduced expenditures, whether within social security and Medicare or through the general budget and general revenues, the shortfall must be covered. Promises must be reduced, taxes must be increased, or other programs must be cut back in size and scale. Identifying exactly who will bear these burdens is considered a political liability because it fills out the long-term accounting sheet.

What deters action on social security and Medicare, therefore, are precisely the same factors that kept the deficit reduction debate going without resolution for so many years. The only real difference is that the budget debate usually centered around deficits in the current year and the next few years. For social security and Medicare, the deficits of consequence are years, even decades, into the future—especially once the baby boomers more fully occupy the ranks of the retired.

Are there ways around this problem? Although not perfect, there are alternative ways to show changes over time. One need not show only differences from a set of promises that cannot be met. One alternative is to show changes from existing levels of benefits, rather than those benefits that are scheduled to grow over time. For instance, in today's dollars social security promises an insurance policy worth approximately $1/4 million in lifetime benefits to an average-income couple retiring today and $1/3 million to an average-income couple retiring in 30 years. If Congress cuts the growth in lifetime benefits so that the future couple only gets $300,000, that can be shown either as a $33,000 cut from "current law" promises, or an increase of $50,000 from "current levels" of benefits.

On the tax side of the budget, one could argue that the existing benefit schedule implies a future "tax" rate of, say, 15 percent to fund social security alone rather than about 10 percent. If the tax rate is kept at 10 percent for the future, then that could be shown as equivalent to a 5 percentage point reduction from the level of taxation implied in current law.

None of these measures is perfect, but at least they do a better job of balancing the tendency to look on only one side of the accounting sheet. The danger is that the political cost of identifying only losers will deter action by most of our elected officials, and that the country will be forced once again to go through years, even decades, of effort to get this longer term deficit into order. Along the way, most other policymaking will continue to be tied into knots.


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A Workable Social Insurance Approach to Expanding Health Insurance Coverage

library C. Eugene Steuerle

This proposal — designed to expand health insurance coverage — was written as a component of a Robert Wood Johnson Foundation-funded project, which was directed by the Economic and Social Research Institute (ESRI). Sixteen other proposals were also written by other authors under the auspices of this project, "Covering America: Real Remedies for the Uninsured." All 17 proposals can be accessed through the ESRI web-site at www.esresearch.org.

The nonpartisan Urban Institute publishes studies, reports, and books on timely topics worthy of public consideration. The views expressed are those of the authors and should not be attributed to the Urban Institute, its trustees, or its funders.

Note: This report is available in its entirety in the Portable Document Format (PDF).

Key Elements

C. Eugene Steuerle has developed an incremental coverage expansion proposal that is designed to mitigate perverse incentives in the present system that discourage cost consciousness and encourage ever-larger private and public spending for health coverage—spending that is often not directed to areas of greatest need or to improving quality of care. The proposal includes the following elements:

THE PROVISION OF THE TAX CODE that allows employees to not pay tax on employer-paid health insurance premiums would be changed: the exclusion would be capped at a fixed-dollar amount, which would not change over time as health insurance premiums increase.

PEOPLE AT ALL INCOME LEVELS could choose to take advantage of a modest tax credit as an alternative to the tax exclusion; the size of tax credit would increase over time.

EMPLOYERS WOULD BE REQUIRED TO OFFER, but not necessarily pay for, at least one state-approved health insurance plan for employees.

AN "INDIRECT" MANDATE WOULD BE ESTABLISHED and enforced through the federal tax system: individuals who failed to get coverage would lose some tax benefit, such as the personal exemption, credits to help pay higher education expenses, etc.

THE INITIAL SOURCES OF FINANCING for the tax credit would be tax revenues from the portion of employer-paid premiums that are newly taxable and the tax penalties imposed on people who fail to arrange coverage.

EMPLOYERS WHO OFFER COVERAGE would be encouraged to adopt the practice of automatically enrolling employees in the employer's health plan unless they specifically chose to opt out.

