NATIONAL BUREAU OF ECONOMIC RESEARCH
NATIONAL BUREAU OF ECONOMIC RESEARCH

NBER Aging Program


The Economics Of Aging Program involves research on the health and economic circumstances of individuals as they age, and on the implications of population aging on the well-being of older persons.

List of Members
Program Working Papers
NBER Center for Aging and Health Research
NBER Disability Research Center
NBER Retirement Research Center
NBER Roybal Center for Behavior Change in Health and Savings
NBER Program Project on Satelite National Health Accounts
Training

Free! Bulletin on Aging and Health

Book series
The Economics of Aging
International Social Security

David A. Wise, Program Director*


[The following Program Report, the most recent on this program, appeared in 2014 Number 2 issue of the NBER Reporter.]

The NBER's Program on the Economics of Aging began in 1986, when the baby boom generation was between the ages of 22 and 40, and when life expectancy at age 62 (the age of eligibility for Social Security) was nearly three years shorter than it is today. The program at its outset was created with a forward-thinking orientation, drawing together economists from multiple subfields of the profession to consider jointly what would become one of the most important demographic, social, and economic transitions of the twenty-first century. The underlying focus of the program is the study of the health and financial well-being of people as they age, and the larger implications of a population that is increasingly composed of older people.

Today, the substantive importance of research on aging has never been greater. The long-anticipated aging of the baby boom generation across the threshold of eligibility for Social Security and Medicare has arrived. Baby boomers are now between the ages of 50 and 68, and their initiation of retirement benefits is accelerating. The societal impact of aging baby boomers is compounded by increasing longevity. In just the next 20 years, the U.S. population aged 65 and older is projected to increase from 43 million to 76 million people.

The implications of these demographic trends are extensive, yet they are just one part of a complex dynamic of changing factors affecting people's well-being as they age. One such factor is a marked shift in employment-based retirement policy, away from traditional defined benefit (DB) pension plans and retiree health benefits, and toward 401(k)-type plans in which individuals manage their own retirement assets. Another factor is the implicit continuing changes in the public programs that benefit older people, most notably Social Security, Medicare, and Medicaid, as financial pressures from the current provisions of these programs intensify. A third factor is the substantial and ongoing effects of the Great Recession, many of which are still being assessed.

The landscape of health and health care is changing rapidly as well, with lower disability rates by age, continuing advances in medical technology and disease management, increases in health care costs, and significant reforms in health policy. Health affects one's ability to work at older ages, and is strongly associated with financial well-being. Our aim through program research is to advance our understanding of well-being in all its dimensions and to determine what can be done to improve well-being in this rapidly changing environment.

Over the last 28 years, the NBER's Program on the Economics of Aging has helped to transform this field from an exploratory new research area into a well-recognized and influential subfield of the economics profession. Throughout its history, the program has benefitted from a substantial base of financial support from the National Institute on Aging (NIA), and from the leadership of a visionary program officer at NIA, Richard Suzman. NIA's recognition of the analytic value of economic research in aging and its support for a highly integrated program of investigators working collaboratively on aging issues was path-breaking. This support has been critical to development of the NBER program, the research subfield, and our understanding more generally of people's well-being as they age. The NBER's Aging Program continues to be anchored by NIA Center and Program Project grants, and by multiple NIA-funded research projects that are administered under the coordinating umbrella of the program. NIA support has been supplemented in recent years by Retirement Research Center and Disability Research Center grants from the Social Security Administration (SSA).

The program has thrived through its history by simultaneously recruiting and inspiring some of the most prominent, established economics scholars along with more emerging scholars to develop a research agenda on economic issues related to aging. This has had a magnetic effect on the size, scope, and productivity of the program as new researchers have been drawn into the field by the prominent senior scholars already working on aging issues. The program has also been leveraged by substantial research development support provided by NIA, including an NIA-funded training program on the economics of aging and NIA funding for pilot projects. The training program alone has supported about 150 investigators, the large majority of whom have developed a long-term research agenda on the economics of aging. Nearly 100 pilot awards have also been supported by NIA, most of which have laid a foundation for larger-scale subsequent research projects. Both the training and research development opportunities in aging have expanded even further in recent years through the SSA-funded research centers.

One measure of the success of these training and development initiatives is that three of the five most recent recipients of the John Bates Clark Medal (awarded annually to the best economist under age 40) are active program affiliates who have been part of the program for most of their careers: Esther Duflo (2010 recipient), Amy Finkelstein (2012 recipient), and Raj Chetty (2013 recipient). Two Nobel Prize winners, Daniel McFadden and the late Robert Fogel, played an important role in building the program, as did several past officers of the American Economic Association (AEA) and some of the intellectual leaders in public economics, health economics, labor economics, financial economics, behavioral economics, and econometrics. What has emerged from this long-term commitment to training and recruitment is a multigenerational consortium of accomplished researchers who work together on important issues and create training opportunities for each new cohort of economists who become involved with the program over time.

Many of the studies taking place through the NBER's Aging Program are distributed initially as NBER Working Papers, examples of which are noted below. Some are also published in a continuing series of NBER research volumes on the economics of aging, the most recent of which are Research Findings in the Economics of Aging (2010),1 Explorations in the Economics of Aging (2011),2 Investigations in the Economics of Aging (2012),3 and Discoveries in the Economics of Aging 4 (2014).

The research composition of the NBER's Program on Aging has evolved as the economics of aging field has matured. The overarching goal is to understand the health and financial well-being of people as they age, how well-being is affected by the changing environment in which people live, and what interventions might be effective in improving health and financial well-being. What is most apparent from the research carried out by program affiliates is the integral relationship between the multiple dimensions of people's well-being.

As we confront the demographic challenges of a substantially larger population of older people, opportunity lies in three sets of trends, all of which are a focus of continuing research. First, saving in 401(k) and similar plans is now a mainstream aspect of retirement preparation. Though large parts of the population appear to save too little, and access to employment-based saving programs is far from universal, a policy foundation for the accumulation of personal retirement resources is in place, and financial preparation can be improved through saving-related interventions. Second, many though not all measures of health are improving, and these improvements can be accelerated through health-related interventions. Third, it may be possible to allocate some of the bounty of longer and healthier lives to prolonging the labor force participation of some older workers, thereby helping to pay for higher Social Security and health care costs, and moderating the macroeconomic challenges we collectively face. But whether people work or retire at one age or another depends significantly on how we structure our public policies and work environments. Each of these issues is being considered in ongoing program research. The summary below describes examples of NBER publications and working papers that have been distributed in the last two years, and that bear on each of these issues.

