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may 20 2012 categories data politics tags public opinion 1 comment on is the reliability of public opinion surveys declining fixing medicare s double counting problem last week i argued that budgeting for medicare s hospital insurance program is flawed today i offer two ways to fix it and reject a third medicare part a is one of several federal programs that control spending through a belt and suspenders combination of regular program rules the belt and an overall limit the suspenders but it s the only one that allows legislated savings to offset the costs of policy changes in other programs and extend the time before the overall limit constrains operations congress can t increase social security payroll taxes to pay for increased health care spending or reduce flood insurance subsidies to pay for tax cuts in both cases the resources stay within the affected programs and when it cuts spending on medicare parts b and d to pay for other spending no one claims those cuts will also postpone the day when trust fund exhaustion will disrupt their operations such double counting is possible only in medicare part a and it s a real problem creating needless confusion and reinforcing the sense that washington plays fast and loose with budget numbers happily congress knows how to fix this problem all it needs to do is apply to medicare a the practices used by one of the other programs that have belt and suspenders budgeting but avoid potential double counting one approach would be the rules used by the national flood insurance program as i discussed in more detail last week those rules require that any legislated savings remain in the program lawmakers can t reduce nfip subsidies to pay for new spending in other programs instead any savings are automatically earmarked to pay future nfip claims that would go unpaid because of the program s borrowing limit for an example see here this approach brings the overall limit explicitly into the budget but it makes for weird budgeting for example the budget baseline would show medicare a breaking even over the long run since the trust fund limit would take precedence over its fundamental deficits a better approach would adopt the rules used by social security those rules show social security running deficits far into the future in the budget baseline but they still take the trust fund seriously when examining new legislation any proposed cuts to the program s spending or increases in its revenues are off budget the congressional budget office reports them but congress can t use them to pay for other spending a recent senate bill provides a telling example the bill would expand the type of income subject to payroll taxes in order to pay for a one year extension of low interest rates on student loans those low rates would cost 6 billion but the senate proposal would raise 9 billion the bill had to overshoot that much because 3 billion comes from higher social security taxes and is thus off limits meanwhile the 6 billion in usable revenues comes from medicare part a which is considered on budget despite having a trust fund just like social security s that difference highlights the inconsistency in current budgeting if policymakers believe the part a trust fund is as sacrosanct as social security s they should provide the same budgetary protection part a savings should be off budget where they couldn t be used to pay for health reform student loans tax cuts or anything else outside the hospital insurance program if congress doesn t believe the trust fund deserves that protection it should adopt a third approach make the part a fund as operationally toothless as the one for medicare b and d those programs spend much more than they receive so their trust fund has unlimited ability to draw on general revenues if the same were true for medicare part a program changes could be used to pay for health reform as they were in 2010 or anything else just like any other mandatory program but we wouldn t have any confusion over whether those changes also extend the program s ability to operate the social security and medicare b and d approaches both make more sense than the mishmash that applies to medicare a today i think the medicare b and d approach is the better of the two not least because it would put all the parts of medicare on equal footing but one could certainly argue for the social security approach instead that s the discussion we should have now so that we can avoid needless double counting debates in the future p s several readers noted an important qualification to my social security discussion in my earlier post many experts believe past social security surpluses have been used to finance deficits in the rest of the budget and as a result social security resources have been paying for higher spending or lower revenues elsewhere in government i agree my comments in these posts apply only to explicit budgeting decisions like those in 2010 s health reform or today s student loan legislation in that context social security savings cannot be legislatively used to pay for other programs but they still might have indirect effects for example by reducing future unified budget deficits social security savings might weaken future congressional efforts to reduce deficits outside social security author donald posted on may 18 2012 may 17 2012 categories budget politics taxes tags budget budget process health politics taxes 1 comment on fixing medicare s double counting problem energy security the infographic the congressional budget office is out with another fine infographic this time on energy security the entire infographic is too big to post here but here s how andrew stocking and maureen costantino portray america s energy sources and uses one of the most notable features is the absence of any link from natural gas to transportation some natural gas is used in transportation of course but not enough to make the cut for this image given the ever growing divergence between oil and natural gas prices i wonder whether that will still be true a decade from now or will someone finally crack the natural gas to transportation fuel market in a big way author donald posted on may 11 2012 may 10 2012 categories data energy tags energy infographic natural gas oil 14 comments on energy security the infographic the fight over medicare double counting the recent double counting dispute isn t just about politics it also reveals a flaw in budgeting for medicare part a budget experts are waging a spirited battle over the medicare changes that helped pay for 2010 s health reform in april chuck blahous one of two public trustees of the program released a study arguing that the affordable care act aca would increase the deficit by at least 340 billion by 2021 a sharp contrast from the 210 billion in deficit reduction estimated by the congressional budget office cbo chuck bases his estimates on several factors but the item that has garnered the most attention is his charge that the aca s spending cuts and revenue increases in medicare part a are being double counted once to help pay for the aca s coverage expansion and a second time to improve the finances of the part a trust fund whose predicted exhaustion was delayed by several years chuck notes that those resources can be used only once they can either offset some costs of health reform or strengthen medicare but not both he believes those resources will ultimately finance additional medicare spending and