Edward Conard

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  • “Unintended Consequences is full of substance, it is one of the must-read books of the year, and once I finish it I will be giving it a second read through right away.” - Tyler Cowen, Professor, George Mason University
  • “…reminds us that inequality sends a signal of what society lacks most, in America’s case, entrepreneurship and risk taking.” - Lawrence Lindsey, CEO, The Lindsey Group, former Director of the National Economic Council
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  • “…serious thinking for serious thinkers. …a thought-provoking blueprint for growing middle- and working-class incomes.” - Mitt Romney, former Governor of Massachusetts
  • “…reminds us that inequality sends a signal of what society lacks most, in America’s case, entrepreneurship and risk taking.” - Lawrence Lindsey, CEO, The Lindsey Group, former Director of the National Economic Council
  • “There are an amazing number of good ideas and interesting points made in Unintended Consequences. The thinking underlying it, and the obvious depth of understanding of the author, are very impressive.” - Steven Levitt, coauthor of Freakonomics; 2004 John Bates Clark Medal
  • “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
  • “…a fresh argument for the productive value of inequality.” - David Autor, Professor of Economics, Massachusetts Institute of Technology
  • “Unintended Consequences represents the most cogent and persuasive analysis of the Financial Crisis to date.” - Andrei Shleifer, 1999 John Bates Clark Medal Winner
  • “…challenges misconceptions that distort our economic debates.” - Arthur Brooks, President of the American Enterprise Institute
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The Anti-Poverty, Targeting, and Labor Supply Effects of the Proposed Child Tax Credit Expansion

Kevin Corinth Becker Friedman Institute
Date Posted:
October 7, 2021
Is Database:
Database

The proposed expansion of the Child Tax Credit (CTC) under the American Families Plan is expected to significantly impact labor supply, with Bruce Meyer estimating that 1.5m workers, or 2.6% of all working parents, will exit the labor force.

The proposed expansion of the Child Tax Credit (CTC) under the American Families Plan is expected to significantly impact labor supply, with Bruce Meyer estimating that 1.5m workers, or 2.6% of all working parents, will exit the labor force. This is primarily due to the reduction in work incentives, as the CTC expansion replaces the Tax Cuts and Jobs Act CTC's work incentives with a universal basic income-type benefit, reducing the return to work by at least $2,000 per child for most workers. The employment loss is concentrated among workers earning below $50,000, who account for 72% of the reduction. Consequently, while the CTC expansion initially appears to reduce child poverty by 34%, accounting for labor supply responses shows a smaller reduction of 22%, with no decrease in deep child poverty. This shift highlights the trade-off between anti-poverty effects and labor market participation.

New Bruce Meyer looks at the likely impact of the child tax credit expansion - he estimates the employment effect of the 1990's EITC expansion would be undone by the CTCT expansion. Basically the CTC work disincentives are significant (which will result in a lower fall in child poverty than proponents ae estimating) core finding, "...The proposed change under the American Families Plan (AFP) to the Tax Cuts and Jobs Act (TCJA) Child Tax Credit (CTC) would increase maximum benefit amounts to $3,000 or $3,600 per child (up from $2,000 per child) and make the full credit available to all low and middle-income families regardless of earnings or income. We estimate the anti-poverty, targeting, and labor supply effects of the expansion by linking survey data with administrative tax and government program data which form part of the Comprehensive Income Dataset (CID). Initially ignoring any behavioral responses, we estimate that the expansion of the CTC would reduce child poverty by 34% and deep child poverty by 39%. The expansion of the CTC would have a larger anti-poverty effect on children than any existing government program, though at a higher cost per child raised above the poverty line than any other means-tested program. Relatedly, the CTC expansion would allocate a smaller share of its total dollars to families at the bottom of the income distribution—as well as families with the lowest levels of long-term income, education, or health—than any existing means-tested program with the exception of housing assistance. We then simulate anti-poverty effects accounting for labor supply responses. By replacing the TCJA CTC (which contained substantial work incentives akin to the EITC) with a universal basic income-type benefit, the CTC expansion reduces the return to working at all by at least $2,000 per child for most workers with children. Relying on elasticity estimates consistent with mainstream simulation models and the academic literature, we estimate that this change in policy would lead 1.5 million workers (constituting 2.6% of all working parents) to exit the labor force. The decline in employment and the consequent earnings loss would mean that child poverty would only fall by 22% and deep child poverty would not fall at all with the CTC expansion...."
Likely employment effects, “…These static calculations ignore any changes in behavior, in particular employment and hours decisions. The AFP CTC would replace the TCJA CTC—which like the EITC has substantial work incentives—with a program akin to a universal basic income that provides benefits regardless of earnings. Consequently, the expansion would reduce the return to work for most working parents by at least $2,000 per child. Among all working parents with earnings below $100,000, the reduced incentive to work at all due to the CTC reform is 88% as large as the reduced incentive to work at all due to a hypothetical elimination of the EITC. We estimate that the CTC expansion would lead 1.5 million working parents to exit the labor force. The vast majority of the effect (1.3 million) is due to the decrease in the return to work.Our estimate is comparable in magnitude to that implied by a National Academy of Sciences simulation of the EITC and to the change in the employment of single mothers during welfare reform. When incorporating the estimated employment reduction into our poverty simulations, we find that the CTC expansion would reduce child poverty by 22% instead of the 34% reduction we found based on our static simulation. The CTC expansion would not decrease deep child poverty, reversing the 39% reduction we estimated based on a static simulation….”