Financial Well-Being

Among the resources that are potentially available to support people in their later years are Social Security, employer-provided pension benefits, financial asset savings, housing wealth, and earnings. In his 2014 Richard T. Ely Lecture to the AEA,5 James Poterba presents an overview of changing retirement security, the increasing importance of individual decisions about saving, and the varying composition of financial resources available in retirement across different segments of the population. Among the research reviewed in that lecture is a series of studies co-authored with Steven Venti and me on the financial status of people as they age, the most recent of which demonstrates the strong lifelong relationships between health, education, Social Security income, financial assets, and depletion of financial assets in later life. 6

As noted, a major trend of the last two decades is away from traditional employer-provided pensions and toward savings-based retirement programs, most notably 401(k) plans. John Beshears, James Choi, David Laibson, Brigitte Madrian, and others have an extensive research agenda on what motivates saving. The consistent finding of their research is that people tend to "follow the path of least resistance," participating more often when enrollment is automatic, and often following the default provisions of their employers' programs. People are also affected by other behavioral factors such as simplification, planning aids,7

reminders, and commitment features.8

Their most recent studies have looked at how small cues in plan descriptions can alter behavior,9

the availability and utilization of 401(k) loans, 10 peer influences on saving, 11 and the use of Roth versus traditional 401(k) plans.12

Using data from Denmark, Chetty, John Friedman, Soren Leth-Petersen, Torben Nielsen, and Tore Olsen find that automatic contributions are more effective at inducing saving than subsidization or financial incentives. 13 Robert Clark, Jennifer Maki, and Melinda Sandler Morrill find that a simple informational flyer about their employer's 401(k) plan and the value of contributions compounding over a career significantly increase the likelihood of younger workers contributing to the plan.14 In similar work, Gopi Shah Goda, Colleen Flaherty Manchester, and Aaron Sojourner find that providing plan participants with income projections, based on saving rates, also increases contributions.15

Related to saving rates is the decision of how to allocate one's savings among alternative investment options. Again, defaults are important, but so are the number of options available and the presentation of those options to plan participants. Clemens Sialm, Laura Starks, and Hanjiang Zhang show that while participants in defined-contribution (DC) plans rarely adjust their portfolio allocations, significant changes in investment composition still occur because of changes in the investment options offered by plan sponsors. 16 Beshears and his co-authors find that when people receive simplified investment disclosure information, they spend less time on their investment decisions, but do not change them significantly. 17 Fabian Duarte and Justine Hastings find that a government-defined fee index in the pension system in Mexico significantly influenced investment behavior, but the design of the index did not necessarily steer investors to the lowest cost funds.18

Because responsibility for retirement planning has shifted from employers to workers, questions have been raised about the importance of financial literacy, as well as the appropriate role for financial advisors. Recent papers by Hastings, Madrian, and William Skimmyhorn 19 and by Annamaria Lusardi, Olivia Mitchell, and Vilsa Curto 20 review the literature on financial education and financial literacy, documenting deficiencies in financial sophistication in survey data and poor performance of many individuals on test-based measures of financial literacy. A study by Lusardi, Pierre-Carl Michaud, and Mitchell shows that financial knowledge can potentially account for a large portion of wealth inequality.21 It is not clear that the use of professional financial advisors helps, however. John Chalmers and Jonathan Reuter find that clients who choose brokers over self-directed investing tend to have riskier portfolios that underperform benchmark portfolios.22 More actively managed investments also have higher fees. For example, Hastings, Ali Hortaçsu, and Chad Syverson find that advertising affects fund manager choice, and may raise average management fees in Mexico's pension system. 23

This line of research on retirement saving has also analyzed the risk and return tradeoffs of different investment portfolios. For example, Mitchell and Stephen Utkus look at the role of target-date funds in shifting investment decisions from workers back to employers (or to fund managers) who adjust portfolios automatically based on a worker's investment horizon.24 However, Pierluigi Balduzzi and Reuter find wide variability in returns to different target-date retirement funds. 25 Andreas Hubener, Raimond Maurer, and Mitchell consider how asset allocations interact with Social Security claiming, survivor benefit rules, and life insurance purchases. 26

While accumulated savings is one aspect of financial well-being at older ages, a related question is how much money people need for financial security in later life. The biggest reason financial need may be changing is the growth of out-of-pocket medical costs. For example, a recent study by Goda, John Shoven, and Sita Slavov finds that after subtracting health spending from Social Security benefits, the average net Social Security benefit has grown more slowly than non-medical inflation.27 In related work, Sanders Korenman and Dahlia Remler consider the feasibility of a health-inclusive poverty measure. 28 Further reinforcing the relationship between out-of-pocket medical costs and financial need, Clark and Mitchell find that public employees who anticipate receiving employer-provided health insurance in retirement save less than their private sector uncovered counterparts.29

In addition to studying saving and the need for saving, investigators in the Aging Program are analyzing how people use their accumulated assets in later life. Of particular interest is the relative importance of annuitized versus non-annuitized resources, and how they are affected by the financial decisions people make. Annuitized assets provide a steady stream of income for life, providing insurance against outliving one's resources. Social Security provides a base level of annuitized income which may be supplemented by traditional employer-provided pension plans or by private annuity products. Non-annuitized assets, on the other hand, are available for unexpected or irregular expenses, such as adverse health events.

Shoven and Slavov show the effect of delayed Social Security claiming as a low-cost approach to increasing people's annuity payment stream. 30 Those leaving jobs with a traditional pension plan may also have the option to retain or to cash out their pension annuities. Clark, Morrill, and David Vanderweide find that even among employees leaving their jobs before age 50, people often keep their annuitized pensions rather than cashing out of them.31 The purchase of annuity products in the private market is less common. Poterba, Venti, and I analyze the amount of annuity income people could potentially purchase if they converted all of their non-annuitized financial assets to annuities.32 We find that fewer than half of households could increase their annuitized income by more than $5,000 per year, but that wealthier households could purchase larger annuities.

