Unlike some other reproductions of classic texts (1) We have not used OCR(Optical Character Recognition), as this leads to bad quality books with introduced typos. (2) In books where there are images such as portraits, maps, sketches etc We have endeavoured to keep the quality of these images, so they represent accurately the original artefact. Although occasionally there may be certain imperfections with these old texts, we feel they deserve to be made available for future generations to enjoy.

"Everyone agrees on the need to reform Medicare but not on how to do it. Some argue the program is too comprehensive, others that it is not comprehensive enough. Some suggest it pays too much for health care, others, too little. Meanwhile, the financial stakes continue to mount. Medicare spending exceeded $400 billion in 2007, making it more expensive than the entire health systems of most other nations, as well as the largest national public program other than Social Security and national defense. In R eforming Medicare, Henry J. Aaron and Jeanne M. Lambrew deftly guide readers through this complex debate. They identify and analyze the three leading approaches to reform. Updated social insurance would retain the current system while rationalizing coverage and reducing bureaucracy. Premium support would replace the current system with a capped, per-person payment that beneficiaries could use to buy health insurance. Consumer-directed Medicare would have beneficiaries pay for care up to a high deductible from government- supported savings accounts and offer premium-support coverage above the deductible. In addition to rating each option on its ability to promote access to health care, improve the quality of care, and control costs, the authors evaluate each reform's political strengths and weaknesses. Given the heat generated by the Medicare debate, it is unlikely that any single approach will be implemented in full. Consequently, Aaron and Lambrew describe incremental strategies that blend elements of each plan. Their analysis provides essential insight into the types of hybrid policies that Congress will consider in coming years. "

The tax system profoundly affects countless aspects of private behavior. It is a powerful policy influence on the distribution of income and it is the one aspect of government that almost every citizen cannot avoid. With tax reform high on the political agenda, this book brings together studies of leading tax economists and lawyers to assess the various reform proposals and examine the effects of tax reform in several distinct areas. Together, these studies and comments on them present a balanced evaluation of professional opinion on the issues that will be critical in the tax reform debate. The book addresses annual and lifetime distributional effects, saving, investment, transitional problems, simplification, home ownership and housing prices, charitable groups, international taxation, financial intermediaries and insurance, labor supply, and health insurance. In addition to Henry Aaron and William Gale, the contributors include Alan Auerbach, University of California, Berkeley; David Bradford, Princeton University; Charles Clotfelter, Duke University; Eric Engen, Federal Reserve; Don Fullerton, University of Texas; Jon Gruber, Massachusetts Institute of Technology; Patric Hendershott, Ohio State; David Ling, University of Florida; Ronald Perlman, Covington & Burling; Diane Lim Rogers, Congressional Budget Office; John Karl Scholz, University of Wisconsin; Joel Slemrod, University of Michigan; and Robert Triest, University of California, Davis.

"In recent years, workers earnings have hardly grown, violence and crime have plagued the inner cities, homelessness and public begging have become commonplace, and family life has greatly deteriorated. With governments facing large deficits and slowly growing revenues, and public distrust in the efficiency of government and elected officials at all-time highs, the authors ask, ""What can government do for you?"" This book brings together a prominent group of experts to answer this critical question. Edited by Henry Aaron and Charles L. Schultze, two of the nation's most noted and experienced economists, the book focuses on the crucial domestic and social issues confronting America today. Seven vital areas are discussed by the following contributors: Henry Aaron on health care; Gordon L Berlin and William McAllister on homelessness; Linda R Cohen and Roger G. Noll on research and development; John J. DiIulio, Jr., on crime; Frank Levy and Richard J. Murnane on education and training; Isabel V. Sawhill on children and families; and Clifford M. Winston and Barry P. Bosworth on infrastructure. In each problem area, the authors use the results of research and analysis to identify existing or proposed governmental interventions that are likely to work, as well as some that are likely to fail and some that need to be reformed. They then present a budget proposal that not only pays for suggested changes in domestic policy, but brings the budget into virtual balance in ten years. "

