Healthcare/Seniors

Analysis of healthcare costs, insurance, delivery, innovation, public programs, aging, and the fiscal and labor-market consequences of longer lives. The archive examines outcomes for patients, providers, workers, and taxpayers.

AI Summary. The average premium in the Affordable Care Act insurance marketplaces is projected to rise 13%, according to an analysis by the health research group KFF. That increase is slightly higher than elsewhere, with consulting firms projecting roughly 10% increases for employer plans covering about 150m people and more than 10% for federal workers.

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According to a KFF analysis, the average benchmark health care premium on the Obamacare insurance marketplaces will increase 13% in 2027, compared to 10% for private insurance. This follows a 26% increase last year.

Are marketplace health premiums rising faster than employer plan premiums?

Core argument: Average premiums in the Obamacare marketplaces will rise 13% in 2027, according to an analysis by KFF that combined newly published federal prices for 30 states with state-level figures.

Obamacare premiums will rise an average of 13% in 2027, following a 26% increase in 2026. Much of the increase reflects rising medical costs, with employer-plan premiums also expected to climb about 10%. But the expiration of enhanced federal subsidies has left some Obamacare customers particularly exposed. Remaining income-based subsidies will shield most enrollees from next year’s premium increases by shifting the additional expense to taxpayers. Those ineligible for assistance—including many self-employed workers and early retirees—must absorb the full increase, sometimes after already paying over $1,000 more per month in 2026.Many customers have responded by buying cheaper coverage with higher deductibles, pushing the average deductible to nearly $4,000 this year. Having already traded down, they have less room to offset further increases. KFF estimates suggest enrollment had fallen by nearly five million by June, while a Commonwealth Fund survey indicates that the uninsured rate among working-age adults has risen.

Takeaways by Macro Roundup® AI

  1. Average premiums in the Obamacare marketplaces will rise 13% in 2027, according to an analysis by KFF that combined newly published federal prices for 30 states with state-level figures.
  2. Reports by several consulting firms project that 2027 premiums for employer plans, which cover around 150 million people, could rise by about 10%, below the 13% marketplace increase.
  3. Premiums for federal workers are increasing by more than 10%.

AI Summary. A National Bureau of Economic Research paper projects U.S. medical spending, 18% of GDP in 2024, reaching 19%–26% of GDP by 2040, with federal medical spending consuming 45%–61% of federal revenue excluding Social Security contributions. The author argues only the low-spending path is consistent with current tax levels and other commitments.

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From 1970 to 2010, growth in US medical spending outpaced GDP growth by ~2.4pp annually. From 2010 to 2024, that growth differential fell to just 0.3pp. If it persists, medical spending reaches only 19% of GDP by 2040; if excess spending growth reverts to 2.4pp, it reaches 26%.

How much federal revenue will medical spending consume by 2040?

Core argument: David Cutler projects U.S. medical spending reaching 26%, 22.3%, or 19% of GDP by 2040 under high, benchmark, and low scenarios, versus 18% in 2024 and 6.9% in 1970.

Figure 1 shows that in 1970, medical care was 6.9% of GDP. In 2024, it was 18%. From 1970 through around 2010; mean medical spending growth exceeded GDP growth by 2.4 pp annually. Since 2010, the growth of medical spending has exceeded the growth of GDP by only 0.3 pp annually. There is no comparable time period with anything like the sustained slowdown in spending growth since 2010. Patient cost-sharing has increased enormously [indirectly reducing overall expenditure via incentives] as shown in Figure 5. An additional role [was] played by the diffusion of cost-reducing technologies. Because they are often less invasive, second-round therapies typically have lower unit prices. [mechanism in Fgure 6]. Finally, there [are] fewer expensive new innovations than in the past. [However], recent data show an uptick in spending growth in 2024, which continued in 2025. Some of this is a result of new technologies— prime examples are GLP-1 medications and new drugs for cancer that are taken on an ongoing basis. To consider a scenario with [a reversion to] more rapid spending increases, I assume that the growth of medical spending above GDP growth after 2024 returns to the average rate realized between 1970 and 2010. This scenario is shown as the High-spending scenario in figure 1, in which medical care in 2040 rises to 26% of GDP.