thus can t offset any health reform costs for that reason he concludes that the aca would increase deficits rather than reduce them that argument inspired a host of commentary from leading budget experts ranging from denunciation to affirmation see for example jeffrey brown howard gleckman peter orszag robert reischauer as quoted by jonathan chait and paul van de water and a follow up by chuck and jim capretta why does this dispute exist it can t just be politics if it were we d have double counting disputes about every program but we don t we thus need an explanation for why this debate has erupted around medicare part a which provides hospital insurance but not around other programs part a is not unique in controlling spending by a belt and suspenders combination of regular program rules the belt and an overall limit the suspenders such budgeting also applies to social security medicare parts b and d which cover physician visits and prescription drugs and the national flood insurance program the federal debt limit acts as suspenders for the entire budget but none of those give rise to double counting disputes that suggests that there is something unusual perhaps flawed about budgeting for medicare part a to see what that is it helps to boil the dispute down to two basic questions about programs subject to belt and suspenders budgeting first can spending reductions or revenue increases in the program offset spending increases or revenue reductions in other programs in short can budget savings pay for other programs or must they stay within the program itself second would hitting the overall budget limit affect program operations in other words do budget savings extend the period during which the program can operate at full capacity or is the limit operationally toothless as shown above policymakers have answered these questions differently for different programs for further details see the appendix this comparison reveals the unique feature of medicare part a it is the only one of these programs that allows budget savings to pay for other programs and has a trust fund with real operational teeth it alone answers yes to both questions that is why medicare part a is the only program that creates the possibility of double counting and suffers from the reality of a double counting dispute double counting isn t possible in social security or the nfip because budget rules require that savings stay in the program it isn t possible for the budget as a whole since there are by definition no other programs to fund and double counting isn t possible in medicare parts b and d because its trust fund does nothing to limit operations but double counting is possible in medicare part a that happens whenever someone claims that the health reform legislation both reduces deficits and provides additional resources to medicare part a i will leave it to others to adjudicate whether any health reform proponents committed that error i will note however that every budget expert including chuck blahous agrees that cbo didn t do so its baseline ignores the trust fund so savings reduce deficits and have no effect on program operations bottom line the peculiar budget rules for medicare part a make it possible for analysts pundits and policymakers whether willfully or inadvertently to double count budget savings in medicare part a that needless confusion is a significant flaw to correct it congress could adopt the budget practices it uses in social security medicare b d or the nfip in a follow up post i will examine the pros and cons of these alternatives appendix how belt and suspenders budgeting works continue reading the fight over medicare double counting author donald posted on may 9 2012 may 18 2012 categories budget politics taxes tags budget budget process health medicare taxes 6 comments on the fight over medicare double counting why free is a bad price american airlines edition companies often run into trouble when they offer a service at a zero price not always of course many all you can eat buffets continue to thrive even though the marginal cost of the next chicken nugget is zero and many content providers manage to stay in business by selling radio tv or display ads against the free content users enjoy but all too often a zero price attracts bad customers and encourages excessive consumption marco arment of instapaper for example discovered that a zero price attracted undesirable customers for his app and at t famously discovered that offering unlimited iphone data could overwhelm its capacity thanks to ken besinger of the los angeles times we now have another juicy example the lifetime passes that american airlines sold to a small group of customers there are frequent fliers and then there are people like steven rothstein and jacques vroom both men bought tickets that gave them unlimited first class travel for life on american airlines it was almost like owning a fleet of private jets passes in hand rothstein and vroom flew for business they flew for pleasure they flew just because they liked being on planes they bypassed long lines booked backup itineraries in case the weather turned and never worried about cancellation fees flight crews memorized their names and favorite meals each had paid american more than 350 000 for an unlimited aairpass and a companion ticket that allowed them to take someone along on their adventures both agree it was the best purchase they ever made one that completely redefined their lives but all the miles they and 64 other unlimited aairpass holders racked up went far beyond what american had expected as its finances began deteriorating a few years ago the carrier took a hard look at the aairpass program heavy users including vroom and rothstein were costing it millions of dollars in revenue the airline concluded how did things go wrong american airlines miscalculated how pass holders would behave we thought originally it would be something that firms would buy for top employees said bob crandall american s chairman and chief executive from 1985 to 1998 it soon became apparent that the public was smarter than we were in economic jargon american fell victim to both adverse selection and moral hazard what customer wants to buy an unlimited lifetime pass one who s happy to spend a great deal of time flying about in first class with friends family members or a random person they just met at the gate and how will they behave as though first class seats are costless easy to book free to cancel a great gift for friends and strangers and even in some cases as a revenue source what happened next shouldn t be surprising first the passes went through a death spiral with american raising the price in a vain effort to make them profitable when last offered a single pass cost 3 million and was purchased by a grand total of nobody second american sicced its revenue management executives on the most flagrant of the frequent flyers as a result several had their passes revoked for misuse and american faces some lawsuits that make one wonder whether it crossed the line in trying to rid itself of these outrageously expensive customers author donald posted on may 7 2012 categories business microeconomics tags adverse selection airlines microeconomics moral hazard pricing 1 comment on why free is a bad price american airlines edition jobs report the soft side of mediocre as expected today s jobs data showed a slowing labor market payrolls expanded by 115 000 in ...
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