Jeffrey Brown, Arie Kapteyn, Erzo Luttmer, and Mitchell suggest that one reason for the small private market for annuities is the difficulty of assessing their value.33 Beshears, Choi, Laibson, Madrian, and Stephen Zeldes look at how the framing and structure of private annuity choices affect people's stated preferences, and how annuities might be structured to increase their appeal.34 Brown, Jeffrey Kling, Sendhil Mullainathan, and Marian Wrobel find that annuities are more attractive when presented in a consumption frame than in an investment frame.35 Vanya Horneff, Maurer, Mitchell, and Ralph Rogalla look at the annuity protections in Guaranteed Minimum Withdrawal Benefit variable annuities.36 Felix Reichling and Kent Smetters find that when valuation risk is incorporated into models of household demand for annuities, the number of households choosing to annuitize declines.37

Many public policy provisions also influence financial well-being in later life. Brown and Scott Weisbenner find that the Windfall Elimination Provision of Social Security reduces benefits proportionately more for households with lower lifetime earnings. 38 Alan Gustman, Thomas Steinmeier, and Nahid Tabatabai find that the 3.5 percent of households that are subject either to the Windfall Elimination or the Government Pension Offset rules have the value of their benefits reduced by an average of about one-fifth. 39 These authors also find that pension data reported in some surveys is understated relative to its contribution in supporting retirees.40

Health and Life Satisfaction

Finances and health are two fundamental aspects of well-being as we age. As we live longer, an important question is whether our lengthening life expectancies are characterized by poor health and functional disability, or by good health and functional independence. A particularly exciting finding of recent research, reported by David Cutler, Kaushik Ghosh, and Mary Beth Landrum, shows the compression of morbidity into a shorter period of time just before death.41 If confirmed in continuing work, this means that the impacts of population aging will not be as severe as they might be if additional life expectancy involved many years of disability and need for care. In prior work, Cutler and Landrum compressed 19 health indicators into three summary measures of physical and social impairment, functional ability, and sensory impairment, which provided an important background to studying health trends. 42

Many factors affect health trends, and many can be influenced by public health interventions. For example, Samuel Preston, Andrew Stokes, Neil Mehta, and Bochen Cao project that future mortality will be affected by both reductions in smoking and increases in obesity, roughly offsetting for women, but with smoking reductions having a bigger effect for men. 43 Program researchers have also tested various behavior-change interventions. Recent work by Beshears, Choi, Laibson, Madrian, and Katherine Milkman investigates the power of planning prompts in inducing more people to keep colonoscopy appointments 44 or to increase flu vaccination rates.45 Larger experimental interventions have been undertaken in poorer regions of the world including a recent study by Abhijit Banerjee, Sharon Barnhardt, and Duflo which examines attempts to better treat anemia with fortified salt. 46

Changes in health insurance and health policy impact health as well, and program researchers have a diverse research agenda on health policy impacts. For example, using data from the Oregon lottery for Medicaid coverage, Finkelstein et al. find that increased insurance coverage led to higher health care utilization, lower out-of-pocket medical expenditures, and better self-reported physical and mental health.47 Charles Courtemanche and Daniela Zapata find that the near universal coverage following health reforms in Massachusetts also led to improvements in multiple measures of health.48 Martin Hackmann, Jonathan Kolstad, and Amanda Kowalski analyze other impacts of the insurance mandate in Massachusetts, finding significant decreases in premiums and average costs, smaller post-reform markups in the individual health insurance market, and a generally healthier mix of enrollees.49

Florian Heiss, Adam Leive, McFadden, and Joachim Winter look at plan choice in the implementation of Medicare Part D and find that a sizeable fraction of consumers are not making the best decisions among plan options. 50 This conclusion is reinforced in a study by Jason Abaluck and Jonathan Gruber, who find both inertia in plan choice and suboptimal decisions even among those who change plans. 51 In addition, Keith Marzilli Ericson finds that firms may raise premiums on existing enrollees, who are slower to change plans they already have, while charging less for comparable new plans. 52 Liran Einav, Finkelstein, and Paul Schrimpf find that there is substantial bunching of pharmaceutical spending just before the "donut hole," where insurance coverage is discontinuously reduced. 53

Trends and patterns in health care spending are another subject of continuing program research. Amitabh Chandra, Jonathan Holmes, and Jonathan Skinner find that the slowdown in health care spending growth over the last decade is a result of three primary factors: the rise in high deductible insurance plans, state-level efforts to control Medicaid costs, and a general slowdown in the diffusion of new technology, particularly in the Medicare population.54 Katherine Baicker, Michael Chernew, and Jacob Robbins find substantial cost-spillover effects in markets with a high concentration of Medicare managed care enrollees, lowering hospital costs for all seniors and for commercially insured younger populations.55 Cutler, Skinner, Ariel Dora Stern, and David Wennberg find that the single most important factor causing regional variation in health care spending is physician beliefs about treatment and not differences in patient demand-side factors. 56

A line of research on health care productivity tries to relate medical advances and medical spending to the health outcomes that are obtained from that spending. For example, Anne Hall and Tina Highfill analyze alternative approaches to calculating disease-based expenditure indexes.57 Chandra, David Malenka, and Skinner look at the pace of new technology adoption, using as a case study drug-eluting stents which they find are adopted more rapidly at higher quality hospitals and at hospitals where patients are more likely to benefit from the technology. 58 Eric Budish, Benjamin Roin, and Heidi Williams find that longer periods of time between pharmaceutical innovation and commercialization can deter R&D investments, at least in part because patents have a fixed term. 59 Chandra, Finkelstein, Adam Sacarny, and Syverson find that the hospital industry has much in common with more traditional production sectors; for example, hospitals with higher productivity measures have comparatively larger and expanding market shares.60

