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November 15, 2017
Labor Supply Constraints and Health Problems in Rural America
A recent research study by Alison Weingarden at the Federal Reserve's Board of Governors found that wages for relatively low-skilled workers in nonmetropolitan areas of the country have been growing more rapidly than those in metropolitan areas. In a talk yesterday in Montgomery, Alabama, Atlanta Fed President Raphael Bostic provided some evidence that differences in labor supply resulting from disability and illness may be behind this shrinking urban wage premium.
For prime-age workers (those between 25 and 54 years old), the dynamics of labor force participation (LFP) differ widely between metropolitan and nonmetropolitan areas. (These data define a metropolitan statistical area, or MSA). The LFP rate in MSAs declined by about 1.1 percentage points between 2007 and 2017 versus a 3.3 percentage point decline in non-MSA areas.
The disparity is also evident within education groups. For those without a college degree, the MSA LFP rate is down 2.6 percentage points, versus 5.0 percentage points in non-MSAs. For those with a college degree, the MSA LFP rate is down 0.7 percentage points, versus a decline of 2.5 percentage points for college graduates in non-MSAs. Moreover, although LFP rates in MSAs have shown signs of recovery in the last couple of years, this is not happening in non-MSAs.
A recent macroblog post by my colleague Ellyn Terry and the Atlanta Fed's updated Labor Force Dynamics web page have shown that the decline in prime-age LFP is partly a story of nonparticipation resulting from a rise in health and disability problems that limit the ability to work. This rise is occurring even as the population is gradually becoming more educated. (Better health outcomes generally accompany increased educational attainment.)
The following chart explores the role of disability/illness in explaining the relatively larger decline in non-MSA LFP. It breaks the cumulative change in the LFP rates since 2007 into the part attributable to demographic trends and the part attributable to behavioral or cyclical changes within demographic groups.
The demographic changes—and especially the increased share of the population with a college degree—has put mild upward pressure on the prime-age LFP rate for both the MSA and non-MSA population. Controlling for the contribution from these demographic trends, increased nonparticipation because of poor health and disability pulled down the LFP rate in MSAs by 0.8 percentage points and lowered the rate in non-MSAs by 2.0 percentage points over the past decade. For those without a college degree, disability/illness accounted for about 1.2 percentage points of the 2.6 percentage point decline in the MSA participation rate, and it accounted for 2.6 percentage points of the 5.0 percentage point decline in the non-MSA participation rate.
Taken together with evidence from business surveys and anecdotal reports about hiring difficulties, it appears that the non-MSA labor market is relatively tight. The greater inward shift of the rural supply of labor is showing through to wage costs, and especially for rural jobs that require less education.
Although the move to higher wages is welcome news for those with a job, it also raises troubling questions about why labor force nonparticipation because of disability and illness has increased so much in the first place—especially among those with less education living in nonmetropolitan areas of the country.
It is clear that the health problems for rural communities have been intensifying. Several interrelated factors have likely contributed to this worsening trend, including poverty, deeply rooted cultural and social norms, and the characteristics of rural jobs, as well as geographic barriers and shortages of healthcare providers that have limited access to care. This complex set of circumstances suggests that finding effective solutions could prove difficult.
August 30, 2017
Is Poor Health Hindering Economic Growth?
It is well known that poor health is bad for an individual's income, partially because it can lower the propensity to participate in the labor market. In fact, 5.4 percent of prime-age individuals (those 25–54 years old) reported being too sick or disabled to work in the second quarter of 2017. This is the most commonly cited reason prime-age men do not want a job, and for prime-age women, it is the second most often cited reason behind family responsibilities (see the chart). (Throughout this article, I use the measure "not wanting a job because of poor health or disability" as a proxy for serious health problems.)
In addition to being prevalent, the share of the prime-age population citing poor health or disability as the main reason for not wanting a job has increased significantly during the past two decades and tends to be higher among those with less education (see the chart).
Yet by some standards, the health of Americans is improving. For example, compared to two decades ago the average American is living two years longer, and the likelihood of dying from cancer or cardiovascular disease has fallen. These specific outcomes, however, may have more to do with improvements in the treatment of chronic disease (and the resulting reduction in mortality rates) than improvements in the incidence of health problems.
