More powerful and affluent today than ever, the United States has promising opportunities to influence the course of history. Yet these prospects are shadowed by significant perils and burdens. In this visionary book, leading scholars from the Brookings Institution and other prominent research organizations and universities analyze the major domestic and foreign policy problems facing the nation over the next five to ten years.The challenges on the domestic front are formidable: assuring fair but affordable access to health care, shoring up retirement income for an aging population, encouraging long-term economic growth, easing the growing pains of an increasingly diverse society, and reconciling energy policies with environmental concerns.In international affairs the central task is to use America's unprecedented power wisely and to protect a homeland that has been revealed as surprisingly vulnerable. Yet efforts must also focus on improving the economic fortunes of poorer countries, expanding trade, and reforming the rules that regulate the flows of capital across national borders.Is the United States government capable of rising to these vast and varied challenges? The concluding chapters of this book offer cautious optimism. While it is often criticized, the American political system is fundamentally resilient and flexible. Ambitious in scope, Agenda for the Nation provides thoughtful, constructive answers to questions of how the U.S. government can effectively serve its citizens and meet its global responsibilities in a world of opportunity and uncertainty.
Many medical authorities predict that average life expectancy could well exceed 100 years by mid century and rise even higher soon thereafter. This astonishing prospect, brought on by the revolution in molecular biology and information technology, confronts policymakers and public health officials with a host of new questions. How will increased longevity affect local and global demographic trends, government taxation and spending, health care, the workplace, Social Security, Medicare, and Medicaid? What ethical and quality-of-life issues are raised by these new breakthroughs? In Coping with Methuselah, a group of practicing scientists and public policy experts come together to address the problems, challenges, and opportunities posed by a longer life span. This book will generate discussion in political, social, and medical circles and help prepare us for the extraordinary possibilities that the future may hold.
Few people realize that one of the nation's largest health programs runs through the tax system. Reformers of all stripes propose to modify current tax rules as part of larger programs to increase coverage and control costs. Is the current system working? Will tax-based reforms achieve their goals? Several of the nation's foremost experts on taxation and health policy address these questions in Using Taxes to Reform Health Insurance, a joint product of the Urban-Brookings Tax Policy Center and the American Tax Policy Institute. Led by respected economists Henry Aaron of the Brookings Institution and Leonard Burman of the Urban Institute, contributors examine the role taxes currently play, the likely effects of recently introduced health savings accounts, the challenges of administering major subsidies for health insurance through the tax system, and options for using the tax system to expand health insurance coverage. No taxpayer or consumer of health care services can afford to ignore these issues.
For the past two decades Americans over age 60 have increasingly delayed their withdrawal from the workforce, a reversal of a century-old trend toward early retirement. For instance, from 1991 to 2010 the employment rate increased by more than half among 68-year-old men and by about two-thirds among women of the same age.
Using data from the Current Population Survey, Working Our Way out of the Deficit explores the historical trajectory of retirement and the labor force participation rate of older men and women. Who chooses to delay retirement? Have older workers delayed their departure from career jobs? How will working longer affect the outlook for the federal budget?
Brookings economists Henry Aaron and Gary Burtless join with renowned colleagues to examine the impact of extended employment against the backdrop of the federal deficit problem. They posit that working longer could help reduce the soaring costs of entitlement programs including Social Security and Medicare.
Aaron and Burtless have also developed new evidence on the role of career jobs. This evidence suggests that lengthening the careers of older workers who have held their jobs for a decade or more significantly contributes to the trend toward later retirement.
As the nation faces a prolonged jobs gap, Working Our Way out of the Deficit provides an important work on a crucial segment of the employment market and guides us toward a path for future recovery.
Academic medical centers provide cutting edge acute care, train tomorrow's physicians, and carry out research that will expand the range of treatable and curable illnesses. But these centers themselves may need urgent care experts generally agree that many are suffering acute even life-threatening financial distress. Many academic medical centers are suffering for several reasons: in-patient admissions are down, as many procedures that once required a hospital stay are now performed on an out-patient basis or in a physician's office ; managed care plans have negotiated discounted fees that cut hospital operating margins; the Balanced Budget Act of 1997 curtailed Medicare reimbursements, lowered margins and pushed some into the red; the revolution in information technology is imposing large new capital costs; and the character of medical education is receiving its most thorough review in decades.While there is a general consensus that medical centers are under pressure, experts disagree about the depth and pervasiveness of the current financial distress. Are they whining about financial pressures other, less-favored sectors find routine; or is the high quality American teaching hospital becoming an endangered species that could face extinction if nothing is done. Because academic medical centers perform such important jobs, it is critical to determine the true nature and depth of their current financial problems and then fashion analytically sound and politically sustainable solutions. This book brings together chief executive officers of major medical centers, university presidents, senior members of Congressional and executive office staffs, and leading analysts. These experts address the key issues and prescribe remedies both regulatory and legislative to ensure that the teaching hospital remains a picture of financial health. Contributors include Nancy Kane (Harvard School of Public Health), Jamie Reuter (Institute for Health Care Research Policy, Georgetown University), Peter van Etten (Juvenile Diabetes Foundation), Ralph Muller (University of Chicago Hospitals and Health System), James Robinson (School of Public Health, University of California, Berkeley), David Blumenthal (Institute for Health Policy, Massachusetts General Hospital), Edward Miller (Johns Hopkins University School of Medicine), Spencer Foreman (Montefiore Medical Center), Lawrence Lewin (Lewin Group), Gail Wilensky (Project HOPE), Robert Dickler (American Association of Medical Colleges), and Kenneth Shine (Institute of Medicine).
Everyone agrees on the need to reform Medicare but not on how to do it. Some argue the program is too comprehensive, others that it is not comprehensive enough. Some suggest it pays too much for health care, others, too little. Meanwhile, the financial stakes continue to mount. Medicare spending exceeded $400 billion in 2007, making it more expensive than the entire health systems of most other nations, as well as the largest national public program other than Social Security and national defense. In R "eforming Medicare, " Henry J. Aaron and Jeanne M. Lambrew deftly guide readers through this complex debate. They identify and analyze the three leading approaches to reform. Updated social insurance would retain the current system while rationalizing coverage and reducing bureaucracy. Premium support would replace the current system with a capped, per-person payment that beneficiaries could use to buy health insurance. Consumer-directed Medicare would have beneficiaries pay for care up to a high deductible from government- supported savings accounts and offer premium-support coverage above the deductible. In addition to rating each option on its ability to promote access to health care, improve the quality of care, and control costs, the authors evaluate each reform's political strengths and weaknesses. Given the heat generated by the Medicare debate, it is unlikely that any single approach will be implemented in full. Consequently, Aaron and Lambrew describe incremental strategies that blend elements of each plan. Their analysis provides essential insight into the types of hybrid policies that Congress will consider in coming years.