As noted earlier in this report, much of the integrative research of the Program on Aging has found strong interrelationships between well-being in the financial and health domains which persist throughout the life course. For example, Till Stowasser, Heiss, McFadden, and Winter describe the existing evidence on the links between socioeconomic status and health and they explain some of the challenges in assessing causal relationships. 61 Hilary Hoynes, Diane Whitmore Schanzenbach, and Douglas Almond find that access to food stamps in childhood leads to a reduction in obesity, high blood pressure, and diabetes later in life. 62 In a longer-term historical analysis of health and the economy, Dora Costa argues that scientific advances (including sanitation projects) played an important historical role in improving health and raising economic productivity. 63 Bruce Meyer and Wallace Mok find that the economic consequences of health impairments are profound. 64 Cutler and Adriana Lleras-Muney explore the relationship between education and health across countries, finding both that education affects health and, in some cases, that health may affect education.65

Extending beyond traditional measures of health, some of the most recent program research has considered well-being in a more general sense. For example, Daniel Benjamin, Ori Heffetz, Miles Kimball, and Nichole Szembrot identify 136 aspects of well-being that incorporate happiness and life satisfaction, goals and achievements, freedoms, engagement, morality, self-expression, relationships, and the well-being of others.66 Exploratory work by Angus Deaton uses well-being data from Gallup surveys over the period of the financial crisis and finds, among other results, a close relationship with stock market performance. 67 In another application of Gallup data, Deaton and Arthur Stone find that elderly Americans who live with people under the age of 18 have lower life evaluations than those who do not: they experience worse emotional outcomes, less happiness and enjoyment, and more stress, worry, and anger.68 McFadden has also evaluated well-being in work on "the new science of pleasure."69

Work and Retirement at Older Ages

While the determinants of work and retirement have been core components of the Aging Program since its inception, an important emerging angle of research is how people’s capacity to work is changing over time, and the effect of public policies and work environments on older people’s incentive to continue working. For example, Kevin Milligan and I document long-term trends in mortality risk in different countries, a measure of health that is comparable across countries and comparable over time within the same country. We find that at each mortality rate in 2007, if American men between the ages of 55 and 69 had worked as much as American men in 1977 they would have worked an additional 3.7 years, or 46.8 percent more. 70 Whether these improvements in health will translate into work behavior is complicated by and highly dependent upon policy. At the individual level, health is clearly a factor that influences work behavior, as quantified in a recent study by Gustman and Steinmeier. 71 At the economy-wide level, policy incentives as well as trends in overall health are likely to play a key role in affecting labor market activity.

I have been directing a long-term NBER project on Social Security and retirement around the world which has engaged an international team of investigators from Belgium, Canada, Denmark, Italy, France, Germany, Japan, the Netherlands, Spain, Sweden, the United Kingdom, and the United States. The current focus of the group is on this question: given health status, to what extent are differences in labor force participation across countries determined by the provisions of disability insurance (DI) programs? 72 Several studies from this project have been circulated recently as NBER Working Papers, including papers on Belgium,73 France,74 Germany,75 and the United Kingdom.76 Courtney Coile, who conducted the U.S. study for a forthcoming Aging volume, finds that leaving the labor force through DI is strongly related to education and policy incentives, even after controlling for the effects of health. 77 Coile, Milligan, and I draw together the findings from the country studies and identify several overarching themes. 78 We find, for example, that neither the variation in DI participation across countries nor the trends in participation within countries over time has much to do with health trends. Much larger factors are changes in DI policy, the financial incentives of the DI policies (in conjunction with other pathways to retirement), and the stringency of the applicant screening process. We also find a strong relationship between education and DI participation in all countries, even after controlling for health. It is also striking that the proportion of people aged 60 to 64 on DI is larger in the United States than in most other countries; there has been a large decline in DI since the mid-1990s and later in most other countries.

Numerous other NBER studies have also explored relationships between policy and labor market behavior at older ages. Looking at Social Security policy, Gustman and Steinmeier estimate generally increasing work at older ages from three potential changes to Social Security policy: raising the early retirement age, raising the normal retirement age, and eliminating the payroll tax. 79 Alexander Gelber, Damon Jones, and Daniel Sacks find considerable bunching at the kink points in the Social Security earnings test that appears to persist even when individuals reach an age at which they are no longer subject to the earnings test, or following legislative changes that eliminate the earnings test for some groups.80 Jingjing Chai, Maurer, Mitchell, and Rogalla find that a lump sum payment for delaying retirement could increase the average retirement age by as much as two years. 81 Neeraj Kaushal finds that the expanded pension system in India had a modestly negative effect on the labor supply of older men, but not of women. 82

Looking at DI policy, Andreas Kostøl and Magne Mogstad find that many DI recipients have considerable capacity to work and can be induced to work more using financial incentives. 83 David Autor, Mark Duggan, and Gruber find that when people need to wait longer to claim private DI benefits, they are less likely to claim the insurance and more likely to work. 84 Timothy Moore finds that roughly one-fifth of the DI recipients who lost benefits as a result of the 1996 removal of drug and alcohol addictions as qualifying conditions for DI subsequently returned to work. 85

With regard to health insurance policy, Shoven and Slavov find that among state and local government employees, access to retiree health coverage raises the probability of leaving the labor force between the ages of 60 and 64 by 5.1 percentage points, or about 28 percent.86 Maria Fitzpatrick finds that after the introduction of retiree health insurance for a group of public teachers, the percentage still employed at age 65 drops from 51 to 29 percent.87 Steven Nyce, Sylvester Schieber, Shoven, Slavov, and I also find very significant increases in early retirement among firms offering more generous retiree health benefits in the private sector, based on an analysis of employee-level data in 64 large firms.88

Studying other workplace programs, Steven Allen, Clark, Maki, and Morrill find that employer-based retirement seminars affect people's planned retirement age and planned age of claiming Social Security benefits.89 Fitzpatrick and Michael Lovenheim document the impact of early retirement incentives on the teaching profession. 90 Goda, Jones, and Manchester look at the influence of selection and incentives in influencing work mobility between DB and DC pension systems. 91 Interestingly, Chalmers, Woodrow Johnson, and Reuter find that within Oregon’s integrated DB-DC pension system, employees receiving DC benefits are more likely to retire before the normal retirement age than employees receiving the DB benefit. 92