Another puzzle—which is perhaps also a clue—is the considerable variation across states in the rates of being too sick or disabled to work. For example, people living in Mississippi, Alabama, Kentucky, or West Virginia in 2016 were more than three times likelier to indicate being too sick or disabled to work than residents of Utah, North Dakota, Iowa, or Minnesota (see the maps below).
This cross-state variation is useful because it allows state-by-state comparisons of the prevalence of specific health problems. Among a list of more than 30 health indicators, the two factors that most correlate with the share of a state's population too sick or disabled to work were high blood pressure (a correlation of 0.86) and diabetes (a correlation of 0.83). Both of these conditions are associated with risk factors such as family history, race, inactivity, poor diet, and obesity. Both of these health issues have increased significantly on a national basis in recent years.
So how might poor health hinder economic growth? Health factors account for a significant part of the decline in labor force participation since at least the late 1990s. After controlling for demographic changes, the share of people too sick or disabled to work is about 1.6 percentage points higher today than it was two decades ago (see the interactive charts on our website). Other things equal, if this trend reversed itself during the next year, it could increase the workforce by up to 4 million people, and add around 2.6 percentage points to gross domestic product (calculated using our Labor Market Sliders).
Of course, such a sudden and large reversal in health is highly unlikely. Nonetheless, significant improvements to the health of the working-age population would help lessen the drag on growth of the labor supply coming from an aging population. Public policy efforts centered on both prevention and treatment of work-impeding health conditions could play an important role in bolstering the nation's workforce.
May 16, 2013
Labor Costs, Inflation Expectations, and the Affordable Care Act: What Businesses Are Telling Us
The Atlanta Fed’s May survey of businesses showed little overall concern about near-term inflation. Year-ahead unit cost expectations averaged 2 percent, down a tenth from April and on par with business inflation expectations at this time last year.
OK, we’re going to guess this observation doesn’t exactly knock you off your chair. But here’s something we’ve been keeping an eye on that you might find interesting. When we ask firms about what role, if any, labor costs are likely to play in their prices over the next 12 months, an increasing proportion have been telling us they see a potential for upward price pressure coming from labor costs (see the chart).
To investigate further, we posed a special question to our Business Inflation Expectations (BIE) panel regarding their expectations for compensation growth over the next 12 months: “Projecting ahead over the next 12 months, by roughly what percentage do you expect your firm’s average compensation per worker (including benefits) to change?”
We got a pretty large range of responses, but on average, firms told us they expect average compensation growth—including benefits—of 2.8 percent. That’s about a percent higher than the average over the past year (as estimated by either the index of compensation per hour or the employment cost index). But a 2.8 percent rise is also about a percentage point below average compensation growth before the recession. We’re included to read the survey as a confirmation that labor markets are improving and expected to improve further over the coming year. But we’re not inclined to interpret the survey data as an indication that the labor market is nearing full employment.
We’ve also been hearing more lately about the potential for the Affordable Care Act (ACA) to have a significant influence on labor costs and, presumably, to provide some upward price pressure. Indeed, several of our panelists commented on their concern about the influence of the ACA when they completed their May BIE survey. So can we tie any of this expected compensation growth to the ACA, a significant share of which is scheduled to go into effect eight months from now?
Because a disproportionate impact from the ACA will fall on firms that employ 50 or more workers, we separated our panel into firms with 50 or more employees, and those employing fewer than 50 workers. What we see is that average expected compensation growth is the same for the bigger employers and smaller employers. Moreover, the big firms in our sample report the same inflation expectation as the smaller firms.
But the data reveal that the bigger firms are a little more uncertain about their unit cost projections for the year ahead. OK, it’s not a big difference, but it is statistically significant. So while their cost and compensation expectations are not yet being affected by the prospect of the ACA, the act might be influencing their uncertainty about those potential costs.