The Anti-Poverty, Targeting, and Labor Supply Effects of the Proposed Child Tax Credit Expansion: Extended Excerpt Image 1


Kevin Corinth, Bruce Meyer, Matthew Stadnicki and Derek Wu, "The Anti-Poverty, Targeting, and Labor Supply Effects of the Proposed Child Tax Credit Expansion," Becker Friedman Institute, October 7, 2021, https://bfi.uchicago.edu/working-paper/2021-115/

“… Workers with earnings below $50,000 account for 72% of the employment loss (Appendix Figure A8). Most the of the employment reduction (1.32 million) is the result of the substitution effect from a decreased return to work. The remaining portion (0.14 million) is the result of the income effect from increasing incomes of working families. Table 4 reports employment reductions under other labor supply elasticity assumptions. We do not account for the reduction in work hours among current workers who continue working under the CTC expansion. Since the implicit marginal tax rate rises for workers on the phase-in portion of the TCJA CTC, there will likely be a reduction in hours worked among those who continue to work. Whereas the TCJA CTC rewards an additional dollar of earnings with approximately $0.15 of benefits for these workers, the AFP CTC provides no reward for an additional dollar of earnings. We estimate that 10.4 million workers on the phase-in portion of the TCJA CTC face on average a 14.6 percentage point increase in their implicit marginal tax rate due to the CTC expansion (Table 5).30F31 Not accounting for reductions in earnings of these workers facing higher implicit marginal tax rates will lead us to understate poverty in our dynamic simulations. The implicit marginal tax rate also rises for workers on the phase-out portion of the incremental CTC. Because the incremental CTC phases out at a 5% rate, the implicit marginal tax rate of these workers rises by 5 percentage points. However, the hours reductions of these workers are unlikely to lead their families into poverty because the phase-out begins at $112,500 of AGI for head of household tax units and $150,000 for married tax units filing jointly…..”

Here is the sexy stuff, “… The extent to which the decrease in the return to work affects labor supply depends on the baseline return to work. If the baseline return to work is lower, a given decrease in the return to work will reduce labor supply more. Appendix Figure A7 shows the percent decrease in the return to work due to the CTC expansion, relative to the baseline return to work under the TCJA CTC. Workers with earnings between $0 and $30,000 face a mean percent decrease in the return to work between 7% and 10%. The percent decrease in the return to work falls as earnings rise beyond $30,000, reflecting the higher baseline return to work (in dollars) for those with higher earnings. We multiply the percent change in the return to work by the relevant labor supply elasticity for each worker (0.75 for single mother EITC recipients and 0.25 for all other workers with children), and we multiply the percent change in income by the relevant income elasticity (0.085 for single mother EITC recipients and 0.05 for all other workers with children). As a result of the CTC expansion, we estimate that employment falls by 1.46 million workers, representing 2.6% of all working parents...”