The health of the macroeconomy has its own effect on labor market behavior. For example, Yuriy Gorodnichenko, Jae Song, and Dmitriy Stolyarov find that flows into both full and partial retirement increase when the unemployment rate rises. 93 However, Andreas Mueller, Jesse Rothstein, and Till von Wachter find no evidence that expiring unemployment insurance benefits lead to a rise in DI applications.94

The fiscal challenges of population aging heighten the importance of our continuing research on these issues, as the baby boom generation moves from the most productive and highest earning phase of their careers to the ages when people have traditionally retired. The implications for the U.S. economy are enormous as the cost of government programs rises, with fewer people in the labor force to pay for them and, at least potentially, a reduction in the aggregate productive capacity of a smaller labor force. In confronting fiscal challenges, Axel Börsch-Supan reviews various approaches considered or implemented in Europe, including contribution or benefit rate changes, indexation of benefits to dependency, measures to induce longer working lives, adapting retirement age to life expectancy, and more reliance on private savings. 95 Alan Auerbach, Lorenz Kueng, and Ronald Lee evaluate the intergenerational impacts of different tax and benefit adjustments to social security policy. 96

A final example of the looming fiscal challenges of population aging and the importance of labor market behavior in confronting these challenges is the unfunded liability of retiree pension and state and local government health care benefits. Byron Lutz and Louise Sheiner estimate the total unfunded liability for state and local health care benefits at more than $1 trillion, or about half the amount of unfunded pension obligations.97 Robert Novy-Marx and Joshua Rauh estimate that without policy changes, full funding of state and local pension systems over the next 30 years would require that contributions increase by 2.5 times, reaching 14.1 percent of revenues. 98 These authors also consider public pension reforms that link benefits to investment performance. 99

Researchers in the Economics of Aging Program will continue to explore the potential for policy to motivate, or at least facilitate, the many positive societal trends that will help meet the demographic challenges ahead: improving health, increasing saving, extending productive working lives, and enhancing well-being as the population ages.


* David Wise is the Director of the NBER's Program on the Economics of Aging and Area Director for Health and Retirement Programs at the NBER. He is also the John F. Stambaugh Professor of Political Economy at the Kennedy School of Government at Harvard University. This report was written with the full collaboration of Richard Woodbury

1. D. A. Wise, ed., Research Findings in the Economics of Aging, Chicago, IL: University of Chicago Press, 2010.

2. D. A. Wise, ed., Explorations in the Economics of Aging, Chicago, IL: University of Chicago Press, 2011.

3. D. A. Wise, ed., Investigations in the Economics of Aging, Chicago, IL: University of Chicago Press, 2012.

4. D. A. Wise, ed., Discoveries in the Economics of Aging, Chicago, IL: University of Chicago Press, 2014.

5. J. M. Poterba, "Retirement Security in an Aging Society," NBER Working Paper No. 19930, February 2014, and American Economic Review, Papers and Proceedings, 104 (2014), pp. 1‒30.

6. J. M. Poterba, S. F. Venti, and D. A. Wise, "Health, Education, and the Post-Retirement Evolution of Household Assets," NBER Working Paper No. 18695, and Journal of Human Capital, 7 (2013), pp. 297-339; J. M. Poterba, S. F. Venti, and D. A. Wise, "The Nexus of Social Security Benefits, Health, and Wealth at Death," NBER Working Paper No. 18658, December 2012, and chapter 4 in D. A. Wise 2014, op. cit. , pp. 159-86; J. M. Poterba, S. F. Venti, and D. A. Wise, "Were They Prepared for Retirement? Financial Status at Advanced Ages in the HRS and AHEAD Cohorts," NBER Working Paper No. 17824, February 2012, and chapter 1 in D. A. Wise 2012, op. cit., pp. 21-69.

7. K. L. Milkman, J. Beshears, J. J. Choi, D. Laibson, and B. C. Madrian, "Following Through on Good Intentions: The Power of Planning Prompts," NBER Working Paper No. 17995, April 2012.

8. B. C. Madrian, "Matching Contributions and Savings Outcomes: A Behavioral Economics Perspective," NBER Working Paper No. 18220, July 2012.

9. J. J. Choi, E. Haisley, J. Kurkoski, and C. Massey, "Small Cues Change Savings Choices," NBER Working Paper No. 17843, February 2012.

10. J. Beshears, J. J. Choi, D. Laibson, and B. C. Madrian, "The Availability and Utilization of 401(k) Loans," NBER Working Paper No. 17118, June 2011, and chapter 4 in D. A. Wise 2012, op. cit., pp. 145-72.

11. J. Beshears, J. J. Choi, D. Laibson, B. C. Madrian, and K. L. Milkman, "The Effect of Providing Peer Information on Retirement Savings Decisions," NBER Working Paper No. 17345, August 2011.

12. J. Beshears, J. J. Choi, D. Laibson, and B. C. Madrian, "Who Uses the Roth 401(k), and How Do They Use It?" NBER Working Paper No. 19193, July 2013.

13. R. Chetty, J. N. Friedman, S. Leth-Petersen, T. Nielsen, and T. Olsen, "Active vs. Passive Decisions and Crowdout in Retirement Savings Accounts: Evidence from Denmark," NBER Working Paper No. 18565, November 2012.

14. R. L. Clark, J. A. Maki, and M. S. Morrill, "Can Simple Informational Nudges Increase Employee Participation in a 401(k) Plan?" NBER Working Paper No. 19591, October 2013.

15. G. S. Goda, C. F. Manchester, and A. Sojourner, "What Will My Account Really Be Worth? An Experiment on Exponential Growth Bias and Retirement Saving," NBER Working Paper No. 17927, March 2012.

16. C. Sialm, L. Starks, and H. Zhang, "Defined Contribution Pension Plans: Sticky or Discerning Money?" NBER Working Paper No. 19569, October 2013.

17. J. M. Poterba, S. F. Venti, and D. A. Wise, "Family Status Transitions, Latent Health, and the Post-Retirement Evolution of Assets," NBER Working Paper No. 15789, February 2010, and chapter 1 in D. A. Wise 2011, op. cit., pp. 23-69.