By Mike Bryan, vice president and senior economist,
Brent Meyer, economist, and
Nicholas Parker, senior economic research analyst, all in the Atlanta Fed’s research department
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February 12, 2007
Another Thought On The Edwards Health Care Plan
The U.S. government will help states and groups of states create regional Health Markets, non-profit purchasing pools that offer a choice of competing insurance plans. At least one plan would be a public program based upon Medicare. All plans will include comprehensive benefits, including full mental health benefits. Families and businesses could choose to supplement their coverage with additional benefits. The markets will be available to everyone who does not get comparable insurance from their jobs or a public program and to employers that choose to join rather than offer their own insurance plans.
The one thing that worries me is the possibility that the endgame is domination by the public Medicare-like program, not because it is the best or most efficient means of providing insurance, but because state-run enterprises can stifle the competition by exploiting their access to taxpayer capital.
Fortunately, there is something of a model for markets in which government and private firms compete. That model comes in the form of the Monetary Control Act of 1980, which governs the behavior of the Federal Reserve when it participates in businesses for which there are actual or potential private-sector alternatives. (An example of such a business would be the collection and clearing of checks.) In essence, the rules of the Act require that the Federal Reserve cover its economic costs, which include the return to capital that would be required by the owners of for-profit businesses.
Why is is it necessary to have the government producing services that private firms are able and willing to provide? Whether you are talking about medical insurance or check-processing, it's a good question. But arguably the provisions of the Monetary Control Act resulted in an efficiency-focused government supplier with some devotion to serving markets (community banks in particular) that might have been less desirable to private providers of those services. And that doesn't sound like a bad outcome for a health care system.
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February 11, 2007
John Edwards Leaves The Gate On Health Care
John Edwards jumped ahead of the other designated major candidates in proposing a detailed plan to get to universal coverage.
Hooray for Senator Edwards, who deserves nothing but credit for jump-starting the debate. His proposal envisions a future with mandatory universal insurance coverage, provided through a combination of public and private sources, and "regional Health markets" designed to resolve the problem of constructing adequate risk pools.
The risk-pool problem has presumably helped (along with tax subsidies, of course) to entangle the provision of insurance with employment, but Senator Edwards is apparently uninterested in moving away from employer-based health care plans:
Businesses have a responsibility to support their employees’ health. They will be required to either provide a comprehensive health plan to their employees or to contribute to the cost of covering them through Health Markets.
This doesn't seem like such a good idea to me. As Gary Becker wrote not too long ago:
The tying together of health insurance with employment is partly a legacy of World War II, when employers began to offer health insurance as a fringe benefit to help them compete better for workers whose wages were regulated by the wartime government. Employer-provided health insurance expanded over time even after wage controls were abolished because income tax rates rose greatly over time. This artificial incentive to combine health insurance with employment would be eliminated under [President Bush's] proposal.
...there does seem to be movement toward universal care, and all sides generally agree that employers should get out of the health insurance business.
An argument for employer-based system might start with arguing that it is the only way to combat the isolate and kill strategy of insurance companies described by Brad DeLong:
Insurance companies work like dogs to avoid selling insurance to people who are expensively sick or likely to get expensively sick. As a result, a huge amount of people's work-time and information technology processing power are wasted on the negative-sum game of trying to pass the hot potato of paying for the care of the sick to somebody else. The more people separate themselves or are separated into smaller and smaller pools with calculably different exposures to risk, the worse this problem gets. The way to solve it is to shove people into pools as big as possible.
Tyler Cowen has a response to this, but in any event it would seem that the Edwards regional Health markets gets to that issue independently -- why the insistence that businesses "provide a comprehensive health plan to their employees"?
The best -- or at least the cleverest --argument I've seen for employer-provided insurance comes from Steve Landsburg in his book The Armchair Economist:
Employers typically have less than perfect information about what their employees are up to. This makes it hard to get incentives right. You can't reward productivity that you can't observe...
