Abstract
The Affordable Care Act (commonly termed Obamacare) has and continues to experience substantial political and economic challenges to the “Exchange” market for individual (non-job-related) insurance it is trying to build to cover the uninsured. The promise to make insurance available to those who have already become above-average risks has resulted in high and growing premiums for Exchange coverage. Efforts to control the rate of growth of medical spending have been ineffective in curbing the growth of private sector spending. Furthermore, the cost of subsidies to the formerly uninsured has provoked taxpayer backlash to such an extent that repeal of the entire program almost succeeded. I explore whether there is a way to redesign subsidies and the distribution of methods to overcome these difficulties by developing insights contained on some of James Buchanan’s work, particularly his contributions to “positive political economy” and “fiscal illusion.”
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References
Buchanan, J. (1949). The Pure Theory of Government Finance: A Suggested Approach. Journal of Political Economy, 57, 496–505.
Buchanan, J. (1967). Public Finance in Democratic Process. Chapel Hill, NC: University of North Carolina Press.
Buchanan, J. (1968). Pure and Impure Goods. The Demand and Supply of Public Goods (Chapter 4). Carmel, IN: Liberty Fund.
Buchanan, J. (1969). Cost and Choice. Chicago: Markham Publishing.
Finkelstein, A., Hendren, N., & Shepard, M. (2017). Subsidizing Health Insurance for Low-Income Adults: Evidence from Massachusetts? (NBER Working Paper 23668). National Bureau of Economic Research: Cambridge, MA.
Gladwell, M. (2005, August 29). The Moral-Hazard Myth. The New Yorker. Available at https://www.newyorker.com/magazine/2005/08/29/the-moral-hazard-myth.
Herring, B., & Lentz, L. K. (2011). What Can We Expect from the “Cadillac Tax” in 2018 and Beyond? Inquiry, 48, 322–327.
Pauly, M. (1970). Optimality, ‘Public’ Goods, and Local Governments: A General Theoretical Analysis. Journal of Political Economy, 78, 572–585.
Pauly, M. (1971). Medical Care at Public Expense. New York and London: Praeger.
Pauly, M. (2010). Health Reform Without Side Effects: Making Markets Work for Individual Health Insurance. Stanford, CA: Hoover Institution Press.
Phelps, C., & Parente, S. (2018). The Economics of US Health Care Policy. New York and London: Routledge.
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Pauly, M. (2018). Subsidizing Health Insurance: Tax Illusion and Public Choice for a Mostly Private Good. In: Wagner, R. (eds) James M. Buchanan. Remaking Economics: Eminent Post-War Economists. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-030-03080-3_10
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DOI: https://doi.org/10.1007/978-3-030-03080-3_10
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