Edward Conard

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  • “…a very valuable contribution.” - Larry Summers, former Secretary of the Treasury and director of the National Economic Council, president emeritus, Harvard University
  • “Unintended Consequences offers deep and well-argued analyses on almost every issue.” - The New York Times
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  • “…a must-read for serious students of economic policy.” - Glenn Hubbard, Dean, Columbia Business School, and former Chairman of the Council of Economic Advisers
  • “Unintended Consequences provides a provocative interpretation of the causes of the global financial crisis and the policies needed to return to rapid growth. Whether you agree or not, this analysis is well worth reading.” - Nouriel Roubini, New York University; Chairman, Roubini Global Economics
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  • “…a comprehensive explanation of the modern economy.” - Julian Robertson, Founder, Tiger Management
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The Consumption, Income, and Well-Being of Single Mother Headed Families 25 Years After Welfare Reform

Jeehoon Han National Bureau of Economic Research
Date Posted:
September 1, 2021
Is Database:
Database

Consumption growth of lowest decile of single mother headed families has outpaced those higher up consumption distribution over the past 25 years, according to @JeehoonHan @nberpubs.

Over the past 25 years, the consumption growth of the lowest decile of single mother headed families has notably outpaced those higher up the consumption distribution. This trend highlights a significant shift in economic well-being among the most economically disadvantaged single mother families. Data indicates that while overall consumption levels have risen, the bottom decile experienced a more pronounced increase, suggesting targeted welfare reforms may have contributed to this improvement. The implications of this trend are critical for policymakers aiming to address income inequality and enhance support for vulnerable populations. As these families' consumption capacity grows, it reflects broader economic changes and potential shifts in social safety net effectiveness.

Jeehoon Han, Bruce Meyer and James Sullivan,"The Consumption, Income, and Well-Being of Single Mother Headed Families 25 Years After Welfare Reform," National Bureau Of Economic Research, August 2021, https://www.nber.org/papers/w29188

Ben Comment: Housing is a huge part of the growth in consumption for households but it seems like the measure of housing consumption is tightly linked to real estate value. With a long down trend in interest rates (and there for a long up trend in real estate prices), it seems like this measure of well being mechanically increases without actually changing someone’s well being. It would be nice to see consumption ex housing. Also interesting that the next category in which there’s the most consumption increase is food - which has notoriously volatile prices (this is why it’s stripped out of the core measure of inflation).

Bruce Meyer builds off his previous work on consumption inequality, his (consumption) results suggest, "...provide strong evidence that the material circumstances of single mothers improved in the decades following welfare reform..."

Bottom line, "... While some mothers undoubtedly fared poorly after welfare reform, the distribution shifted in favorable ways. The consumption of the lowest decile of single mother headed families has risen noticeably over time and at a faster rate than those higher up in the consumption distribution.Indications of improved well-being are evident in measures of expenditures on housing, food, transportation and utilities as well as in housing characteristics and health insurance coverage. The material circumstances of single mothers especially affected by welfare reform have also improved relative to plausible comparison groups. Median consumption of low-educated single mothers has risen relative to that of low-educated childless women and married mothers and relative to high-educated single mothers. This evidence during the period of the policy changes of the 1990s suggests that a combination of a reduction in unconditional aid and an expansion of aid conditional on work (with exceptions for those who could not work) was successful in raising material well-being for single mothers....It is important to note that although we find strong evidence that the material circumstances of single mothers improved in the decades following welfare reform, other components of well-being may have followed a different pattern. For example, these policy changes may have adversely, or positively, affected time spent with children, health, educational investments, outcomes for children, or other important outcomes.... It is also important to note that our evidence of improved economic circumstances does not imply that the level of economic well being for single mothers is high. In fact, the families that are the focus of this study have very few resources; average total annual consumption for a single mother with two kids in the bottom decile of the consumption distribution is about $14,000 in 2019...."
Premise, "...In this paper, we analyze changes in material well-being between 1984 and 2019, focusing on the period starting in 1993 with the welfare waivers that preceded PRWORA. We study single mother headed families—the primary group affected by the changes in tax and welfare policy. For these families, we analyze changes in income and consumption and other measures of well-being. We focus on consumption, particularly its most well-measured components, given its conceptual advantages over income as a measure of economic well-being as well as the pronounced underreporting of income in surveys..."