Takeaways by Macro Roundup® AI

  1. David Cutler projects U.S. medical spending reaching 26%, 22.3%, or 19% of GDP by 2040 under high, benchmark, and low scenarios, versus 18% in 2024 and 6.9% in 1970.
  2. Federal medical spending consumed 45% of “discretionary revenue”—total federal revenue less Social Security contributions—in 2024, up from 13% in 1987, and Cutler projects 61% by 2040 under the high-spending scenario.
  3. Cutler states that only the low-spending scenario is consistent with current tax levels and non-medical spending commitments, attributing the post-2010 slowdown to high-deductible plans, prior authorization, cost-reducing technology, and reduced administrative friction.

AI Summary. In France, social protection and health rose from 53.1% to 58.7% of total government spending, and are projected to reach 59.7%, while education, defense and public order fell from 15.2% to 13.7% and transport from 5.3% to 3.8%. Public pension spending rose from 12.7% of GDP to 14.8%.

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At 59.7% of total government spending, France’s social safety net is crowding out core state functions such as education, defense and public order, whose collective share of spending fell from 15.2% to 13.7% of the total btw 1995 and 2024.

Is social spending squeezing out education, defense, and transport?

Core argument: French social protection and health spending, including all public pensions, rose from 53.1% to 58.7% of total government spending between 1995 and 2024, with a projected further increase to 59.7% in 2026.

Between 1995 and 2024, spending on social protection and health, including all public pensions (social spending from here on) increased from 53.1% to 58.7% as a fraction of total government spending. Social spending is projected to increase even more to 59.7% in 2026. Over the same period, government spending on education, defense and public order decreased from 15.2 % to 13.7% of total government spending. To compute these shares, I removed the State’s imputed pension contributions for teachers, soldiers and other civil servants from each function and from total spending, since the pensions actually paid are already counted in social spending; this gives a better sense of what the government spends on teaching kids and keeping the country safe. Transport fell from 5.3% to 3.8%. Pensions account for the lion’s share of transfers. Total public pension spending in France added up 14.8% of GDP in 2024, and it is projected to increase to 15% of GDP this year, up from 12.7% in 1995.

Takeaways by Macro Roundup® AI

  1. French social protection and health spending, including all public pensions, rose from 53.1% to 58.7% of total government spending between 1995 and 2024, with a projected further increase to 59.7% in 2026.
  2. French government spending on education, defense and public order fell from 15.2% to 13.7% of total government spending between 1995 and 2024, while transport fell from 5.3% to 3.8%.
  3. Total French public pension spending reached 14.8% of GDP in 2024, up from 12.7% in 1995, and is projected to reach 15% of GDP this year.

AI Summary. Women starting GLP-1 weight-loss treatment lose 1.4–2.5 BMI points, rising to 2.7–4.2 points after 1.5 years or more, and those who are single increase their probability of being married or cohabiting by 18.3 percentage points, with no change for women already partnered. Women not employed at the outset raise their employment rate by 13 percentage points.

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Women who began treatment with GLP-1 drugs when not currently married or partnered saw an increased probability of marriage or cohabitation of ~29pp after 6 quarters. Those not initially employed were 27pp more likely to be working after 6 quarters.

Does weight-loss medication improve women's marriage and employment outcomes?

Core argument: Women who were single when starting GLP-1 treatment raised their probability of being married or cohabiting by 18.3 pp overall and 28.6 pp (s.e. 7.1) at six or more quarters, building gradually as they lost weight.

BMI is flat before women start [GLP-1 treatment] and then falls (Figure 2, Panel A). All groups lose between 1.4 and 2.5 BMI points in the post period. These effects grow to between 2.7 and 4.2 BMI points at 1.5+ years after initiation. The largest magnitude change is in the marriage market. Women who are single when they start (Figure 2, Panel B) increase their probability of being married or living with a partner by 18.3 pp overall and 28.6pp (s.e. 7.1) at six or more quarters, building gradually as they lose weight. Partnered women’s relationships, by contrast, are stable. Their partnership probability barely moves (0.1 points, s.e. 1.8), and there is no excess relationship dissolution (0.0, s.e. 1.7). The marriage-market response is the making of new matches, not the breaking or remaking of old ones. In contrast, single women’s weight loss seems to dramatically affect first impressions of potential partners, leading to a large increase in marriage and cohabitation. This is consistent with prior work on the obesity penalty negatively affecting women in the marriage market. Figure 2, panels C and D show that women not employed at baseline move into work: their employment rate rises 13pp overall and 27pp after six or more quarters, and their weekly hours rise by nearly ten hours at the longer horizon.

