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