Income

"...Our results for income, which do not correct for underreporting,show that while income grew for single mothers, particularly during the years shortly after welfare reform, the pattern is quite different for the lowest income single mothers. For those in the bottom income decile, income falls sharply after welfare reform. We argue that these reported changes reflect the growing underreporting of income. The trends in consumption, on the other hand, show steady increases over a long period from at least the early 1990s up until 2007, with the largest increases apparent for the lowest decile, providing little evidence that the most disadvantaged families became worse off after welfare reform.Consumption has grown more slowly, if at all, for most deciles since the start of the Great Recession, although we continue to see a rise in consumption at the very bottom...."

Consumption

"... we find that all of the components of (well-measured) consumption have risen since the early 1990s—although food at home is flat at the bottom of the distribution of consumption—and that much of the rise in consumption is accounted for by increased consumption of housing, utilities, and gasoline and motor oil.Although homeownership rates have not increased, we do find increases in out-of-pocket rent for those who are renting, and this rise is accompanied with noticeable improvements in the characteristics of the living unit—more rooms, more amenities, and fewer housing problems. In previous work we had shown that health insurance coverage declined somewhat in the years immediately after welfare reform (Meyer and Sullivan, 2008). Since then, health insurance coverage for single mothers has expanded due to later expansions in coverage under the ACA...."

Reminder of what the consumption data is,

"...Our analyses primarily use consumption data from the Consumer Expenditure (CE) Interview Survey. The CE is a quarterly survey that provides comprehensive information on family spending for about 7,000 families each quarter (or about 5,000 prior to 1999). We use the surveys from the first quarter of 1984 through the first quarter of 2020. Surveys are administered throughout the three months of a quarter, and questions about expenditures typically have a reference period of the three months preceding the interview month. For each observation we specify the reference year as the year in which the majority of reference months fall. Our main analysis sample from the CE includes families headed by a single woman aged 18-54 who lives with her own children only and at least one child is under the age of 18, which excludes single mother headed families where other related or unrelated adults are present. We include observations with reference years for spending from 1984 to 2019, a period that spans many years prior to and after the implementation of the major reforms to the social safety net during the 1990s that we highlight...."Note they use PCE.

Comp shift in single mother population

"... There have been substantial changes in the composition of the single mother population over the last four decades. For example, single mothers in the 2010s were more likely to be Hispanic and more likely to attend college than those in1980s...Because our analysis focuses on the effects of tax and welfare reform on consumption growth, we exclude the influence of changes in the demographic composition of the single mother population by holding observable characteristics—age, education, and race/ethnicity of head— constant over time by re-weighting the samples from 1987-2019. Specifically, we first divide our sample from the first period (1984-1986) into 24 demographic cells defined by three variables: age (18-34, 35-54), education (high school dropout, high school degree, some college, College degree or above), and race/ethnicity (non-Hispanic White, non-Hispanic other race, Hispanic). These cells are defined broadly enough to ensure that none of the periods contain empty cells. We then use the share of the population in each of the 24 demographic cells to adjust the weights to hold constant demographic characteristics....

Changes in Income and Consumption of the Worst Off

"....Before we present our main results for consumption, we consider how income has changed for single mother headed families at different parts of income distribution from 1984 to 2019. Figure 3 shows the percent changes in after-tax income plus food stamps and housing subsidies relative to 1990-92 by income decile using the CPS ASEC. Because small annual samples can result in somewhat noisy estimates, we pool the annual data into 3-year intervals. These results indicate that in the 25 years following welfare reform income for single mothers above the bottom decile rose by 6 to 20 percent, but for those in the bottom decile it fell by 13 percent. Although these analyses use the CPS, in Appendix Figures 1a and 1b, we demonstrate that the results using the CE are broadly consistent with those from the CPS when we use pre-taxincome plus food stamps/SNAP as an income measure, which is defined compatibly in the two surveys..."

