The Redistributive Effects of Medicare

描述(由申请人提供)：联邦医疗保险旨在保障医疗 关爱弱势老年人。然而，它恰恰是这样的脆弱 倾向于更早死亡和获得更少医疗保险福利的人口。 基于这一事实，我们建议回答三个问题。(1)是联邦医疗保险吗 在精算上对高死亡风险的个人公平吗？(2)什么是 医疗保险对不同死亡风险人群福利的影响？(3) 不同的支付方案，如经济状况调查或更多的累进税种 支付，改善医疗保险的福利效果？我们特别专注于 高危人群的三个特征：教育程度低， 作为一个少数族裔，作为一个吸烟者。计算进行…的计算 为了公平起见，我们建议使用健康和退休调查(FIRS) 用于计算以下人员支付的医疗保险税总额的收入和福利补充 具有不同死亡风险的群体。然后比较预期的纳税金额。 至预期的联邦医疗保险福利，从联邦医疗保险当前受益人计算 调查(MCBS)数据。为了计算医疗保险的福利效应，我们依赖于 联邦医疗保险作为强制性年金的理论见解 医疗护理。年轻的纳税人被要求购买这笔年金，这笔钱 当纳税人年满65岁时，就可以享受医疗服务了。要求每个人都要 购买这项年金提高了个人支付的年金价格。 对于低死亡风险的人来说，降低了死亡风险。这一分析 为我们提供了计算高危人群福利损失的公式 由低风险人群使用生命表数据和MCBS数据获得。最后，我们 将使用我们的结果来模拟对精算公平性的影响 使医疗保险税收和共同支付费率更具累进性的福利。

DESCRIPTION (provided by applicant): Medicare was designed to guarantee medical care to the vulnerable elderly. However, it is precisely this vulnerable population that tends to die younger and receive fewer Medicare benefits. Motivated by this fact, we propose to answer three questions. (1) Is Medicare actuarially fair to individuals at high risk for mortality? (2) What is the effect of Medicare on the welfare of groups with different mortality risks? (3) Can different payment schemes, such as means testing or more progressive tax payments, improve the welfare effects of Medicare? We focus specifically on three identifiers of high-risk individuals: having low educational attainment, being a racial minority, and being a smoker. To conduct the calculations of actuarial fairness, we propose to use the Health and Retirement Survey (FIRS) Earnings and Benefits supplement to calculate total Medicare taxes paid by groups with different mortality risks. Expected tax payments are then compared to expected Medicare benefits, calculated from Medicare Current Beneficiary Survey (MCBS) data. To calculate the welfare effects of Medicare, we rely on the theoretical insight that Medicare functions as a mandatory annuity for medical care. Young taxpayers are required to purchase this annuity, which pays out medical care when the taxpayer reaches age 65. Requiring everyone to purchase this annuity raises the annuity price paid b individuals with high mortality risks and lowers it for those with low mortality risks. This analysis provides us with formulae for calculating the welfare lost by high-risk people and gained by low-risk people, using life table data and MCBS data. Finally, we will use our results to simulate the impacts on actuarial fairness and on welfare of making Medicare taxes and co-payment rates more progressive.