About the Author

C. EUGENE STEUERLE, PH.D., is a Senior Fellow at The Urban Institute and co-director of the Urban-Brookings Tax Policy Center. He is the author, co-author, editor, or co-editor of ten books, and over 150 reports and articles, 600 columns, and 50 Congressional testimonies or reports. Among many other positions, he has served as Deputy Assistant Secretary of the Treasury for Tax Analysis, President of the National Tax Association (2001 to 2002), chair of the 1999 Technical Panel advising Social Security on its methods and assumptions, President of the National Economists Club Educational Foundation, and Resident Fellow at the American Enterprise Institute. Between 1984 and 1986 he served as Economic Coordinator and original organizer of the Treasury's tax reform effort, for which Treasury and White House officials have written that tax reform "would not have moved forward without your early leadership" and the "Presidential decision to double the personal exemption...[is] due to your insightful analysis." Dr. Steuerle has published articles on such issues as the financing of health care, the use of mandates, and the economic effect of health insurance subsidies. He has provided Congress with testimony and served as faculty at health reform retreats by both the Senate Finance Committee and the House Ways and Means Committee. He has promoted health reform proposals to focus on children and to provide both "carrots and sticks" to encourage the purchase of health insurance.

Introduction

The federal government's health budget is expanding by leaps and bounds even as the number of uninsured increases and average out-of-pocket costs for Americans rise faster than income. Does this seem incongruous? It shouldn't. Federal policy toward health care operates like a man running with a blindfold on: that he trips, falls over cliffs, and generally fails to reach his objective shouldn't be surprising. What is questionable is the federal government's continual exhortation to run faster under these circumstances. If the blindfold comes off, then policy can be "run" at a more sustainable and efficient pace.

The task here, to identify ways to expand health insurance coverage and reduce the number of uninsured, cannot be achieved without squarely facing the constraints and dilemmas of health policy. Here, the nonhealth side of the wider market and the financing side of government must be given their due. That is, government expenditures on health care are one part of a broader balance sheet; the other parts of that sheet change simultaneously when health policy is reformed. Ignoring them will not make them go away.

The growth in federal expenditures on health care is so large today that it claims a major share of all new revenues to the government and has led, over time, to a decline in the share of almost all non-health functions, other than retirement, relative to both total expenditures and gross domestic product (GDP). Spending more on new health programs on top of the automatic growth in existing programs does mean less to spend on education, homeland security, community development, and everything else—in the aggregate and, often, separately. The high level of current expenditures helps to make reform very difficult, because change can be very expensive and affects a wide range of interest groups.

Even if one wants to argue that tax increases can meet demands for new public interventions (that is, that privately paid-for goods and services, rather than other public goods and services, are what should decrease), this scenario still gives health care priority to use those government revenues and weakens the ability of other functions to maintain their current resource shares, much less capture some higher future share.109

This situation is not as bleak as it might first appear. Although the high, automatic, growth rate in existing health care entitlement programs—a growth requiring no new legislation—greatly constrains achieving legislative reforms, those constraints are more political than economic. Indeed, the political problem is how to move off a path of unsustainable promises, but the economic problem is how to capture some of the sustainable portion of public health expenditure growth and steer it toward more optimal use. Here, much can be achieved.

While some components of the reform package set out here are similar to those in other proposals, this paper approaches the task by recognizing up-front all parts of the health care balance sheet. Thus, many health care proposals start from a health needs assessment that includes inadequate health insurance coverage. Then they blithely ignore all the dilemmas and constraints embedded in current health policy, ranging from large budgetary cost to high implicit and hidden tax rates. The approach here is, first, to identify the constraints and dilemmas and then see how a reform plan might be developed that recognizes and addresses them.

Note: This report is available in its entirety in the Portable Document Format (PDF).

109 Higher tax rates raise the efficiency cost, even for the same level of expenditure on other functions. That is, economic theory suggests that at the margin, the efficiency cost of taxes rises with the tax rate. Hence, if education programs require tax rates to rise from 35 to 36 percent, they are more costly in terms of efficiency than if they require tax rates to rise from 25 to 26 percent. Even if one does not accept the economic logic, it is fairly clear that taxpayers reduce their support for government functions at higher tax rates. Either way, large amounts spent on health care weaken legislators' ability to tap taxpayers yet again for non-health purposes. Trade-offs are real.

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