Many employers provide their employees with more health care coverage than is required by law, essentially giving an extra $500 worth of medical insurance instead of an extra $500 in wages. At first this seems mysterious: Why not give employee the cash and let them spend it as they want? A partial answer -- and perhaps the entire answer -- is that employees prefer nontaxable benefits to taxable wages. But another possible answer is that good health care enhances productivity. If productivity were easily observed and rewarded, there would be no issue here, because employees would have ample incentives on their own to acquire adequate health care. But in a word of imperfect information, employee benefit packages can be the best way to enforce good behavior.
Interesting argument, but it is, of course, a reason employers would continue to provide health care benefits of their volition -- no mandate, or tax subsidy, required.
So, I'm not quite sold on the whole Edwards package, but do say kudos again for laying the ideas out in plain view. Now, I think, the onus is on everyone else to explain what they have in mind, and why it is better than what is now on the table.
UPDATE: Arnold Kling lays out his own vision, at TCS Daily. (Here I offer a wildly unnecessary, but nonetheless obligatory, hat tip to Instapundit.) As far as I know, Arnold is not running for anything, but some smart candidate might think about adding him to the team.
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» Blog Round Up: Karl Rove, Health Care, and More from John Edwards 08 Blog
piIs anyone talking about their agenda for America? [Karl]Rove asked, noting the possible exception of former Sen. John Edwards, D-N.C., who has been out of office since 2005./i/p pSo says Rove in a hre... [Read More]
Tracked on Feb 14, 2007 11:55:01 PM
February 01, 2007
One Health Care Problem I'm Not So Worried About
A week ago Brad DeLong posted a very interesting -- and despairing -- contemplation on the rising cost of health care, offering up this possibility:
... now Marit Rehavi comes by with an additional reason to despair. For according to her reading, as America ages and as American society changes an increasing share of the increase in health care costs is going to be driven not by increases in adverse selection by insurers or by moral hazard driven by doctors ordering inappropriate and barely effective care, but by expensive chronic diseases and risk factors driven by long-term lifestyle choices.
I've been mulling that one over, and my first reaction is that this additional reason to despair sounds a lot like moral hazard to me. This definition, from The Economist, is pretty serviceable:
Moral hazard means that people with insurance may take greater risks than they would do without it because they know they are protected, so the insurer may get more claims than it bargained for.
So if the problem -- or a big part of it -- is "expensive chronic diseases and risk factors driven by long-term lifestyle choices," then there would seem to be a logical solution: Make people pay for making those bad lifestyle choices. In other words, higher premiums for smokers and for people who are overweight, lower premiums for those who enroll in certified exercise plans, that sort of thing. This is after all, just the market answer to Brad's "nanny state" solution. It wouldn't be perfect, but surely it would go a long way to ameliorating some of the most obvious risks.
That would still leave "adverse selection by insurers or by moral hazard driven by doctors ordering inappropriate and barely effective care" to fret about, but why pile on other problems if we don't have to?
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August 30, 2006
There is a little something for everyone -- that is to say, things to cheer about, things to frown about -- in the Census Bureau's report on Income, Poverty, and Health Insurance Coverage for 2005. MarketWatch summarizes:
Real U.S. median household income rose 1.1% in 2005, climbing for the first increase since 1999, but inflation-adjusted incomes still have not recovered fully from the 2001 recession, the Census Bureau reported Tuesday.
Real median incomes for 2005 rose 1.1% to $46,326 but were down 0.5% from 2001's $46,569. Median income means half of the 114.4 million U.S. households earned less, half earned more. The figures have been adjusted for inflation.
Income inequality continued to increase, with the top 20% of families accounting for a record 50.4% of all household income, just the third time since the mid-1960s that they've taken more than half. For the top 20%, the median income rose by $3,592, or 2.2%, to $166,000.
Meanwhile, the bottom 20% captured just 3.4% of income, matching their lowest share since the mid-1960s. Median incomes for the bottom 20% increased by $17, or 0.2%, to $11,288...
The poverty rate declined for the first time since 2000, nosing down to 12.6% from 12.7%, but this amounted to a statistically insignificant change, the government said. The poverty rate was 1.3 percentage points higher than 2001's 11.3% but was lower than the 13.8% average in the 1990s.