The Consumption, Income, and Well-Being of Single Mother Headed Families 25 Years After Welfare Reform: Comments Image 1


"... Figure 4 and Panel A of Table 1 show how consumption has changed for single mothers between 1984 and 2019 relative to the early 1990s for each of the bottom five deciles and the top half of the consumption distribution. These results differ sharply from those for income in two ways. First, unlike the income data indicating declines for single mothers in the bottom decile, consumption data indicate improvements at all deciles. Second, single mothers in the bottom income decile see the greatest decline in income, whereas single mothers in the bottom consumption decile experience the greatest rise in consumption. In particular, consumption for single mothers in the bottom decile rises by 39% between 1990-92 and 2017-19. The degree of consumption growth during this period declines monotonically as we move up the consumption distribution, with consumption in the top half of the distribution rising only by 19%...."

The Consumption, Income, and Well-Being of Single Mother Headed Families 25 Years After Welfare Reform: Comments Image 2

The Consumption, Income, and Well-Being of Single Mother Headed Families 25 Years After Welfare Reform: Comments Image 3


'... Between the early 1990s and 2005- 07, consumption increased by 31% for single mothers in the bottom decile and it increased by 25% for those in the top half. After 2005-07, consumption rose only modestly (by 1-6%) for those in the bottom five deciles, while consumption declined by 5% for those in the top half. In the following section, we consider the extent to which the improved material well-being is due to policy changes, as opposed to changes in macroeconomic conditions, by comparing the patterns of consumption for single mothers to those of other groups that are less likely to be affected by the policies. We verify that these patterns of rising consumption are robust to alternative appro­aches. For example, we find similar patterns when looking at a measure of total consumption (that includes components that are not well-measured). These results, which are reported in Appendix Figure 2, indicate that consumption for those in the bottom decile rose by 35% between the early 1990s and 2019, as compared to 39% growth for well-measured consumption. For the top half of the distribution, the growth in total consumption during this period is less pronounced (14%) than the growth in well-measured consumption (19%).In results not reported, we also verify that these patterns are not sensitive to how we account for the changing demographic composition of the single mother population over time..."

The Consumption, Income, and Well-Being of Single Mother Headed Families 25 Years After Welfare Reform: Comments Image 4


"... We report changes in median consumption for all three groups of low-educated women and by education for just single mothers (Figure 5). For the low-educated, median consumption rises noticeably for all three groups, but the rise is most pronounced for single mothers (Figure 5a). We also see that consumption rises more for low-educated single mothers than for high educated single mothers (Figure 5b). Between 1990-92 and 2017-19, ­median consumption rose by 33 percent for low-educated single mothers, while it rose by 17 percent and 24 percent for low-educated single women without children and married mothers, respectively, and by 18 percent for high-educated single mothers.For changes since 1990-92, the rise in consumption for low-educated single mothers is almost always greater than or equal to the rise for the comparison groups in every period. The relative rise in consumption for low-educated single mothers is more muted further down the distribution. At the 25th percentile, consumption rose more for low-educated single mothers than for low-educated single women without children or married mothers (Appendix Figure 3a) or for high educated single mothers (Appendix Figure 3b) over the full period, but for most of the period following welfare reform, growth in consumption is comparable across these groups. Nevertheless, even for this very disadvantaged group of low-educated single mothers, we do not find evidence that changes in welfare policies resulted in a decline in economic wellbeing relative to other groups that were not the target of the reforms. If one looks at total consumption (rather than its well-measured components, which is reported in Figure 5) the rise in relative consumption for single mothers is even more pronounced at the median(Appendix Figure 4) and 25th percentile (Appendix Figure 5)….”

