Smoking: taxing health and Social Security

While the health risks associated with smoking are well known, the impact on income distributions is not. This paper extends the literature by examining the distributional effects of a behavioral choice, in this case smoking, on net marginal Social Security tax rates (NMSSTR). The results show that smokers, as a result of shorter life expectancies, incur a higher NMSSTR than nonsmokers. In addition, as low-earnings workers have a higher smoking prevalence than high-earnings workers, smoking works to widen the income distribution. This higher tax rate could have implications for both labor supply behavior and Social Security system funding.

Smoking: taxing health and Social Security

Cigarette smoking is costly in terms of not only its effects on smokers' health but also the direct and indirect financial costs it imposes on smokers and their families. For instance, premature death caused by smoking may redistribute Social Security income in unexpected ways that affect behavior and reduce the economic well-being of smokers and their dependents. ; This article examines the effects of smoking-attributable mortality on the net marginal Social Security tax rate (NMSSTR)—the difference between the statutory payroll tax rate and the present value of future benefits to which a covered worker is entitled. ; The analysis shows that smokers, as a result of shorter life expectancies, incur a higher NMSSTR than nonsmokers. This higher tax rate could have implications for both labor supply behavior and the Social Security System's funding. ; The authors note that smoking status should be considered in assessing Social Security legislative proposals designed to reduce system inequities or promote social adequacy—in particular, amendments designed to reduce poverty among young widows and widowers. Failure to take smoking status into account may unintentionally promote behavior that is detrimental to health.Social security

Does disability explain state-level differences in the quality of Medicare beneficiary hospital inpatient care?

Almost 20 percent of the total U.S. population and 42 percent of the population over the age of sixty-six are disabled. Research has shown that the presence of a disability can crowd out treatment for medical conditions not necessarily related to the disability and that states that are disproportionately African-American have a lower quality of hospital care. This paper uses quality of care data from the Centers for Medicare and Medicaid Services (CMS) to determine whether disability also explains state-level differences in quality of hospital care. The quality of Medicare beneficiary hospital care was measured using process measures for several medical conditions, including acute myocardial infarction, heart failure, stroke, and pneumonia, that are the leading causes of mortality. We use nonlinear least squares to assess the association between Medicare beneficiary quality of care and state- and medical system–level characteristics. The result for the key variable of interest—disability—reveals that a 1 percent increase in a state's disability rate leads to a 1 percentage point reduction in the score of the state's quality of hospital care. Without explicitly incorporating strategies to eliminate disparities in care incurred by people with disabilities, CMS may not adequately promote the goal of delivering the highest quality of care to all Medicare beneficiaries.

The quality of preventive and diagnostic medical care: why do southern states underperform?

As the cost of health care increases rapidly, the health care industry has turned its attention to methods of cost containment. However, concern exists that the drive to contain costs could lead to compromises in the quality of medical care. One practice that may slow the growth rate of health care expenditures and improve morbidity and mortality rates is the widespread use of preventive and diagnostic services. ; Using data compiled by the Centers for Medicare and Medicaid Services, this article evaluates the quality of care received by Medicare beneficiaries in each state. The authors examine states’ use of preventive services (influenza and pneumococcal immunizations) and diagnostic services (mammograms and diabetes screening tests) among Medicare beneficiaries. ; The analysis points out regional differences in preventive and diagnostic care across the United States. The West has higher levels of preventive care while the Northeast has higher scores for diagnostic care. But the South had the lowest average score for quality of care in both categories. The authors attribute differences among states’ levels of preventive and diagnostic care to their socioeconomic and demographic characteristics, noting in particular that the percentage of a state’s Medicare population that is black is inversely related to the quality of medical care. ; A better understanding of the causes behind racial disparities in the quality of medical care, the authors conclude, will promote the delivery of the highest quality of care to all Medicare beneficiaries and slow the growth rate of health care costs.