18. F. Duarte and J. S. Hastings, "Fettered Consumers and Sophisticated Firms: Evidence from Mexico's Privatized Social Security Market," NBER Working Paper No. 18582, December 2012.

19. J. S. Hastings, B. C. Madrian, and W. L. Skimmyhorn, "Financial Literacy, Financial Education and Economic Outcomes," NBER Working Paper No. 18412, September 2012.

20. A. Lusardi, "Numeracy, Financial Literacy, and Financial Decision-Making," NBER Working Paper No. 17821, February 2012; A. Lusardi, O. S. Mitchell, and V. Curto, "Financial Sophistication in the Older Population," NBER Working Paper No. 17863, February 2012; A. Lusardi and O. S. Mitchell, "The Economic Importance of Financial Literacy: Theory and Evidence," NBER Working Paper No. 18952, April 2013, and Journal of Economic Literature, 52 (2014), pp. 5-44.

21. A. Lusardi, P. Michaud, and O. S. Mitchell, "Optimal Financial Knowledge and Wealth Inequality," NBER Working Paper No. 18669, January 2013.

22. J. Chalmers and J. Reuter, "What is the Impact of Financial Advisors on Retirement Portfolio Choices and Outcomes?" NBER Working Paper No. 18158, June 2012.

23. J. S. Hastings, A. Hortaşsu, and C. Syverson, "Advertising and Competition in Privatized Social Security: The Case of Mexico," NBER Working Paper No. 18881, March 2013.

24. O. S. Mitchell and S. Utkus, "Target-Date Funds in 401(k) Retirement Plans," NBER Working Paper No. 17911, March 2012.

25. P. Balduzzi and J. Reuter, "Heterogeneity in Target-Date Funds: Optimal Risk Taking or Risk Matching?" NBER Working Paper No. 17886, March 2012.

26. A. Hubener, R. Maurer, and O. S. Mitchell, "How Family Status and Social Security Claiming Options Shape Optimal Life Cycle Portfolios," NBER Working Paper No. 19583, October 2013.

27. G. S. Goda, J. B. Shoven, and S. N. Slavov, "How Well Are Social Security Recipients Protected from Inflation?" NBER Working Paper No. 16212, July 2010, and chapter 3 in D. A. Wise 2012, op. cit., pp. 119-39.

28. S. Korenman and D. Remler, "Rethinking Elderly Poverty: Time for a Health Inclusive Poverty Measure?" NBER Working Paper No. 18900, March 2013.

29. R. L. Clark and O. S. Mitchell, "How Does Retiree Health Insurance Influence Public Sector Employee Saving?" NBER Working Paper No. 19511, October 2013, and forthcoming in the Journal of Health Economics.

30. J. B. Shoven and S. N. Slavov, "Recent Changes in the Gains from Delaying Social Security," NBER Working Paper No. 19370, August 2013; J. B. Shoven and S. N. Slavov, "When Does It Pay to Delay Social Security? The Impact of Mortality, Interest Rates, and Program Rules," NBER Working Paper No. 18210, July 2012; J. B. Shoven and S. N. Slavov, "The Decision to Delay Social Security Benefits: Theory and Evidence," NBER Working Paper No. 17866, February 2012.

31. R. L. Clark, M. S. Morrill, and D. Vanderweide, "Defined Benefit Pension Plan Distribution Decisions by Public Sector Employees," NBER Working Paper No. 18488, October 2012.

32. J. M. Poterba, S. F. Venti, and D. A. Wise, "The Composition and Draw-down of Wealth in Retirement," NBER Working Paper No. 17536, October 2011, and Journal of Economic Perspectives, 25 (2011), pp. 95‒118.

33. J. R. Brown, A. Kapteyn, E. F. P. Luttmer, and O. S. Mitchell, "Decision Complexity as a Barrier to Annuitization," NBER Working Paper No. 19168, June 2013.

34. J. Beshears, J. J. Choi, D. Laibson, B. C. Madrian, and S. P. Zeldes, "What Makes Annuitization More Appealing?" NBER Working Paper No. 18575, November 2012, and forthcoming in the Journal of Public Economics.

35. J. R. Brown, J. R. Kling, S. Mullainathan, and M. V. Wrobel, "Framing Lifetime Income," NBER Working Paper No. 19063, May 2013.

36. V. Horneff, R. Maurer, O. S. Mitchell, and R. Rogalla, "Optimal Life Cycle Portfolio Choice with Variable Annuities Offering Liquidity and Investment Downside Protection," NBER Working Paper No. 19206, July 2013.

37. F. Reichling and K. Smetters, "Optimal Annuitization with Stochastic Mortality Probabilities," NBER Working Paper No. 19211, July 2013.

38. J. R. Brown and S. Weisbenner, "The Distributional Effects of the Social Security Windfall Elimination Provision," NBER Working Paper No. 18342, August 2012.

39. A. L. Gustman, T. L. Steinmeier, and N. Tabatabai, "The Social Security Windfall Elimination and Government Pension Offset Provisions for Public Employees in the Health and Retirement Study," NBER Working Paper No. 19724, December 2013.

40. A. L. Gustman, T. L. Steinmeier, and N. Tabatabai, "Mismeasurement of Pensions Before and After Retirement: The Mystery of the Disappearing Pensions with Implications for the Importance of Social Security as a Source of Retirement Support," NBER Working Paper No. 18542, November 2012, and Journal of Pension Economics and Finance, 13 (2014), pp. 1-26.

41. D. M. Cutler, K. Ghosh, and M. B. Landrum, "Evidence for Significant Compression of Morbidity in the Elderly U.S. Population," NBER Working Paper No. 19268, August 2013, and chapter 1 in D. A. Wise 2014, op. cit., pp. 21‒79.

42. D. M. Cutler and M. B. Landrum, "Dimensions of Health in the Elderly Population," NBER Working Paper No. 17148, June 2011, and chapter 5 in D. A. Wise 2012, op. cit. , pp. 179‒200.