Takeaways by Macro Roundup® AI

  1. Women who were single when starting GLP-1 treatment raised their probability of being married or cohabiting by 18.3 pp overall and 28.6 pp (s.e. 7.1) at six or more quarters, building gradually as they lost weight.
  2. Partnered women's relationships remained stable after GLP-1 initiation, with partnership probability moving 0.1 points (s.e. 1.8) and no excess dissolution (0.0, s.e. 1.7).
  3. Women not employed at baseline moved into work after GLP-1 initiation, with employment rates rising 13 pp overall and 27 pp after six or more quarters and weekly hours up nearly ten at the longer horizon.

AI Summary. Victoria's Secret shares hit a record high after the lingerie retailer beat earnings estimates and raised its annual net sales guidance to as much as $7.13bn. The company has posted four consecutive quarters of annual revenue growth, with its bras gaining market share among 18- to 44-year-olds and growth in both the under-$50,000 and over-$200,000 income categories.

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As the use of GLP-1 drugs for weight loss expands, lingerie sales are rising. Victoria’s Secret has posted four consecutive quarters of annual revenue growth, and its stock is up ~236% since the fall of 2024.

Is a focus on core products lifting a lingerie retailer's sales?

Core argument: Victoria's Secret raised its annual net sales guidance to as much as $7.13 billion and reported quarterly net sales of $1.56 billion for the period ended May 2, exceeding analyst estimates and sending shares to a record high.

Victoria’s Secret shares soared after the company beat earnings estimates and boosted its outlook, adding to signs that Chief Executive Officer Hillary Super’s turnaround plan is on track. The lingerie retailer raised its annual net sales guidance to as much as $7.13 billion and reported net sales of $1.56 billion for the quarter ended May 2, exceeding analysts estimates. The company has posted four consecutive quarters of annual revenue growth, with Victoria’s Secret bras gaining market share with 18- to 44-year-olds, and the retailer seeing growth in the under-$50,000 and over-$200,000 annual income categories.

Takeaways by Macro Roundup® AI

  1. Victoria's Secret raised its annual net sales guidance to as much as $7.13 billion and reported quarterly net sales of $1.56 billion for the period ended May 2, exceeding analyst estimates and sending shares to a record high.
  2. Victoria's Secret has posted four consecutive quarters of annual revenue growth, with its bras gaining market share among 18- to 44-year-olds.
  3. Victoria's Secret is seeing growth in both the under-$50,000 and over-$200,000 annual income categories, adding to signs that Chief Executive Officer Hillary Super's turnaround plan is on track.

AI Summary. U.S. GDP per capita, about $87,000, is projected to reach $102,000 by 2035 with 1.8% annual productivity growth, or $110,000 with 2.7% growth. Because the healthcare sector has been slow to adopt AI, health spending is projected to rise from 18.3% of GDP to 21% under slower growth and 21.7% under faster growth.

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Warshawsky argues AI may paradoxically worsen the US fiscal outlook, as the income effect of higher overall growth increases demand for low-productivity-growth healthcare. The rise in healthcare spending may “swamp rising tax revenues.”

Does faster productivity growth reduce health spending as a share of GDP?

Core argument: U.S. GDP per capita, about $87,000, is projected to reach $102,000 by 2035 with 1.8% annual productivity growth, or $110,000 if productivity rises to 2.7%.

Currently, GDP per capita is about $87,000. With annual productivity growth of 1.8%, based on historical averages, this welfare measure for the U.S. population will grow to $102,000 by 2035. With productivity rising to 2.7%, per capita income is projected to reach $110,000, a clearly positive result for welfare. Currently, healthcare spending is 18.3% of GDP. With 1.8% productivity growth in the broad economy but not in the healthcare sector, which has been slow to adopt AI, and an aging population, the health spending-to-income ratio is projected to rise to 21% of GDP by 2035, with relative healthcare inflation running at 1.1% annually. When productivity increases to 2.7%, health prices rise more rapidly at 1.8% annually, pushing spending to 21.7% of GDP.