Cigarette smoking and food insecurity among low-income families in the United States, 2001

The goal of this research is to quantify the association between food insecurity and smoking among low-income families. This analysis is a retrospective study using data from the 2001 Panel Study of Income Dynamics, a longitudinal study of a representative sample of U.S. men, women, and children and the family units in which they reside. Family income is linked with U.S. poverty thresholds to identify 2,099 families living near or below 200 percent of the federal poverty level. Food insecurity (that is, having insufficient funds to purchase enough food to maintain an active and healthy lifestyle) is calculated from the eighteen core items in the food security module of the U.S. Department of Agriculture. The results indicate that smoking prevalence is higher among low-income families who are food insecure compared to low-income families who are food secure (43.6 percent versus 31.9 percent). Multivariate analysis reveals that smoking is associated with an increase in food insecurity of approximately 6 percentage points. Given our finding that families near the federal poverty level spend a large share of their income on cigarettes, perhaps it would be prudent for food assistance and tobacco control programs to work together to help low-income people quit smoking.

Incorporating insurance rate estimates and differential mortality into net marginal Social Security tax rate calculations

This paper extends the literature on net marginal tax rates created by the Social Security program by including variations in both the probability of being eligible to receive benefits and income-related life expectancy. The previous literature has found that women incur a lower net marginal tax rate because they have longer life expectancies. The results presented in this paper indicate that including variations in eligibility for benefits partially reverses this result by increasing net marginal Social Security tax rates for older women. In addition, the existing literature has shown that low-income households pay lower net marginal tax rates because the benefit formula is progressive. Including variations in life expectancy reduces, but does not eliminate, this result. This implies that differential mortality increases the net marginal Social Security tax rates incurred by low-income households. These results are important from a policy standpoint given the gender differences in poverty among the population over age sixty-five and the current debate on the future of the Social Security system.Social security ; Insurance ; Poverty ; Taxation

The influence of year-end bonuses on colorectal cancer screening

The objective of the paper is to estimate the effect of physician bonus eligibility on CRC screening while controlling for patient and primary care physician characteristics. The study is retrospective, using a managed care plan’s claims data on fifty-year-old commercially insured patients in the years 2000 and 2001. The data also include links to enrollment and provider files. Multivariate logistic regression models are used to assess the association between CRC screening receipt and physician bonus eligibility. The results indicate that the probability that a patient received a CRC screening was approximately 3 percentage points higher in the year physicians were eligible for a bonus. There were also significant differences according to the gender of both the patient and physician, income, and race.

Dynamical instabilities of a resonator driven by a superconducting single-electron transistor

We investigate the dynamical instabilities of a resonator coupled to a superconducting single-electron transistor (SSET) tuned to the Josephson quasiparticle (JQP) resonance. Starting from the quantum master equation of the system, we use a standard semiclassical approximation to derive a closed set of mean field equations which describe the average dynamics of the resonator and SSET charge. Using amplitude and phase coordinates for the resonator and assuming that the amplitude changes much more slowly than the phase, we explore the instabilities which arise in the resonator dynamics as a function of coupling to the SSET, detuning from the JQP resonance and the resonator frequency. We find that the locations (in parameter space) and sizes of the limit cycle states predicted by the mean field equations agree well with numerical solutions of the full master equation for sufficiently weak SSET-resonator coupling. The mean field equations also give a good qualitative description of the set of dynamical transitions in the resonator state that occur as the coupling is progressively increased.Comment: 23 pages, 6 Figures, Accepted for NJ

Measuring mechanical motion with a single spin

We study theoretically the measurement of a mechanical oscillator using a single two level system as a detector. In a recent experiment, we used a single electronic spin associated with a nitrogen vacancy center in diamond to probe the thermal motion of a magnetized cantilever at room temperature {Kolkowitz et al., Science 335, 1603 (2012)}. Here, we present a detailed analysis of the sensitivity limits of this technique, as well as the possibility to measure the zero point motion of the oscillator. Further, we discuss the issue of measurement backaction in sequential measurements and find that although backaction heating can occur, it does not prohibit the detection of zero point motion. Throughout the paper we focus on the experimental implementation of a nitrogen vacancy center coupled to a magnetic cantilever; however, our results are applicable to a wide class of spin-oscillator systems. Implications for preparation of nonclassical states of a mechanical oscillator are also discussed.Comment: 17 pages, 6 figure