Income Redistribution and the Political Economy of Social Health Insurance: Comparing Germany and Switzerland

In many countries, collectively financed health insurance systems or health services delivery systems (such as the NHS) exist. Typically, these institutions are financed via general taxes or specific contributions levied on earnings. As benefits are not dependent upon income, this implies a redistribution from high to low earners. An exception can be found in Switzerland, where equal per-capita contributions are used. From a public-choice perspective it is natural to ask whether the combination of health insurance and income redistribution leads to an expansion or a contraction of the size of a public health care system, a question that is particularly relevant in view of the projected rapid increase of health care costs in the next decades due to population ageing and medical progress. Building upon the work of Gouveia (1997) and an earlier paper by the author (Breyer 1995) I use a simple model of direct democracy to analyze under what circumstances income redistribution tends to expand the size of a public health insurance system. The predictions of the model are confronted with existing evidence from Germany and Switzerland and are used to develop hypotheses on the future development of the systems.

Health Care Rationing and Distributive Justice

The rapid progress in medical technology makes it unavoidable to ration health care. In the discussion how to ration many people claim that principles of justice in distributing scarce resources should be applied. In this paper we argue that medical resources are not scarce as such but scarcity is a necessary by-product of collective financing arrangements such as social health insurance. So the right question to ask is the determination of the benefit package of such an institution. Hartmut Kliemt is currently involved in a commendable interdisciplinary research project in which principles of 'prioritization' of medical care are studied. This contribution adds a specific perspective to this endeavour: we ask how the goal of distributive justice can be interpreted in this context and compare different approaches to implementing 'just' allocation mechanisms.health care, health ethics, rationing in medicine, allocation, distributive justice, scarce resources, prioritization

Why Funding Is not a Solution to the "Social Security Crisis"

Es ist heute unbestritten, dass die umlagefinanzierten staatlichen Rentensysteme in den meisten OECD.Ländern in den kommenden Jahrzehnten wegen der dramatisch steigenden Alterslastquote schwerwiegende finanzielle Probleme bekommen werden. Dennoch gibt es eine intensive Debatte über die angemessene Therapie. Gerade in den letzten Jahren haben Vorschläge zugenommen, die auf einen (teilweisen) Übergang zur Kapitaldeckung hinauslaufen. Da ein solcher Übergang bekanntlich keine Pareto-Verbesserung bewirkt, muss man fragen, durch welche Zielsetzungen er gerechtfertigt werden könnte. Die vorliegende Arbeit geht dieser Frage nach und identifiziert sieben Trugschlüsse, die von Anhängern eines solchen Übergangs häufig begangen werden. It is now a commonplace that the unfunded public pension systems of many OECD countries will run into severe financing problems in the coming decades due to a dramatically increasing pensioner/worker ratio. While this diagnosis is completely undisputed, there is still a vigorous debate on the appropriate therapy. In this debate, a number of proposals have been brought forward in particular in the last five years, which mainly consist in a (partial) transition to a funded pension system. Because such a transition is not a Pareto improvement, it is necessary to ask what can be the policy target that justifies such a redistributive move? The present paper tries to examine this question by identifying seven fallacies that are commonly made by advocates of such a transition.

A New Pension Formula: For More Fairness and Less Old-Age Poverty

The statutory pension insurance system is set up according to the principle of participatory equivalence. This principle seeks to hold pension claims at a specific ratio to paid contributions so that a redistribution of income does not take place. In truth, however, there is a massive redistribution in favor of wage earners with higher incomes, as these individuals draw on their pensions for a longer period of time due to their greater statistical life expectancy. If life expectancy was taken into consideration in the pension formula, this would not only lead to greater distributional neutrality, it would also lead to significantly less old-age poverty among long-term contributors to the pension system.Social security, Life expectancy, Poverty, Redistribution

Voting on social security: evidence from OECD countries

An examination of the subset of public choice models for Social Security that have empirical implications. The data, collected from OECD countries for the years 1960, 1970, 1980 and 1990, show that higher median voter age, greater income heterogeneity, similarity in family size, and variables that make a public pension program profitable are all associated with a larger program.Social security