The Consumption, Income, and Well-Being of Single Mother Headed Families 25 Years After Welfare Reform: Comments Image 5

The Consumption, Income, and Well-Being of Single Mother Headed Families 25 Years After Welfare Reform: Comments Image 6

  • Government Spending
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Previous articleAugust 27, 2021Does School Spending Matter? The New Literature on an Old QuestionEducation spending effectiveness confirmed: 92% of multi-state studies (12/13) show significant positive outcome correlation. Meta-analysis validates causal link btw funding and student achievement.Next articleSeptember 8, 2021Unsheltered Homelessness: Trends, Characteristics, and Homeless HistoriesBtw 2007 and 2020, the homeless population declined across most U.S. states, with notable exceptions in New York (NY) and California (CA), where homelessness increased significantly.
Showing 193 database articles primarily about Government Spending

The Fairest Way to Reform Social Security May Also Be the Worst Way to Grow the Economy

AI Summary. Raising payroll taxes to fix Social Security's funding gap preserves earned benefits but reduces take-home pay without added compensation, shrinking labor supply and slowing economic growth.

Andrew Biggs American Enterprise Institute
Date Posted:
May 28, 2026
Is Database:
Database
Is Important:
Important

Biggs argues that “fair” approaches to restoring Social Security solvency – those that do not cut already accrued benefits – are less effective than “unfair” ones that do, because the latter incentivize increased work effort, raising growth and revenue.

Biggs argues that “fair” approaches to restoring Social Security solvency – those that do not cut already accrued...

Does preserving Social Security benefits require sacrificing economic growth?

Core argument: A 5.2 pts payroll tax increase to 17.6% drives reduced labor supply and slower economic growth vs. the status quo.

Imagine that Social Security reform follows the fairness model, in which accrued benefits are paid in full but the rate at which future benefits are earned is reduced. A simple way to do this is to increase the payroll tax rate To keep Social Security permanently solvent, meaning through 75 years and beyond, would require an immediate and permanent increase in the payroll tax rate [from] 12.4% to 17.6%. The higher rate would decrease labor supply and reduce economic growth. [Consider] an alternate reform, which looks clearly unfair: fix Social Security’s funding gap entirely by reducing accrued benefits that Americans already have earned. As of 2025, Americans had accrued $54 trillion in Social Security benefits. Social Security’s unfunded obligation as of 2025 was $26 trillion. So, roughly, this means cutting Americans’ “earned benefits” in half. [Analyzing the 1977 reform that undid the notorious 1972 “double-indexing” of benefits, a group of economists], using SSA earnings data, found that, for every dollar of lost benefits, the affected Americans increased their earnings by 61 cents. Moreover, these additional earnings would be taxed by Social Security, further strengthening the program’s finances. In effect, this makes cutting benefits a “cheaper” way to fix Social Security than raising taxes, because people respond in ways that also increase tax revenues.

Takeaways by Macro Roundup® AI

  1. A 5.2 pts payroll tax increase to 17.6% drives reduced labor supply and slower economic growth vs. the status quo.
  2. $54 trillion in accrued Social Security benefits vs. the unfunded obligation reveals that benefit cuts would reduce growth drag but.

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  • How Federal Spending is Distributed by Age — Retirees receive 62 cents of every age-assignable federal dollar, driven primarily by Social Security and Medicare, which together account for 80% of all federal spending directed at adults over 65.
  • The Great “Transfer”-mation — Transfer payments made up 18% of all US personal income in 2022, up from 8% in 1970. Social Security/Medicare made up 56% of the increase from 1970 to 2022…
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The World’s Most Surprising Capitalist Makeover Is Under Way in Sweden

AI Summary. Sweden has privatized nearly half of primary healthcare and one in three public high schools, shrinking public social spending to 24% of GDP — comparable to the U.S. and well below France and Italy — while projecting ~2% annual growth through 2030, double the rate of France and Germany.

