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将资源从年轻群体转移到老年群体。然而，不太清楚的是，联邦医疗保险在队列中重新分配资源的方式。虽然弱势群体缴纳的医疗保险税较少，但他们也往往更早去世，获得的医疗保险福利也更少。我们建议使用几个新的数据源来调查医疗保险是否将资源重新分配给队列中的弱势群体，以及它是否改善了任何或所有这些群体的福利。我们将把受教育程度较低的人与受教育程度较高的人进行比较，将非白人与白人进行比较，并将吸烟者与非吸烟者进行比较。我们的计算将主要基于联邦医疗保险当前受益人调查中关于联邦医疗保险福利的个人水平数据，以及从健康和退休研究的收入历史文件中支付的终身联邦医疗保险税收的个人水平纵向数据。我们的方法与以前的研究不同，它使用的是个人层面的数据--与之前对地理聚集的联邦医疗保险索赔数据的研究不同--似乎揭示了联邦医疗保险中极高程度的累进。我们的数据表明，处于不利地位的人--病情较重的人--获得了更多的医疗保险福利，尽管富裕地区的平均医疗保险申领人数更高。因此，对于较贫穷的群体来说，联邦医疗保险的现金价值似乎更高。我们提出了这一结果的至少两个原因：较富裕地区的医疗价格水平较高，因此医疗支出的地理差异可能具有误导性；此外，较富裕地区往往拥有更好的医疗设施，因此将吸引更多患病的人。我们提出了两种不同的计算福利效应的方法：第一，结构较少的方法产生了医疗保险福利和累进性的下限；第二，结构较少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政策变化的福利影响--例如废除联邦医疗保险收入上限--以及拟议的政策变化--例如联邦医疗保险处方药福利、联邦医疗保险资格年龄的变化，或联邦医疗保险的“买入”提议。

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.