Making Medicare advantage a middle-class program
This paper studies the role of Medicare's premium policy in sorting beneficiaries between traditional Medicare (TM) and managed care plans in the Medicare advantage (MA) program. Beneficiaries vary in their demand for care. TM fully accommodates demand but creates a moral hazard inefficiency. MA rations care but disregards some elements of the demand. We describe an efficient assignment of beneficiaries to these two options, and argue that efficiency requires an MA program oriented to serve the large middle part of the distribution of demand: the “middle class.” Current Medicare policy of a “single premium” for MA plans cannot achieve efficient sorting. We characterize the demand-based premium policy that can implement the efficient assignment of enrollees to plans. If only a single premium is feasible, the second-best policy involves too many of the low-demand individuals in MA and a too low level of services relative to the first best. We identify approaches to using premium policy to revitalize MA and improve the efficiency of Medicare.
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- Frank, Richard G. & Glazer, Jacob & McGuire, Thomas G., 2000. "Measuring adverse selection in managed health care," Journal of Health Economics, Elsevier, vol. 19(6), pages 829-854, November.
- repec:mpr:mprres:5928 is not listed on IDEAS
- Daron Acemoglu & Amy Finkelstein & Matthew J. Notowidigdo, 2013.
"Income and Health Spending: Evidence from Oil Price Shocks,"
The Review of Economics and Statistics,
MIT Press, vol. 95(4), pages 1079-1095, October.
- Daron Acemoglu & Amy Finkelstein & Matthew J. Notowidigdo, 2009. "Income and Health Spending: Evidence from Oil Price Shocks," NBER Working Papers 14744, National Bureau of Economic Research, Inc.
- Acemoglu, Daron & Finkelstein, Amy & Notowidigdo, Matthew J., 2009. "Income and Health Spending: Evidence from Oil Price Shocks," CEPR Discussion Papers 7255, C.E.P.R. Discussion Papers.
- Miller, Nolan H., 2005. "Pricing health benefits: A cost-minimization approach," Journal of Health Economics, Elsevier, vol. 24(5), pages 931-949, September.
- Newhouse, Joseph P., 2006. "Reconsidering the moral hazard-risk avoidance tradeoff," Journal of Health Economics, Elsevier, vol. 25(5), pages 1005-1014, September.
- Glazer, Jacob & McGuire, Thomas G., 2011. "Gold and Silver health plans: Accommodating demand heterogeneity in managed competition," Journal of Health Economics, Elsevier, vol. 30(5), pages 1011-1019.
- Randall P. Ellis & Thomas G. McGuire, 2006.
"Predictability and Predictiveness in Health Care Spending,"
Boston University - Department of Economics - Working Papers Series
WP2006-001, Boston University - Department of Economics.
- Ellis, Randall P. & McGuire, Thomas G., 2007. "Predictability and predictiveness in health care spending," Journal of Health Economics, Elsevier, vol. 26(1), pages 25-48, January.
- Van de ven, Wynand P.M.M. & Ellis, Randall P., 2000. "Risk adjustment in competitive health plan markets," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 14, pages 755-845 Elsevier.
- Simona Grassi & Ching-to Albert Ma, 2009.
"Public Sector Rationing and Private Sector Selection,"
Boston University - Department of Economics - Working Papers Series
wp2009-a, Boston University - Department of Economics.
- Simona Grassi & Ching‐To Albert Ma, 2012. "Public Sector Rationing and Private Sector Selection," Journal of Public Economic Theory, Association for Public Economic Theory, vol. 14(1), pages 1-34, 02.
- Ching-to Albert MA & Simona Grassi, 2011. "Public Sector Rationing And Private Sector Selection," Boston University - Department of Economics - Working Papers Series WP2011-021, Boston University - Department of Economics.
- Borger, Christine & Rutherford, Thomas F. & Won, Gregory Y., 2008. "Projecting long term medical spending growth," Journal of Health Economics, Elsevier, vol. 27(1), pages 69-88, January.
- Pauly, Mark V. & Ramsey, Scott D., 1999. "Would you like suspenders to go with that belt? An analysis of optimal combinations of cost sharing and managed care," Journal of Health Economics, Elsevier, vol. 18(4), pages 443-458, August.
- Keeler, Emmett B. & Carter, Grace & Newhouse, Joseph P., 1998. "A model of the impact of reimbursement schemes on health plan choice," Journal of Health Economics, Elsevier, vol. 17(3), pages 297-320, June.
- Steven T. Berry, 1994. "Estimating Discrete-Choice Models of Product Differentiation," RAND Journal of Economics, The RAND Corporation, vol. 25(2), pages 242-262, Summer.
- M. Kate Bundorf & Jonathan D. Levin & Neale Mahoney, 2008.
"Pricing and Welfare in Health Plan Choice,"
NBER Working Papers
14153, National Bureau of Economic Research, Inc.
- Pauly, Mark V. & Blavin, Fredric E., 2008. "Moral hazard in insurance, value-based cost sharing, and the benefits of blissful ignorance," Journal of Health Economics, Elsevier, vol. 27(6), pages 1407-1417, December.
- repec:mpr:mprres:3849 is not listed on IDEAS
- Balsa, Ana I. & Cao, Zhun & McGuire, Thomas G., 2007. "Does managed health care reduce health care disparities between minorities and Whites?," Journal of Health Economics, Elsevier, vol. 26(1), pages 101-121, January.
- Town, Robert & Liu, Su, 2003. " The Welfare Impact of Medicare HMOs," RAND Journal of Economics, The RAND Corporation, vol. 34(4), pages 719-36, Winter.
- Besley, Timothy & Coate, Stephen, 1991.
"Public Provision of Private Goods and the Redistribution of Income,"
American Economic Review,
American Economic Association, vol. 81(4), pages 979-84, September.
- Besley, T. & Coate, S., 1989. "Public Provision Of Private Goods And The Redistribution Of Income," Papers 36, Princeton, Woodrow Wilson School - Discussion Paper.
- repec:mpr:mprres:4160 is not listed on IDEAS
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