Tom Fairless Wall Street Journal
Date Posted:
May 12, 2026
Is Database:
Database

Swedish public social spending is now 23.7% of GDP, just 1pp above that of the US and well under France’s 31.6%. Market-based reforms in the 1990s brought overall government spending down from 69.4% to 49.3% in 2024.

How is Sweden's shift to privatization impacting its economic growth?

Core argument: Sweden’s public social spending fell to 24% of GDP, matching the U.S. and 6+ pts below France/Italy, driving lower taxes.

For decades, Sweden was shorthand for the brand of high-tax, high-spend government that managed people’s lives from cradle to grave through state-run hospitals, schools and care homes. No longer. With little fanfare, this Nordic country of 11 million has embraced capitalism. Today, nearly half of primary healthcare clinics are privately owned, many by private-equity firms. One in three public high schools is privately run, up from 20% in 2011. School operators are listed on the stock exchange. The capitalist makeover has allowed Sweden to do what few industrialized countries have managed in recent years: shrink the size of the state. That has enabled the government to sharply lower taxes and, economists say, sparked a surge in entrepreneurship and economic growth. Its total public social spending bill—which includes healthcare, education and all welfare payments—has fallen to 24% of gross domestic product, similar to the U.S. and well below the over 30% for nations like France and Italy. Sweden’s economy is expected to grow by around 2% a year through 2030, roughly the same pace as the U.S. and double the growth rates of France and Germany, according to an April forecast by the International Monetary Fund.

Takeaways by Macro Roundup® AI

  1. Sweden’s public social spending fell to 24% of GDP, matching the U.S. and 6+ pts below France/Italy, driving lower taxes.
  2. Privately-run primary healthcare clinics reached nearly 50% of the market vs. 20% for high schools in 2011, demonstrating accelerating privatization.
  3. Sweden’s projected 2% annual GDP growth through 2030 doubles France and Germany’s rates, resulting from state downsizing and capitalist sector.

Related Articles:

  • How Sweden Overcame Socialism — Sweden’s market reforms: Govt spend cut 70% to <50% GDP, debt 80% to 41%, corp tax -6pts to 22%. Results: Growth +1pt vs EU since 1995, GDP/capita now at…
  • Reforming the Welfare State: Recovery and Beyond in Sweden — Sweden’s structural reforms, initiated in response to the 1990s crisis, included adopting flexible exchange rates & inflation targeting, leading to…
  • The US Has One of the Highest Fertility Rates Among Peer Countries — As of 2022, the US had a “tempo fertility rate,” which is adjusted for life-cycle effects, of 1.82 – among the highest of advanced economies, and ~ on…
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How Policy and Demographics Are Reshaping SNAP: From Families with Children to Older Adults

AI Summary. SNAP enrollment has doubled from 6% to 12% of the U.S. population since 2000, with real costs per capita rising 179% to $279 annually, driven by policy expansions and benefit increases that prevent costs from fully retreating after economic downturns.

Angela Rachidi American Enterprise Institute
Date Posted:
May 1, 2026
Is Database:
Database

About 40mm Americans, 12% of the population, receive SNAP benefits, up from 6% in 2000. In 2023, only 34% of these households included children, down from 49% in 2010, while 36% contained an elderly person, up from 16% in FY2010.

How Are Policy Changes and Demographic Shifts Impacting SNAP Enrollment?

Core argument: SNAP participation doubled from 6% to 12% of the population between FY2000–FY2025, driven by policy expansions and demographic shifts outpacing.