If you are poor and not working -- which is the most common circumstance for those under the poverty line -- the reasons are not obviously associated with a lack of jobs for those who choose to remain in the labor force.
February 11, 2006
A Case Against Medical Savings Accounts
Courtesy of Gerald Prante at Tax Policy Blog, we are informed that former Congressional Budget Office director Douglas Holtz-Eakin is not a fan of the President's proposal for tax-preferred medical savings accounts:
In response to the idea of adding a tax exclusion for individually purchased health care expenses -- in addition to the current one for employer-provided care -- Holtz-Eakin had this to say:
I think it's bad tax policy. We ought to have in this country a tax system that means something. I am less in favor of tax systems that are designed to do things other than raise revenue. We are likely to spend a lot of money in the future. The government is likely to be bigger than it is now -- I don't know how much -- and we need a tax system that raises those revenues efficiently and doesn't muck up our economy too much. Things like this are a recipe for mucky up the tax system and the economy and so I really am nervous about that as -- from a tax-policy perspective, and implementation perspective.
In general, I am the picture of sympathy for this sentiment. The best tax code is one that has low marginal tax rates and a broad base. That latter requirement means that there should be minimal use of the tax code as a tool for social engineering (or, worse, political gain).
But I make an exception for health care. The fact is that we are not talking about simply adding a distortion that was previously nonexistent. Distortions are already present in the form of tax preference for employer-provided health insurance expenditures. As Andrew Samwick emphasizes in his related Wall Street Journal debate with Mark Thoma, the idea of the tax-preferred accounts to finance out-of-pocket expenditures is designed to eliminate the perverse incentives created by subsidizing insurance with low deductibles, and to improve the portability of health care provisions.
I gather that Dr. Holtz-Eakin would prefer that we address the problem by eliminating all tax preferences of this sort, and there I am somewhat sympathetic. A preferable course might well be to address some of the regulatory issues that Andrew discusses (such as making health care coverage mandatory) and dealing with the availability of coverage to the poor through a straight system of transfers (although it would be mistaken to claim that this isn't mucking up the tax system to some degree). But absent the social consensus to move in that direction, something like medical saving accounts seems like a reasonable second-best strategy.
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Tracked on Feb 27, 2006 1:05:29 AM
February 08, 2006
This Week In Entitlement Reform
In this the federal budget week, blogland brings a couple of interesting discussions on social security and health policy reform. First up (in reverse chronological order) is the latest Econoblog installment featuring Mark Thoma and Andrew Samwick. This, from Andrew, neatly summarizes my thinking about the foundation on which social insurance reform must be built:
As global trade increases, the U.S. loses its ability to be the least-cost producer if it stipulates that employment contracts must include taxes for all manner of redistributive programs. If we are to purse both social insurance and economic growth, we need to consider alternatives to the employment relationship as a way to deal with our health and retirement needs.
Mark agrees, but is skeptical about solutions that rely primarily on the private sector:
There are substantial problems -- market failures -- in the private-sector provision of health and retirement insurance that are not easily overcome with market-based regulatory schemes.
For example, adverse selection issues, where high medical-cost individuals are excluded from coverage or are forced to pay extremely high premiums, plague health-insurance markets. High administrative costs of private health insurance are another problem, and there are problems in the private provision of retirement insurance as well. When markets fail, the insured often pay for the uninsured, and for these and other reasons I believe it's best to share the burden more generally through government programs that require individuals to contribute insurance premiums.
I confess that I don't quite buy that one. As Andrew points out, there is a distinction between government regulation of an industry and government production of the service that the industry supplies:
The first mistake is to make insurance voluntary when we don't subsequently exclude those who need care from getting it at the public's expense. We should make health insurance mandatory, but we should do so by putting the mandate on the individual, not the employer...
The second mistake is to allow the tax code to distort the type of insurance offered. Premiums are fully excludable from taxation, but out-of-pocket expenses are only imperfectly tax deductible. This generates extremely generous, first-dollar coverage and little incentive for individuals to economize on the care they receive. Rather than the Bush administration's proposal to make out-of-pocket expenses deductible via expanded medical savings accounts, I favor removing the excludability of health-insurance premiums from taxable income.