Takeaways by Macro Roundup® AI

  1. U.S. GDP per capita, about $87,000, is projected to reach $102,000 by 2035 with 1.8% annual productivity growth, or $110,000 if productivity rises to 2.7%.
  2. Healthcare spending, at 18.3% of GDP, is projected to reach 21% by 2035 under 1.8% productivity growth, with relative healthcare inflation of 1.1% annually, an aging population, and slow AI adoption in healthcare.
  3. Productivity growth of 2.7% is projected to raise health prices 1.8% annually and health spending to 21.7% of GDP by 2035.

AI Summary. The authors use the end of UK sugar rationing as a natural experiment and estimate that a sugar-rich early-childhood diet raised adult chronic inflammation, diabetes, cholesterol and arthritis, and led to less human capital, lower odds of a skilled occupation, and less wealth. They also find early exposure elevated sugar consumption across the lifespan.

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Using a regression discontinuity design exploiting the end of sugar rationing in September 1953, Gertler and Gračner find that birth cohorts post-dating the policy change experience worse lifetime outcomes in many health measures as well as economic success.

Does a sugar-rich early childhood diet worsen adult health and wealth?

Core argument: Using the end of UK sugar and sweets rationing in 1953 as a natural experiment, the authors find that early-childhood exposure to a sugar-rich diet increased adult chronic inflammation, a marker of chronic disease.

We study the long-term effects of exposure to a sugar-rich diet in early childhood on health and economic well-being in later adulthood, and identify diet as a possible pathway. We exploit the end of sugar and sweets rationing in 1953 in the UK as a natural experiment inducing variation in exposure to a sugar-rich diet in early childhood. We find that the end of rationing increased the adult prevalence of chronic inflammation, an important marker of chronic disease. We also find increases in poor metabolic health; particularly diabetes, cholesterol and arthritis. Finally, we find that excessive intake of sugar also results in worse economic outcomes; specifically, in reduced human capital accumulation, a lower likelihood of having a skilled occupation, and a lower accumulation of wealth. While the effects of a sugar-rich diet early in life may have affected these outcomes directly via physiological programming, we find that a sugar-rich diet early in life elevated free sugar consumption across lifespan, consistent with evidence that life-long dietary preferences and habits form early, and that sugar may be addictive.

Takeaways by Macro Roundup® AI

  1. Using the end of UK sugar and sweets rationing in 1953 as a natural experiment, the authors find that early-childhood exposure to a sugar-rich diet increased adult chronic inflammation, a marker of chronic disease.
  2. The authors find that early-childhood exposure to a sugar-rich diet raised the prevalence of poor metabolic health in later adulthood, particularly diabetes, cholesterol and arthritis.
  3. Early exposure to a sugar-rich diet is associated with worse economic outcomes — reduced human capital accumulation, a lower likelihood of holding a skilled occupation, and lower wealth accumulation — and with elevated free sugar consumption across the lifespan.

AI Summary. An analysis classifying $4.4tn of $7tn in federal spending by age finds retirees aged 65 and older receive $2.7tn, 38.6% of total outlays and 61.9% of age-assignable spending, versus $1.2tn for working-age adults and $449bn for those under 26. Social Security and Medicare account for 80% of age-assignable spending on older adults.

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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.

How is federal spending distributed across age groups?

Core argument: Retirees aged 65 and older receive $2.7 trillion of federal spending in fiscal 2025, equal to 38.6% of total outlays and 61.9% of age-assignable spending, versus $1.2 trillion for working-age adults aged 26–64.

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. Retirees aged 65 and older receive $2.7 trillion of federal spending in fiscal 2025, equal to 38.6% of total outlays and 61.9% of age-assignable spending, versus $1.2 trillion for working-age adults aged 26–64.
  2. Children and young adults under age 26 receive $449 billion, or 10.3% of age-assignable federal spending, out of $4.4 trillion classified by age within a $7 trillion budget, with $2.6 trillion assigned to an all-ages residual.
  3. Social Security directs $1.3 trillion and Medicare $835 billion to retirees, together 80% of age-assignable spending on older adults, with federal employee retirement benefits ($169 billion), housing assistance, Medicaid long-term care, and VA medical care contributing further.