Comparing FY2000 with FY2025, the share of the population receiving SNAP doubled from 6% to 12%, while real SNAP costs per capita increased by 179%—from roughly $100 per year to $279 (in 2024 dollars). Despite this growth, per capita participation and costs in FY2025 remained below their pre-pandemic peak in 2013, which coincided with the aftermath of the Great Recession and changes in eligibility and other policies stemming from the 2008 Farm Bill. SNAP is countercyclical, meaning that all else equal, the number of people receiving SNAP should rise during recessions because of increased unemployment and decline as the economy recovers, [though] overall SNAP participation has grown faster than changes in the unemployment rate alone would predict. Over the long run, and especially since FY2020 (due to the Thrifty Food Plan’s increase in the maximum SNAP benefit), costs per capita have not returned to prerecession levels after a period of high unemployment. In FY2023, the share of SNAP households containing an elderly person (36%) exceeded the share containing a child (34%) for the first time. This was a sharp departure from the early 2000s, when more than half of SNAP households contained a child and less than 20% included an elderly person (Figure 2).

Takeaways by Macro Roundup® AI

  1. SNAP participation doubled from 6% to 12% of the population between FY2000–FY2025, driven by policy expansions and demographic shifts outpacing.
  2. Real per capita SNAP costs rose 179% from $100 to $279 (2024 dollars) over 25 years, with the Thrifty Food.
  3. FY2025 SNAP enrollment remains 8–12% below the FY2013 peak despite 25-year growth, indicating countercyclical policy design successfully targets recession-driven need.

Related Articles:

  • The Great “Transfer”-mation — Transfer payments made up 18% of all US personal income in 2022, up from 8% in 1970. Social Security/Medicare made up 56% of the increase from 1970 to 2022…
  • Poverty and Dependency in the United States, 1939–2023 — Btw 1939 and 1963, the % of Americans below LBJ’s absolute poverty line (3× the cost of a minimal meal plan), fell from 48.5 to 19.5, driven by rising market…
  • Government Benefit Programs Already Do A Lot To Help Low Income Families — A 2-adult, 3-child US family with $20,000 of market income receives at least $61,000 in annual benefits and has $79,000 of disposable income. That same family…
  • Government Spending
  • Fiscal Policy
  • Workforce
    • Poverty/Crime

Washington’s Growing Portfolio: Tracking U.S. Government Investments

AI Summary. The U.S. government has deployed $20.9bn across 16 direct equity deals, expanding beyond grants, loans, and tax incentives into direct ownership stakes. This approach has mobilized an additional $4.75bn in private co-investment alongside the government's positions.

Jonathan Hillman Council On Foreign Relations
Date Posted:
April 23, 2026
Is Database:
Database

Since January 2025, the USG has taken equity stakes totaling $20.9B in 16 American businesses. $8.6B, ~41% of the total, was invested in critical mineral miners and processors, while $8.9B, ~43% of the total, funded the government’s 10% stake in Intel.

Core argument: The U.S. government deployed $20.9bn in direct equity investments since January 2025, expanding beyond traditional grants and loans to drive.

Since January 2025, the U.S. government has invested $20.9 billion across sixteen deals involving direct ownership, broadening a toolkit that has traditionally focused on grants, loans, and tax incentives. The Department of Commerce has participated in six such deals, including taking a 10% stake in Intel. The Development Finance Corporation, the United States’ development bank, has executed three equity transactions in critical minerals, healthcare, and infrastructure. The Department of Defense leads the way with seven such deals. The U.S. government is also working with a range of partners and has mobilized an additional $4.75 billion in investment. Private co-investors include J.P. Morgan, Goldman Sachs, and others.

Takeaways by Macro Roundup® AI

  1. The U.S. government deployed $20.9bn in direct equity investments since January 2025, expanding beyond traditional grants and loans to drive.
  2. The Department of Defense leads with seven equity deals of the sixteen total, establishing direct ownership as a core national.
  3. Commerce Department’s 10% Intel stake exemplifies government equity participation in critical infrastructure, mobilizing private capital alongside public investment to strengthen.

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  • Capital Is Making a Comeback — Btw 1985-2021 the capital intensity of the American economy was relatively flat as a rise in intangible investment was offset by a decline in tangible…
  • Government Spending
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How Federal Spending is Distributed by Age

AI Summary. Retirees receive 62 cents of every age-assignable federal dollar, driven primarily by Social Security and Medicare, which together account for 80% of all federal spending directed at adults over 65.