“…Of those adults, 23% (13 million) had tax unit earnings of less than $30,000, and 43% had tax unit earnings of between $30,000 and $100,000. For workers with earnings between $30,000 and $100,000, the mean return to work falls by approximately $2,900 to $3,300 (Appendix Figure A6).For workers with earnings below $30,000, the return to work falls by less—with cell means between $450 and $2,400—because their TCJA CTC benefit had not yet fully phased in. Notably, the binned estimates of the decrease in the return to work that we empirically estimate using the CID align closely with the changes in the return to work across current earnings calculated for a hypothetical family in Appendix Figure A1…”

Dynamic Results Accounting for Changes in Labor Supply

"...We start by calculating the percent change in the return to work for each tax unit, which is the change in the return to work due to the CTC expansion divided by the current return to work under the TCJA CTC. The change in the return to work is the incremental CTC benefit when working at the current earnings level minus the incremental CTC benefit when not working (as described in Section 2). The current return to work under the TCJA CTC is current earnings minus the additional tax liability accrued due to working minus the transfer benefits lost due to working. To calculate the percent change in the probability of working for each tax unit that is currently working, we multiply the percent change in the tax unit’s return to work by the relevant elasticity for the tax unit. We apply an elasticity of 0.75 for single mother tax units currently receiving the EITC and 0.25 for all other tax units. The 0.75 elasticity for single mother tax units receiving the EITC is equal to the midpoint of the 0.3 to 1.2 range recommended for EITC-eligible workers based on the literature review relied on by the CBO (McClelland and Mok 2012).26F27 The 0.25 elasticity is consistent with those used by other simulation models and the academic literature (Congressional Budget Office 2012; Chetty et al. 2013).27F28 As we show later, our elasticity assumptions produce employment effects consistent with the NAS (2019) simulation of an expansion of the EITC. In addition to the effects of a decreased return to work, the increase in incomes due to the CTC expansion would be expected to further reduce labor force participation through an income effect. To estimate the reduction in labor force participation due to higher incomes, we apply elasticities that indicate the percent change in the probability of participation due to a one percent change in income. We follow NAS (2019) in their simulation of a child allowance, which uses an elasticity of -0.085 for single-mother tax units. We assign an elasticity of -0.05 for all other tax units.28F29 We multiply these elasticities by the increase in income due to the CTC expansion divided by income under the TCJA CTC for the tax unit’s family. To estimate the total number of current workers exiting the labor force due to the CTC expansion, we multiply each individual worker’s weight in the CPS ASEC by the percent change in the probability of the worker exiting the labor force, either due to the decrease in the return to work or to higher incomes. We sum these products over all workers with children in the CPS ASEC to estimate the number of current workers exiting the labor force. See Appendix C for further details of our methodology. We report changes in work incentives and employment for workers based on the earnings of their tax unit, in intervals of $10,000. We estimate that there were 56 million adults with children who worked during the year and were a member of a tax unit with nonzero earnings (Appendix Figure A5)…”

How they get there.

  • Government Spending
  • Fiscal Policy
  • Workforce
    • Poverty/Crime
    • Unemployment/Participation
Previous articleOctober 7, 2021Genetic and environmental contributions to IQ in adoptive and biological families with 30-year-old offspringA 1SD increase in parental environment quality boosts IQ by ~2.83 points, highlighting the economic benefits of investing in family environments. @MattMcGueNext articleOctober 11, 2021David Shor Is Telling Democrats What They Dont Want to HearDavid Shor’s analysis suggests Democrats face a challenging electoral landscape, particularly in the Senate, due to educational polarization and reduced ticket splitting.
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.

Related Articles:

  • Social Security and Trends in Wealth Inequality — .@sc_cath @mjmill611 and @NatashaRSarin calculate that the market value of future Social Security benefits represented 49% of the wealth of the bottom 90% in…
  • 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…
  • Government Spending
  • Fiscal Policy
    • Fiscal Deficits
    • Taxation

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…
  • Government Spending
  • Fiscal Policy
    • Fiscal Deficits
  • Politics

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.

Related Articles:

  • Industrial Policy and Economic Security — Chris Miller asks, “How much inefficiency should we swallow in exchange for the security of self-sufficiency?” He argues it’s “a tricky…
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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
  • Fiscal Policy
  • Politics
  • Productivity
    • Investment
  • Security

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…
  • Government Spending
  • Fiscal Policy
    • Fiscal Deficits
  • Healthcare/Seniors
  • Workforce
    • Poverty/Crime

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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