Question A:
Consider one of two proposals for restraining future Medicare spending, each by the same amount: The method that President Obama enacted in the Affordable Care Act — reducing Medicare-related payments to private insurers and altering the payment system for doctors and hospitals — imposes risks on future Medicare patients because over time the supply of doctors, hospitals and insurers willing to offer them health services may decline in response to restrained payments.
Responses
Responses weighted by each expert's confidence
Question B:
Consider the other of two proposals for restraining future Medicare spending, each by the same amount: The method that Governor Romney advocates — giving future seniors a fixed payment for premiums and letting private insurers compete with Medicare — imposes risks on future Medicare patients because competition may not be powerful to enough to offer future seniors the same quality of care that is currently promised without supplementing their premium support.
Responses
Responses weighted by each expert's confidence
Question A Participant Responses
| Participant | University | Vote | Confidence | Bio/Vote History |
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 Daron Acemoglu |
MIT | Bio/Vote History | ||
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There is fat and monopoly markups in the system to be cut. The problem with the ACA is the absence of across the board credible cost cutting
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 Alberto Alesina |
Harvard | Did Not Answer | Bio/Vote History | |
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 Joseph Altonji |
Yale | Bio/Vote History | ||
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 Alan Auerbach |
Berkeley | Bio/Vote History | ||
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 David Autor |
MIT | Bio/Vote History | ||
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Obamacare is a risky step into the unknown; The alternative of voucher-care is a faith-based exercise, already disproved by the evidence.
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 Katherine Baicker |
University of Chicago | Bio/Vote History | ||
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 Marianne Bertrand |
Chicago | Bio/Vote History | ||
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 Raj Chetty |
Harvard | Bio/Vote History | ||
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 Judith Chevalier |
Yale | Bio/Vote History | ||
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Savings could result both from particular therapies being disallowed as well as control over price of a given therapy.
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 Janet Currie |
Princeton | Bio/Vote History | ||
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Medicare is such an important market that providers will not be able to turn their backs on these patients.
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 David Cutler |
Harvard | Bio/Vote History | ||
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Every policy has risks, so one can't say no. The evidence suggests this is not major, though.
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 Angus Deaton |
Princeton | Bio/Vote History | ||
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It is supposed to be compensated by there being fewer uninsured.
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 Darrell Duffie |
Stanford | Bio/Vote History | ||
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 Aaron Edlin |
Berkeley | Bio/Vote History | ||
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The amount of risk depends not just on supply but on the political will to restrain payments if supply shrinks
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 Barry Eichengreen |
Berkeley | Bio/Vote History | ||
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 Ray Fair |
Yale | Bio/Vote History | ||
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 Pinelopi Goldberg |
Yale | Bio/Vote History | ||
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 Claudia Goldin |
Harvard | Bio/Vote History | ||
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 Austan Goolsbee |
Chicago | Did Not Answer | Bio/Vote History | |
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 Michael Greenstone |
University of Chicago | Did Not Answer | Bio/Vote History | |
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 Robert Hall |
Stanford | Bio/Vote History | ||
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It seems unlikely that such serious cutbacks would ever occur. The risk is to the government's fiscal position, not to US health.
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 Bengt Holmström |
MIT | Bio/Vote History | ||
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Implementation details will determine how severe this problem becomes. Not a big problem in many countries with national health insurance.
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 Caroline Hoxby |
Stanford | Did Not Answer | Bio/Vote History | |
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 Kenneth Judd |
Stanford | Bio/Vote History | ||
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These payments come from a bargaining process. When too high, Medicare pushes them down. If there is exit, Medicare will allow them to rise.
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 Anil Kashyap |
Chicago Booth | Bio/Vote History | ||
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Assuming that they actually hold the line on payments.
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 Pete Klenow |
Stanford | Bio/Vote History | ||
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Medicare is not on a sustainable path, so some sacrifice of promised future benefits is inevitable.
-see background information here |
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 Edward Lazear |
Stanford | Did Not Answer | Bio/Vote History | |
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 Jonathan Levin |
Stanford | Bio/Vote History | ||
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Surely pricing decisions in Medicare have incentive effects but would expect how cuts are made to matter a lot.
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 Eric Maskin |
Harvard | Bio/Vote History | ||
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 William Nordhaus |
Yale | Bio/Vote History | ||
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 Maurice Obstfeld |
Berkeley | Bio/Vote History | ||
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 Emmanuel Saez |
Berkeley | Bio/Vote History | ||
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 José Scheinkman |
Columbia University | Did Not Answer | Bio/Vote History | |
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 Richard Schmalensee |
MIT | Bio/Vote History | ||
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 Hyun Song Shin |
Princeton | Bio/Vote History | ||
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 Nancy Stokey |
University of Chicago | Bio/Vote History | ||
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If it becomes a serious problem, the reimbursement method or something else) will be modified.