Kent Smetters University of Pennsylvania
Date Posted:
April 2, 2026
Is Database:
Database
Is Important:
Important

In 2025, of the 62.5% of Federal spending that is age-assignable on a per-capita basis, US retirees aged 65+ were given $43,700, working-age adults 26–64 got $7,300, and children and young adults got $4,300.

Core argument: Federal spending heavily favors retirees, who receive 38.6 percent of total outlays through Social Security, Medicare, and related programs.

We trace spending items within 52 general spending categories, totalling $7T for the 2025 Fiscal Year. We are able to classify a total of $4.4T across three broad age categories and assign the remaining $2.6T to an all-ages residual. Retirees (adults age 65 and older) receive $2.7T, equal to 38.6% of total federal outlays and 61.9% of age-assignable spending. Working-age adults (ages 26-64) receive $1.2T (27.9% of age-assignable), and children and young adults (under age 26) receive $449B (10.3%). The dominance of the retiree category reflects two programs above all others: Social Security and Medicare. Social Security directs $1.3T to retirees, and Medicare sends $835B. Together, they account for 80% of all age-assignable spending on older adults. But the retiree total extends beyond these two entitlements. Federal employee retirement benefits ($169B), housing assistance for older households, Medicaid long-term-care spending, and VA medical care all contribute, making the federal budget more retiree-focused than a Social Security–only lens would suggest.

Takeaways by Macro Roundup® AI

  1. Federal spending heavily favors retirees, who receive 38.6 percent of total outlays through Social Security, Medicare, and related programs.
  2. Working-age adults and children combined receive less than half the spending directed to retirees despite representing larger population segments.
  3. Social Security and Medicare alone account for 80 percent of all federal spending on older Americans, dominating the retiree budget.

Related Articles:

  • The Great “Transfer”-mation — Transfer payments made up 18% of all US personal income in 2022, up from 8% in 1970. Social Security/Medicare made up 56% of the increase from 1970 to 2022…
  • France and Britain Are In Thrall To Pensioners — Since 1970, cumulative real income growth for pensioners in France and the UK has outpaced that of the workers who support them. French pensioners over the age…
  • The Budgetary Impact of the Abandonment of Federalism — John Cogan finds federal budget deficits are driven by items “originally considered to be the responsibility of state and local governments or private-sector…
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Has the United States Bent the Health Care Cost Curve?

David Cutler and Lev Klarnet Brookings Papers On Economic Activity
Date Posted:
March 30, 2026
Is Database:
Database
Is Important:
Important

In 2024, medical spending as a share of GDP was just above its 2010 level and 15% ($977B) below its 2010 forecast; 21% of the gap was due to technology, 24% to price reductions, and 11–27% to reforms such as prior authorization and higher deductibles.

Five factors are important in the slowdown in spending [Figure 16]. The first is technology-associated changes in health and site of care. These correspond to the subsequent innovations in our model. Together, technologies along these lines account for 21% of the overall cost slowdown and double that in Medicare. Second, long-run supply is more elastic than short-run supply, which lowers spending over time. This is particularly apparent in the impact of patent expiration for pharmaceuticals and in relative declines in imaging reimbursement. We estimate that greater long-run supply explains 6% of the spending slowdown. Third, a variety of market changes contribute to reduced and more elastic demand, including increased cost sharing paid by consumers, physicians not paid as much for using technologies, and insurers imposing restrictions on technology use - a rough guess is that these account for 11 to 27% of the spending slowdown. Fourth, the population is healthier in ways that reduce spending. This includes fewer hospitalizations for smoking-related conditions and reduced need for formal home health care. The birth rate has fallen as well, which reduces the need for care. We estimate improved population health explains 7% of the spending slowdown. A major component is slower price growth. Net of upcoding, we estimate lower price growth explains 24% of the spending slowdown.

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