43. S. H. Preston, A. Stokes, N. K. Mehta, and B. Cao, "Projecting the Effect of Changes in Smoking and Obesity on Future Life Expectancy in the United States," NBER Working Paper No. 18407, September 2012.

44. K. L. Milkman, J. Beshears, J. J. Choi, D. Laibson, and B. C. Madrian, 2012, op. cit.

45. K. L. Milkman, J. Beshears, J. J. Choi, D. Laibson, and B. C. Madrian, "Using Implementation Intentions Prompts to Enhance Influenza Vaccination Rates," NBER Working Paper No. 17183, June 2011.

46. A. Banerjee, S. Barnhardt, and E. Duflo, "Nutrition, Iron Deficiency Anemia, and the Demand for Iron-Fortified Salt: Evidence from an Experiment in Rural Bihar," chapter 10 in D. A. Wise 2014, op. cit., pp. 343-87.

47. A. Finkelstein, S. Taubman, B. Wright, M. Bernstein, J. Gruber, J. P. Newhouse, H. Allen, K. Baicker, and the Oregon Health Study Group, "The Oregon Health Insurance Experiment: Evidence from the First Year," NBER Working Paper No. 17190, July 2011, and The Quarterly Journal of Economics, 127 (2012), pp. 1057-106.

48. C. J. Courtemanche and D. Zapata, "Does Universal Coverage Improve Health? The Massachusetts Experience," NBER Working Paper No. 17893, March 2012, and Journal of Policy Analysis and Management, 33 (1) (2014), pp. 36-69.

49. M. B. Hackmann, J. T. Kolstad, and A. E. Kowalski, "Health Reform, Health Insurance, and Selection: Estimating Selection into Health Insurance Using the Massachusetts Health Reform," NBER Working Paper No. 17748, January 2012, and American Economic Review: Papers and Proceedings, 102 (2012), pp. 498-501; M. B. Hackmann, J. T. Kolstad, and A. E. Kowalski, "Adverse Selection in an Individual Mandate: When Theory Meets Practice," NBER Working Paper No. 19149, June 2013.

50. F. Heiss, A. Leive, D. L. McFadden, and J. Winter, "Plan Selection in Medicare Part D: Evidence from Administrative Data," NBER Working Paper No. 18166, June 2012, and Journal of Health Economics, 32 (6) (2013), pp. 1325-44.

51. J. Abaluck and J. Gruber, "Evolving Choice Inconsistencies in Choice of Prescription Drug Insurance," NBER Working Paper No. 19163, June 2013.

52. K. Ericson, "Consumer Inertia and Firm Pricing in the Medicare Part D Prescription Drug Insurance Exchange," NBER Working Paper No. 18359, September 2012.

53. L. Einav, A. Finkelstein, and P. Schrimpf, "The Response of Drug Expenditures to Non-Linear Contract Design: Evidence from Medicare Part D," NBER Working Paper No. 19393, August 2013.

54. A. Chandra, J. Holmes, and J. Skinner, "Is This Time Different? The Slowdown in Healthcare Spending," NBER Working Paper No. 19700, December 2013.

55. K. Baicker, M. Chernew, and J. Robbins, "The Spillover Effects of Medicare Managed Care: Medicare Advantage and Hospital Utilization," NBER Working Paper No. 19070, May 2013.

56. D. M. Cutler, J. Skinner, A. D. Stern, and D. Wennberg, "Physician Beliefs and Patient Preferences: A New Look at Regional Variation in Health Care Spending," NBER Working Paper No. 19320, August 2013.

57. A. E. Hall and T. Highfill, "Calculating Disease-Based Medical Care Expenditure Indexes for Medicare Beneficiaries: A Comparison of Method and Data Choices," NBER Working Paper No. 19720, December 2013.

58. A. Chandra, D. Malenka, and J. Skinner, "The Diffusion of New Medical Technology: The Case of Drug-Eluting Stents," chapter 11 in D. A. Wise 2014, op. cit., pp. 389-409.

59. E. Budish, B. N. Roin, and H. Williams, "Do Fixed Patent Terms Distort Innovation? Evidence from Cancer Clinical Trials," NBER Working Paper No. 19430, September 2013.

60. A. Chandra, A. Finkelstein, A. Sacarny, and C. Syverson, "Healthcare Exceptionalism? Productivity and Allocation in the U.S. Healthcare Sector," NBER Working Paper No. 19200, July 2013.

61. T. Stowasser, F. Heiss, D. L. McFadden, and J. Winter, "Understanding the SES Gradient in Health Among the Elderly: The Role of Childhood Circumstances," chapter 5 in D. A. Wise 2014, op. cit., pp. 187‒221.

62. H. W. Hoynes, D. W. Schanzenbach, and D. Almond, "Long Run Impacts of Childhood Access to the Safety Net," NBER Working Paper No. 18535, November 2012.

63. D. Costa, "Health and the Economy in the United States, from 1750 to the Present," NBER Working Paper No. 19685, November 2013.

64. B. D. Meyer and W. K. C. Mok, "Disability, Earnings, Income and Consumption," NBER Working Paper No. 18869, March 2013.

65. D. M. Cutler and A. Lleras-Muney, "Education and Health: Insights from International Comparisons," NBER Working Paper No. 17738, January 2012.

66. D. J. Benjamin, O. Heffetz, M. S. Kimball, and N. Szembrot, "Beyond Happiness and Satisfaction: Toward Well-Being Indices Based on Stated Preference," NBER Working Paper No. 18374, September 2012.

67. A. S. Deaton, "The Financial Crisis and the Well-Being of Americans," NBER Working Paper No. 17128, June 2011, published as "The Financial Crisis and the Well-Being of America," chapter 10 in D. A. Wise 2012, op. cit., pp. 343‒68.

68. A. S. Deaton and A. A. Stone, "Grandpa and the Snapper: The Wellbeing of the Elderly Who Live with Children," NBER Working Paper No. 19100, June 2013, and chapter 8 in D. A. Wise 2014, op. cit., pp. 283-303.

69. D. L. McFadden, "The New Science of Pleasure," NBER Working Paper No. 18687, January 2013.

70. K. S. Milligan and D. A. Wise, "Health and Work at Older Ages: Using Mortality to Assess the Capacity to Work across Countries," NBER Working Paper No. 18229, July 2012.