" Setting National Priorities continues the highly acclaimed and influential series of books that examine domestic and foreign policy choices confronting the United States. Members of the Brookings staff join outside experts to evaluate America's course through the next decade. In clear and nontechnical terms the contributors explain and evaluate options for the United States in the 1990s, consider whether the federal government's current pollicies are consistent with long-term objectives, and explain what action could best achieve those goals. Charles L. Schultze shows why it is important to solve the problem of the federal budget deficit and how it can be done: John D. Steinbruner addresses the revolution taking place in American foreign policy and explains how the United States can be more secure with lower defense spending; Lawrence J. Korb evaluates President Bush's defense budget and suggests possible improvements; Robert Z. Lawrence describes how the U.S. government and private industry should respond to the competitive challenge from foreign companies; William D. Nordhaus explains the risks form global warming and presents a policy to meet them; John E. Chubb and Eric A. Hanshek chart new directions of American elementary and secondary education; Henry J. Aaron identifies the major problems with the financing of healthcare and describes how they can be solved; and Thomas E. Mann considers how political institutions and public preferences constrain our ability to enact needed policy changes and what might be done to overcome those obstacles. "

Examines the effects of rising social security costs and of measures adopted to deal with them, and discusses possible ways of coping with the shortfall of available money for the aging American population.

Whether the nation would be better served by an income tax or by a consumption tax has been debated by tax experts for decades. In practice, tax systems everywhere are mixed or ""hybrid"" systems. And while legislators have reasons for enacting such systems, the mix results in inequities, inefficiencies, and abuse.For Uneasy Compromise, Brookings brought together some of the nation's most knowledgeable tax experts and analysts to address the question: How should lawmakers grapple with the problems that arise from the side-by-side existence of principles of consumption taxation with principles of income taxation? Rather than propose rules for an ideal system that will never exist, this book addresses the problems created by a hybrid system. In so doing, it offers policymakers a comprehensive and sophisticated analysis of our current tax system and the tools for evaluating proposed refinements.

The well-documented gap between men's and women's earnings has aroused intense debate over the concept of comparable worth, that is, equal pay for work judged to be of equal value. Government, business, labor unions, and the courts have been forced to consider whether workers in dissimilar jobs of comparable worth measured by such criteria as working conditions, degree of difficulty, and knowledge and responsibility required should receive equal wages, and how wage adjustments can be implemented.The issue has provoked inflated rhetoric, litigation, and considerable confusion.In this concise study, Henry J. Aaron and Cameran M. Lougy review the conditions that have sparked the debate and unravel the implications of comparable worth for employers in public and private sectors, for labor union agendas and employer-employee negotiations, and for the administrative and and judicial burdens of the nation's courts. The authors conclude with general guidelines for implementing wage adjustments in ways that would not seriously disrupt society or have a major impact on overall economic efficiency.

"Reform of the United States tax system has become a central political issue. Assessing Tax Reform is a concise, nontechnical book to help general readers and students understand the tax reform issues Congress is now debating. Henry Aaron and Harvey Galper lay out the major alternative proposals and analyze principles of taxation that can be used for judging them. They explore the issues surrounding a move to a comprehensive income tax, a cash-flow tax, and the value-added tax or other consumption-based taxes. They show the conflicts and opportunities resulting from large current government deficits and the move for tax reform. In addition to clarifying the problems that must be solved if large-scale, long-term reform is to be achieved, the authors describe alternative strategies for increasing revenues quickly. They also present their own program for a fair, efficient, and less complex tax structure. They conclude with an examination of the political pitfalls that continue to make any major improvements in the tax system hard to enact. "

The social security system affects people throughout most of their lives, at work and in retirement. The supposed effects of social security on saving, labor supply, and the distribution of income figure prominently in current debates about whether and how to change the system. Theorists have developed alternative analytical frameworks for studying social security, but all involve extreme assumptions introduced for the sake of analytical tractability. Each study seems to describe the behavior of some, but not all or even most people. The shortcomings of available data have created additional roadblocks. As a result, the effects of social security on saving and labor supply are difficult to measure, and how such a complex system influences behavior is not at all well understood.Yet decisions on social security cannot be avoided. If analysts cannot agree, policymakers are likely to increase the weight they attach to perceptions of equity, adequacy of benefits, fairness of taxes, and similar qualitative considerations. Hence it is desirable for lay observers to understand the framework that analysts use and the reasons why there is so much uncertainty. This book sheds light on social security issues by examining evidence from economic studies about how the system affects saving, labor supply, and income distribution. It shows that these studies provide little evidence to support or refute assertions that social security has reduced saving, but they do indicate that it has contributed to the trend toward early retirement. The author finds that the aged are now about as well off on the average as the general population and that social security has played a considerable role in bringing about this equality. This volume is the sixteenth in the second serioes of Brookings Studies of Government Finance.

