Chris Pope

@biggsag is there any evidence that the negative work incentives of the payroll tax are in any way offset by the vague link of future benefit levels to prior employment?

The optimum strategy, from a growth if not fairness perspective, is default on already-accrued Social Security benefits while keeping the rate at which future benefits are earned reasonably generous.

A wonky point: from an economic perspective this approach-honor accrued Social Security benefits, then change the deal going forward-is actually the worst thing. People work less because their accrued benefits are secure, then work even less because the deal worsens at the margin

@proales I was being conservative with the claim!

@CPopeHC more scrutiny than Medicaid spending $25b

It's not an exaggeration to say that a village board will apply more scrutiny and oversight to $25,000 in its budget than the federal government will to $250,000,000 in Medicaid spending.

Studies find the growth of Medicare Advantage penetration from ~15% to ~30% generates a "spillover effect" in FFS savings due to changes in medical practice styles. But this doesn't necessarily imply that practice styles would revert if MA penetration declined from 50% to 40%.

Before Medicare and Medicaid, the healthcare safety-net was mostly a matter of public hospitals. That was probably underrated as a method of targeting public aid at unmet needs, while minimizing crowd-out of private resources or moral hazard. nber.org/papers/w34976

The issue with taxes on Medicaid providers is simply how much states should be allowed to tax the federal government. Ideally, this should be zero.

According to the National Survey of Children's Health: 32% of children are overweight. 7% of parents are concerned their kids are overweight. nschdata.org/browse/survey/… nschdata.org/browse/survey/…

@lawsonhmansell The attempt to pass the buck on dealing with key trade-offs has been an obvious flaw since before the bill was passed: manhattan.institute/article/make-s…

@CPopeHC And they only get paid when they make a ruling, creating an incentive to accept ineligible disputes rather than weed them out. Determining eligibility is easy, and should definitely not be the abritrator's job

A fundamental problem is that providers are effectively the customers of arbitrators, and so arbitrators have an incentive to keep them happy by ruling in their favor.

It's hard to not be reminded of Allan Bloom's observation about public health being last refuge of the moral instinct. But you end up with an impoverished case for a good life if you insist on making it in medical terms: healthaffairs.org/content/forefr…

Life expectancy increased from 59 to 75 from 1925 to 1985, but Americans reported they were getting sicker. (to some extent because many were living longer) archive.org/details/worrie…

Apparently New York has the nation's most expensive public school system.

If AI reduces the cost of administrative tasks, why do providers need to be paid *more* to use it? insidehealthpolicy.com/daily-news/beh…

It makes no sense to want to eliminate the (mostly state/local) non-profit hospital tax exemption, while also wanting to reduce the ability of states to inflate federal Medicaid costs with "provider taxes."

@sc_cath That's not true. The bottom quintile are already in Medicaid or use uncompensated care, but many of them would be hit with a big new payroll tax. Most of the additional spending would go to upper-income people who currently have private insurance. meps.ahrq.gov/mepsweb/data_s…

@JoshuaTMcCabe If you want money for the unemployed and new parents who need it, the best (and likely politically easier) way to get it is by temporarily *cutting* payroll taxes! manhattan.institute/article/target…

@CPopeHC Yes, diminishing marginal returns to OASDI expansion but still lots of protection of existing benefits and lots of room to expand other programs like UI and PFML.

Democrats used to be good at making the case for raising revenue to fund social policy priorities. From the best policy history you probably never read: "By 1937, 73 percent of respondents to a Gallup poll 'approved of the current social security tax on their wages'."

@JoshuaTMcCabe ...it's hard to imagine anything that would reduce the popularity of Medicare more than requiring an increase in the Medicare Payroll tax to the degree needed to also finance Parts B and D.

@JoshuaTMcCabe Contributory financing was popular in the Samuelsonian Ponzi era, when it could give everyone more than they put in -- but it now implies the opposite (which is why few propose broad-based FICA rate increases).

Income taxes on low-income workers are already pretty low, but this is a pretty good way to signal that you're more interested in keeping things that way, than increasing redistribution to public sector interest groups.