71. A. L. Gustman and T. L. Steinmeier, "The Role of Health in Retirement," NBER Working Paper No. 19902, February 2014.

72. D. A. Wise, ed., Social Security Programs and Retirement Around the World: Disability Insurance Programs and Retirement, forthcoming from the University of Chicago Press.

73. A. Jousten, M. Lefebvre and S. Perelman, "Health Status, Disability and Retirement Incentives in Belgium," NBER Working Paper No. 20035, April 2014, and chapter in D. A. Wise forthcoming, op. cit.

74. L. Behaghel, D. Blanchet, and M. Roger, "Retirement, Early Retirement and Disability: Explaining Labor Force Participation after 55 in France," NBER Working Paper No. 20030, April 2014, and chapter in D. A. Wise forthcoming, op. cit.

75. H. Jürges, L. Thiel, T. Bucher-Koenen, J. Rausch, M. Schuth, and A. Börsch-Supan, "Health, Financial Incentives, and Early Retirement: Micro-Simulation Evidence for Germany," NBER Working Paper No. 19889, February 2014, and chapter in D. A. Wise forthcoming, op. cit.

76. J. Banks, C. Emmerson, and G. C. Tetlow, "Effect of Pensions and Disability Benefits on Retirement in the UK," NBER Working Paper No. 19907, February 2014, and chapter in D. A. Wise forthcoming, op. cit.

77. C. Coile, "Disability Insurance Incentives and the Retirement Decision: Evidence from the U.S.," chapter in D. A. Wise forthcoming, op. cit.

78. C. Coile, K. S. Milligan, and D. A. Wise, "Social Security Programs and Retirement Around the World: Disability Insurance Programs and Retirement - Introduction and Summary," NBER Working Paper No. 20120, May 2014.

79. A. L. Gustman and T. L. Steinmeier, "Effects of Social Security Policies on Benefit Claiming, Retirement and Saving," NBER Working Paper No. 19071, May 2013.

80. A. M. Gelber, D. Jones, and D. W. Sacks, "Earnings Adjustment Frictions: Evidence from the Social Security Earnings Test," NBER Working Paper No. 19491, October 2013.

81. J. Chai, R. Maurer, O. S. Mitchell, and R. Rogalla, "Exchanging Delayed Social Security Benefits for Lump Sums: Could This Incentivize Longer Work Careers?" NBER Working Paper No. 19032, May 2013.

82. N. Kaushal, "How Public Pension Affects Elderly Labor Supply and Well-being: Evidence from India," NBER Working Paper No. 19088, May 2013, and World Development, 56 (2014), pp. 214-25.

83. A. R. Kostøl and M. Mogstad, "How Financial Incentives Induce Disability Insurance Recipients to Return to Work," NBER Working Paper No. 19016, May 2013.

84. D. Autor, M. Duggan, and J. Gruber, "Moral Hazard and Claims Deterrence in Private Disability Insurance," NBER Working Paper No. 18172, June 2012.

85. T. J. Moore, "The Employment Effect of Terminating Disability Benefits," NBER Working Paper No. 19793, January 2014.

86. J. B. Shoven and S. N. Slavov, "The Role of Retiree Health Insurance in the Early Retirement of Public Sector Employees," NBER Working Paper No. 19563, October 2013.

87. M. D. Fitzpatrick, "Retiree Health Insurance for Public School Employees: Does It Affect Retirement?" NBER Working Paper No. 19524, October 2013.

88. S. Nyce, S. Schieber, J. B. Shoven, S. N. Slavov, and D. A. Wise, "Does Retiree Health Insurance Encourage Early Retirement?" NBER Working Paper No. 17703, December 2011, and Journal of Public Economics, 104 (2013), pp. 40-51.

89. S. G. Allen, R. L. Clark, J. A. Maki, and M. S. Morrill, "Golden Years or Financial Fears? Decision Making After Retirement Seminars," NBER Working Paper No. 19231, July 2013.

90. M. D. Fitzpatrick and M. F. Lovenheim, "Early Retirement Incentives and Student Achievement," NBER Working Paper No. 19281, August 2013.

91. G. S. Goda, D. Jones, and C. F. Manchester, "Retirement Plan Type and Employee Mobility: The Role of Selection and Incentive Effects," NBER Working Paper No. 18902, March 2013.

92. J. Chalmers, W. T. Johnson, and J. Reuter, "The Effect of Pension Design on Employer Costs and Employee Retirement Choices: Evidence from Oregon," NBER Working Paper No. 18517, November 2012.

93. Y. Gorodnichenko, J. Song, and D. Stolyarov, "Macroeconomic Determinants of Retirement Timing," NBER Working Paper No. 19638, November 2013.

94. A. I. Mueller, J. Rothstein, and T. M. von Wachter, "Unemployment Insurance and Disability Insurance in the Great Recession," NBER Working Paper No. 19672, November 2013, and forthcoming in the Journal of Labor Economics.

95. A. Börsch-Supan, "Entitlement Reforms in Europe: Policy Mixes in the Current Pension Reform Process," NBER Working Paper No. 18009, April 2012, and chapter 10 in Fiscal Policy after the Financial Crisis, A. Alesina and F. Giavazzi, eds., Chicago, IL: University of Chicago Press, 2013, pp. 405-35.

96. A. Auerbach, L. Kueng, and R. Lee, "Propagation and Smoothing of Shocks in Alternative Social Security Systems," NBER Working Paper No. 19137, June 2013.

97. B. Lutz and L. Sheiner, "The Fiscal Stress Arising from State and Local Retiree Health Obligations," NBER Working Paper No. 19779, January 2014.

98. R. Novy-Marx and J. D. Rauh, "The Revenue Demands of Public Employee Pension Promises," NBER Working Paper No. 18489, October 2012.

99. R. Novy-Marx and J. D. Rauh, "Linking Benefits to Investment Performance in U.S. Public Pension Systems," NBER Working Paper No. 18491, October 2012, and forthcoming in the Journal of Public Economics.


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