The third mistake is to force young workers to subsidize older workers in group health-insurance markets. Insurance is supposed to transfer resources from those who have unpredictably low expenses to those who have unpredictably high expenses.
I agree with Mark that the government should mandate coverage, but that doesn't mean the government should centralize the provision of services or dictate their terms. I would prefer to fix some of the obvious mistakes before making such radical changes to the system.
Andrew's diagnosis gets a second from Dr. Becker in this week's installment of the Becker-Posner Blog:
...many of the problems in the health system are correctable with the right policies. I believe the three most important defects are the over 40 million Americans who are not insured, the weak incentives to economize on unnecessary medical spending by most people covered by some form of health insurance, and the tying together of health insurance with employment as a result of special tax privileges provided to employers.
Arguably the best parts of President Bush's State of the Union address are his suggested reforms in the health care system. They do not fully attack all the problems, but they do offer significant improvements. I will concentrate particularly on his proposals to extend Health Savings Accounts (HSAs), and to improve the portability of health insurance when workers change jobs.
Professor Becker goes on to an extensive discussion of the HSA proposal, the benefits of such a plan, and a very wise observation about at least one of the costs:
President Bush has proposed changes in the health care system that initially will reduce tax collections and increase federal spending at a time when the US government is already spending too much and running a sizeable budget deficit. However, by making the health delivery system more efficient, this important set of proposals in the State of the Union address might end up raising tax collections, and certainly would improve the efficiency of the American economy.
There are plenty of other interesting things in these two items -- the discussion, for example, of the Liebman-MacGuineas-Samwick social security reform proposal which I have endorsed (and which was met with a resistance I find as baffling as members of Congress giving themselves a standing ovation for doing absolutely nothing about fixing a system that clearly needs to be fixed).
Really, I beg you. Read the whole things.
UPDATE: William Polley agrees the key question is "How much social insurance should be provided by the government and how much should be provided by markets."
You'll find some thoughts about the Posner half of the Becker-Posner conversation at winterspeak.
Max remains a consistent reform-skeptic (at least as it relates to social security).
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January 22, 2006
We Are Richer, Therefore We Spend (On Health Care)
Angry Bear apparently never sleeps, and to prove it Kash Mansori has an interesting post on medical care spending (posted at 4:15 AM Saturday morning!). A few highlights:
It should come as no surprise to anyone that, partly as a result of a persistently higher-than-average rate of inflation in medical care, consumers have been spending a larger and larger fraction of their income on medical care...
... [Bureau of Economic Analysis] data attributes much of this increase in health care's budget share to an increase in real medical care spending, not to inflation. In other words, the rapid advances in health care spending during the 2000s are largely due to the fact that individuals are consuming more health care, according to the BEA...
A few weeks ago I suggested that higher spending may be associated with declines in the effective cost of medical care, by which I mean costs inclusive of factors such as pain, probability of complications, and recovery time. Implicitly I was suggesting that we overestimate the price of medical services, a possibility Kash notes in his post.
Economists Charles Jones and Robert Hall have another explanation: Rising shares of expenditure on medical care is the natural outcome of becoming ever wealthier. From their abstract:
Health care extends life. Over the past half century, Americans spent a rising share of total economic resources on health and enjoyed substantially longer lives as a result. Debate on health policy often focuses on limiting the growth of health spending. We investigate an issue central to this debate: Is the growth of health spending the rational response to changing economic conditions---notably the growth of income per person? We develop a model based on standard economic assumptions and argue that this is indeed the case. Standard preferences---of the kind used widely in economics to study consumption, asset pricing, and labor supply---imply that health spending is a superior good with an income elasticity well above one.... In projections based on the quantitative analysis of our model, the optimal health share of spending seems likely to exceed 30 percent by the middle of the century.
Kash has it just right when he says
... what is underlying dramatic change in medical care spending of the past few years. .. [is clearly] an important question, because it plays a crucial role in understanding whether the rapid rise in people's spending on health care in recent years is a good thing or bad.
As of now, I'm in the good thing camp.
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