First published in 1862, this is a narrative of the life led in the islolated Ethiopia of a century ago.

Few people realize that one of the nation's largest health programs runs through the tax system. Reformers of all stripes propose to modify current tax rules as part of larger programs to increase coverage and control costs. Is the current system working? Will tax-based reforms achieve their goals? Several of the nation's foremost experts on taxation and health policy address these questions in Using Taxes to Reform Health Insurance, a joint product of the Urban-Brookings Tax Policy Center and the American Tax Policy Institute. Led by respected economists Henry Aaron of the Brookings Institution and Leonard Burman of the Urban Institute, contributors examine the role taxes currently play, the likely effects of recently introduced health savings accounts, the challenges of administering major subsidies for health insurance through the tax system, and options for using the tax system to expand health insurance coverage. No taxpayer or consumer of health care services can afford to ignore these issues.

More powerful and affluent today than ever, the United States has promising opportunities to influence the course of history. Yet these prospects are shadowed by significant perils and burdens. In this visionary book, leading scholars from the Brookings Institution and other prominent research organizations and universities analyze the major domestic and foreign policy problems facing the nation over the next five to ten years. The challenges on the domestic front are formidable: assuring fair but affordable access to health care, shoring up retirement income for an aging population, encouraging long-term economic growth, easing the growing pains of an increasingly diverse society, and reconciling energy policies with environmental concerns. In international affairs the central task is to use Americas unprecedented power wisely and to protect a homeland that has been revealed as surprisingly vulnerable. Yet efforts must also focus on improving the economic fortunes of poorer countries, expanding trade, and reforming the rules that regulate the flows of capital across national borders. Is the United States government capable of rising to these vast and varied challenges? The concluding chapters of this book offer cautious optimism. While it is often criticized, the American political system is fundamentally resilient and flexible. Ambitious in scope, Agenda for the Nation provides thoughtful, constructive answers to questions of how the U.S. government can effectively serve its citizens and meet its global responsibilities in a world of opportunity and uncertainty.

Academic medical centers provide cutting edge acute care, train tomorrow's physicians, and carry out research that will expand the range of treatable and curable illnesses. But these centers themselves may need urgent care --experts generally agree that many are suffering acute --even life-threatening --financial distress. Many academic medical centers are suffering for several reasons: in-patient admissions are down, as many procedures that once required a hospital stay are now performed on an out-patient basis or in a physician's office; managed care plans have negotiated discounted fees that cut hospital operating margins; the Balanced Budget Act of 1997 curtailed Medicare reimbursements, lowered margins and pushed some into the red; the revolution in information technology is imposing large new capital costs; and the character of medical education is receiving its most thorough review in decades. While there is a general consensus that medical centers are under pressure, experts disagree about the depth and pervasiveness of the current financial distress. Are they whining about financial pressures other, less-favored sectors find routine; or is the high quality American teaching hospital becoming an endangered species --that could face extinction if nothing is done. Because academic medical centers perform such important jobs, it is critical to determine the true nature and depth of their current financial problems --and then fashion analytically sound and politically sustainable solutions. This book brings together chief executive officers of major medical centers, university presidents, senior members of Congressional and executive office staffs, and leading analysts. These experts address the key issues and prescribe remedies both regulatory and legislative to ensure that the teaching hospital remains a picture of financial health. Contributors include Nancy Kane (Harvard School of Public Health), Jamie Reuter (Institute for Health Care Research Policy, Georgetown University), Peter van Etten (Juvenile Diabetes Foundation), Ralph Muller (University of Chicago Hospitals and Health System), James Robinson (School of Public Health, University of California, Berkeley), David Blumenthal (Institute for Health Policy, Massachusetts General Hospital), Edward Miller (Johns Hopkins University School of Medicine), Spencer Foreman (Montefiore Medical Center), Lawrence Lewin (Lewin Group), Gail Wilensky (Project HOPE), Robert Dickler (American Association of Medical Colleges), and Kenneth Shine (Institute of Medicine).

