WHOM DOES MEDICARE BENEFIT

描述（由申请人提供）：医疗保险索赔支付的快速增长已经将资源从年轻人群转移到老年人群。然而，不太清楚的是，医疗保险是如何在人群中重新分配资源的。虽然弱势群体缴纳的医疗保险税较少，但他们往往死得更早，获得的医疗保险福利也更少。我们建议使用几个新的数据来源来调查医疗保险是否将资源重新分配给一个队列中的弱势群体，以及它是否改善了任何或所有这些群体的福利。我们将比较受教育程度较低的人和受教育程度较高的人，非白人和白人，吸烟者和不吸烟者。我们的计算将主要基于医疗保险当前受益人调查中关于医疗保险福利的个人层面数据，以及健康与退休研究的收入历史档案中关于终身医疗保险税的个人层面纵向数据。我们的方法不同于以前的研究，它使用个人层面的数据，这与以前的研究不同，地理上汇总的医疗保险索赔数据，似乎揭示了医疗保险的高度累进性。我们的数据表明，处境不利的人——病情更重的人——获得更多的医疗保险福利，尽管富裕地区的平均医疗保险索赔更高。因此，医疗保险的现金价值似乎对贫困群体更高。对于这一结果，我们提出了至少两个原因：富裕地区的医疗保健价格水平较高，因此医疗保健支出的地理差异可能具有误导性；此外，较富裕的地区往往拥有更好的医疗设施，因此会吸引病情较重的人。我们提出了两种不同的方法来计算福利效应：第一种，较少结构性的方法产生了医疗保险福利和累进性的下限；第二种更为结构性的方法产生的上限和下限也可能更紧。最后，我们的数据可以用来评估过去的政策变化对福利的影响——比如废除医疗保险收入上限——以及拟议的政策变化——比如医疗保险处方药福利、医疗保险资格年龄的变化，或者医疗保险“买入”提案。

DESCRIPTION (provided by applicant): Rapid growth in Medicare claims payments has transferred resources away from younger cohorts to elderly cohorts. Less clear, however, is the way in which Medicare redistributes resources within cohorts. While disadvantaged groups pay fewer Medicare taxes, they also tend to die earlier and receive fewer Medicare benefits. We propose to use several new data sources to investigate whether Medicare redistributes resources towards disadvantaged groups within a cohort, and whether it improves the welfare of any or all these groups. We will compare less educated people to the more educated, non-whites to whites, and smokers to nonsmokers. Our calculations will be based primarily on individual-level data on Medicare benefits from the Medicare Current Beneficiary Survey, and on individual-level longitudinal data on lifetime Medicare taxes paid from the Health and Retirement Study's Earnings History Files. Our approach differs from previous research in its use of individual-level data, which--unlike the previous studies of geographically aggregated Medicare claims data--seem to reveal an extremely high degree of progressivity in Medicare. Our data suggests that disadvantaged people--who are sicker--receive more Medicare benefits, even though average Medicare claims are higher in richer areas. As a result, the cash value of Medicare seems to be higher for poorer groups. We propose at least two reasons for this result: health care price levels are higher in richer areas, so that geographic variation in health care expenditures can be misleading; in addition, richer areas will tend to have better health care facilities and will thus attract sicker people. We propose two distinct methods for calculating welfare effects: the first, less structural approach yields a lower bound on the benefits and progressivity of Medicare; the second, more structural approach yields both upper and lower bounds that are also likely to be tighter. Finally, our data can be used to evaluate the welfare impact of past policy changes-- such as the repeal of the Medicare earnings cap--and proposed policy changes--such as a Medicare prescription drug benefit, changes in the age of Medicare eligibility, or Medicare "buy-in" proposals.