The Incidence of Medicare

Mark McClellan, Jonathan Skinner

NBER Working Paper No. 6013
Issued in April 1997
NBER Program(s):Aging, Health Care, Public Economics

The Medicare program transfers more than $200 billion annually from taxpayers to beneficiaries. This paper considers the incidence of such transfers. First, we examine the net tax payments and program expenditures for individuals in different lifetime income groups. We find Medicare has led to net transfers from the poor to the wealthy, as a result of relatively regressive financing mechanisms and the higher expenditures and longer survival times of wealthier beneficiaries. Even with recent financing reforms, net transfers to the wealthy are likely to continue for at least several more decades. Second, we consider the insurance value of Medicare in providing a missing market for health insurance. With plausible parameter values, our simulations suggest that low-income elderly benefitted more than the dollar flows would suggest. Including this insurance value implies that, on net, there is faint redistribution from the highest income deciles to the lowest income deciles. We also consider the likely distributional impact of several proposed reforms in Medicare financing and benefits.

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Document Object Identifier (DOI): 10.3386/w6013

Published: McClellan, Mark and Jonathan Skinner. "The Incidence Of Medicare," Journal of Public Economics, 2006, v90(1-2,Jan), 257-276. citation courtesy of

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