Why did President Clinton's efforts to reform the financing of American health care fail? For years to come, politicians and scholars of public policy will revisit the debate over Clinton's health care plan. What did planners do right? And what did they do wrong? How can the mistakes of that experience be avoided in the future? What steps can now be taken to achieve some measure of reform in smaller pieces? In The Problem That Won't Go Away, economists, political scientists, sociologists, public opinion experts, and government staff offer answers to these and other crucial questions. They recount the history of the Clinton health care plan, present several alternative strategies the administration might have pursued, and conclude that none was likely to achieve the administration's goals of universal coverage and cost containment. Many support the view that the administration, Congress, and the nation lacked the political consensus and the information to credibly describe the effects of any single bill to reform the U.S. health care system. In that case, was the only option available to the administration to reach for goals far more modest than those it sought? Health care financing as a national political issue will not go away. Pressure to cut public spending to balance the budget means that medicare and medicaid will stay in the legislative spotlight; the retirement of the baby-boom generation in the beginning of the next century promises large increases in the cost of medicare; and a flood of new and costly medical technologies will continue to put financial pressure on everyone responsible for paying for health insurance. But, as this book illustrates, the nature of the debate inthe years after the demise of the Clinton plan will be altogether different from that of the past several decades.

The United States spends more on health care than any other nation in the world, yet millions of Americans cannot afford basic care for acute illnesses, few are insured against the costs of long-term care, and many frequently used medical procedures have never been fully evaluated. The goals of controlling spiraling health care costs and extending insurance coverage or even maintaining current insurance coverage seem to be in conflict. But progress can be made on both goals if they are tacked together. Henry Aaron evaluates these critical issues and explores how adequate care can be provided without fueling inflation. Because the current arrangements for financing America's health care cannot endure, Aaron contends that a major national debate on the restructuring of the U.S. system of financing health care is inescapable, and major legislation is likely. Serious and Unstable Condition offers a guide that is crucial to understanding the reform debate. It explains the important economic issues of health care as a background for evaluating both the current system and proposals for change. Aaron compares the U.S. system of health care financing with certain foreign systems and reviews major options for reform. He cautions that unless the health insurance system is radically changed, the number of uninsured will continue to increase and costs will continue to escalate. He then offers his own comprehensive plan to address these problems.

First published in 1862, this is a narrative of the life led in the islolated Ethiopia of a century ago.

In the early 1960s America was in a confident mood and embarked on a series of efforts to solve the problems of poverty, racial discrimination, unemployment, and inequality of educational opportunity. The programs of the Great Society and the War on Poverty were undergirded by a broad consensus about what our problems as a nation were and how we should solve them. But by the early seventies both political and scholarly tides had shifted. Americans were divided and uncertain about what to do abroad, fearful of military inferiority, and pessimistic about the capacity of government to deal affirmatively with domestic problems. A new administration renounced the rhetoric of the Great Society and changed the emphasis of many programs. On the scholarly front, new research called into question the old faiths on which liberal legislation had been based. In this book, the sixteenth volume in the Brookings series in Social Economics, Henry Aaron describes both the initial consensus and its subsequent decline. He examines the evolution of attitude and pronouncements by scholars and popular writers on the role of the federal government and its capacity to bring about beneficial change in three broad areas: poverty and discrimination, education and training, and unemployment and inflation. He argues that the political eclipse of the Great Society depended more on events external to it--war in Vietnam, dissolution of the civil rights coalition, and, finally, the Watergate scandal and all its repercussions--than on its intrinsic failings. Aaron concludes that both the initial commitment to use national polices to solve social and economic problems and the subsequent disillusionment of scholars andlaymen alike rest largely on preconceptions and faiths that have little to do with research themselves.