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 Richard Thaler |
Chicago Booth | Bio/Vote History | ||
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Of course, there is no such thing as a risk free lunch.
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 Christopher Udry |
Northwestern | Bio/Vote History | ||
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There is some probability that complementary policies to contain the growth of medical costs will not be sufficiently effective.
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 Luigi Zingales |
Chicago Booth | Bio/Vote History | ||
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Question B Participant Responses
| Participant | University | Vote | Confidence | Bio/Vote History |
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Daron Acemoglu |
MIT | Bio/Vote History | ||
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the problem isn't lack of power from competition but other parts of the plan which do not make sense and may rely on cutting redistribution
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Alberto Alesina |
Harvard | Did Not Answer | Bio/Vote History | |
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Joseph Altonji |
Yale | Bio/Vote History | ||
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Alan Auerbach |
Berkeley | Bio/Vote History | ||
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David Autor |
MIT | Bio/Vote History | ||
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There is no evidence that private sector is more effective at healthcare cost control than public sector. Privatization only shifts costs.
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Katherine Baicker |
University of Chicago | Bio/Vote History | ||
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Marianne Bertrand |
Chicago | Bio/Vote History | ||
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Raj Chetty |
Harvard | Bio/Vote History | ||
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Judith Chevalier |
Yale | Bio/Vote History | ||
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Janet Currie |
Princeton | Bio/Vote History | ||
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The market for health care is not competitive. Under this proposal prices will increase, leaving seniors unable to afford care.
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David Cutler |
Harvard | Bio/Vote History | ||
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This depends enormously on how the voucher is set wrt expected costs. The proposals involve enormous risks.
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Angus Deaton |
Princeton | Bio/Vote History | ||
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Darrell Duffie |
Stanford | Bio/Vote History | ||
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Aaron Edlin |
Berkeley | Bio/Vote History | ||
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This risk verges on certainty. The private insurance system has not been very good at restraining costs.
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Barry Eichengreen |
Berkeley | Bio/Vote History | ||
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Ray Fair |
Yale | Bio/Vote History | ||
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Pinelopi Goldberg |
Yale | Bio/Vote History | ||
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Claudia Goldin |
Harvard | Bio/Vote History | ||
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Cherrypicking will occur and the government option gets more adversely selected.
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Austan Goolsbee |
Chicago | Did Not Answer | Bio/Vote History | |
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Michael Greenstone |
University of Chicago | Did Not Answer | Bio/Vote History | |
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Robert Hall |
Stanford | Bio/Vote History | ||
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So, of course, premium support in lieu of Medicare would be raised. Again the risk is to fiscal, not medical, health.
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Bengt Holmström |
MIT | Bio/Vote History | ||
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I don't see how competition can eliminate serious adverse selection problems
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Caroline Hoxby |
Stanford | Did Not Answer | Bio/Vote History | |
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Kenneth Judd |
Stanford | Bio/Vote History | ||
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Insurance companies will spend money to attract healthy people and push others to Medicare.
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Anil Kashyap |
Chicago Booth | Bio/Vote History | ||
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Also risky assuming premium support is limited; some cherry picking could also cause problems for traditional Medicare
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Pete Klenow |
Stanford | Bio/Vote History | ||
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Future benefits have to fall, and this is one way. Massachusetts offers hope that a hybrid plan could reduce non-plan costs too.
-see background information here |
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Edward Lazear |
Stanford | Did Not Answer | Bio/Vote History | |
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Jonathan Levin |
Stanford | Bio/Vote History | ||
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Again seems hard to say - depends on plan requirements and level of premium support.
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Eric Maskin |
Harvard | Bio/Vote History | ||
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William Nordhaus |
Yale | Bio/Vote History | ||
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Maurice Obstfeld |
Berkeley | Bio/Vote History | ||
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Emmanuel Saez |
Berkeley | Bio/Vote History | ||
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José Scheinkman |
Columbia University | Did Not Answer | Bio/Vote History | |
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Richard Schmalensee |
MIT | Bio/Vote History | ||
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Hyun Song Shin |
Princeton | Bio/Vote History | ||
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Nancy Stokey |
University of Chicago | Bio/Vote History | ||
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It is not obvious what the current system "promises" to a fifty- or sixty-year old.
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Richard Thaler |
Chicago Booth | Bio/Vote History | ||
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This one is more substantive. It is like changing from an indexed DB plan to a nominal DC plan. Worse, adds risks that states default!
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Christopher Udry |
Northwestern | Bio/Vote History | ||
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Luigi Zingales |
Chicago Booth | Bio/Vote History | ||
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