The Dead-Anyway Effect Revis(it)ed

In the expected-utility theory of the monetary value of a statistical life, the so-called "dead-anyway" effect discovered by Pratt and Zeckhauser (1996) asserts that an individuals' willingness to pay (WTP) for small reductions in mortality risk increases with the initial level of risk. Their reasoning is based on differences in the marginal utility of wealth between the two states of nature: life and death. However, this explanation is based on the absence of markets for contingent claims, i.e. annuities and life insurance. This paper reexamines the "dead-anyway" effect and establishes two main results: first, for a risk-averse individual without a bequest motive, marginal WTP for survival does increase with the level of risk but when insurance markets are perfect, this occurs for a different reason than given by Pratt and Zeckhauser. Secondly, when the individual has a bequest motive and is endowed with a sufficient amount of non-inheritable capital, the effect of initial risk on WTP for survival is reversed: the higher initial risk the lower the value of a statistical life.Value of life, expected utility, willingness to pay, insurance markets

On the Fairness of Early Retirement Provisions

Declining fertility and increasing longevity have rendered public pension systems in many OECD countries unsustainable and have triggered substantial reforms of these systems. One of the officially declared reform objectives is to raise the average retirement age. Crucial parameters for this endeavor are first the legal retirement age and secondly the early retirement provisions inherent in the public pension system. In this paper we discuss several notions of "fairness" of early retirement provisions in pay-as-you-go financed public pension systems and we claim that the "right" notion of fairness depends upon the objectives pursued in the design of pension systems. We point out the problems attached to the extreme positions "efficiency" and "welfare maximization" and propose a more modest concept of equity called "distributive neutrality", which is based on the notion that the ratio between total benefits and total contributions to the pension system should not depend systematically on the individual’s ability. By applying this concept to the German retirement benefit formula and taking empirically estimated relationships between average annual income, life expectancy and retirement age into account, we show that at the present discount rate of 3.6 per cent per year there is systematic redistribution from low to high earners, which would be attenuated if the discount rate were raised. This seemingly paradoxical finding is due to the fact that in our data set, there is a negative relationship between earnings and retirement age.public pension system, early retirement

Income and Longevity Revisited: Do High-Earning Women Live Longer?

The empirical relationship between income and longevity has been addressed by a large number of studies, but most were confined to men. In particular, administrative data from public pension systems are less reliable for women because of the loose relationship between own earnings and household income. Following the procedure first used by Hupfeld (2010), we analyze a large data set from the German public pension scheme on women who died between 1994 and 2005, employing both non-parametric and parametric methods. To overcome the problem mentioned above we concentrate on women with relatively long earnings history. We find that the relationship between earnings and life expectancy is very similar for women as for men: Among women who contributed at least for 25 years, a woman at the 90th percentile of the income distribution can expect to live 3 years longer than a woman at the 10th percentile.Life expectancy and income, women, public pensions, Germany

Fairness of Public Pensions and Old-Age Poverty

In several OECD countries, public pay-as-you-go financed pension systems have undergone major reforms in which future retirement benefit promises have been scaled down. A consequence of these reforms is that especially in countries with a tight tax-benefit linkage, the retirement benefit claims of low-income workers might not even exceed the minimum income guarantee which the government provides the aged. Recently, some German politicians have criticized this likely development because it was unjust that persons who have paid contributions over a long working life end up with no higher benefits than people who have never worked or paid any contributions. However, the government defended the current retirement benefit formula with the argument that every Euro paid as contributions had exactly the same value in generating future retirement benefits. But this logic has been questioned recently, e.g. by Breyer and Hupfeld (2009), since the value of a contributed Euro depends on the life expectancy of the individual, which is positively correlated with annual income. In that earlier paper, we introduced the concept of "distributive neutrality", which takes income-group-specific differences in life expectancy into account. The present paper estimates the relationship between annual earnings and life expectancy of German retirees empirically and shows how the formula that links benefits to contributions would have to be modified to achieve distributive neutrality. We compare the new formula to the benefit formulas in other OECD countries and analyze a data set provided by the German Pension Insurance Office on a large cohort of pensioners to find out how the old-age poverty rate would be affected by the proposed change of the benefit formula. Finally, we discuss other possible effects of a change in the benefit formula, especially on the labour supply of different earnings groups.Social security, life expectancy, poverty, redistribution

Life Expectancy and Health Care Expenditures: A New Calculation for Germany Using the Costs of Dying

Some people believe that the impact of population ageing on future health care ex-penditures will be quite moderate due to the high costs of dying. If not age per se but proximity to death determines the bulk of expenditures, a shift in the mortality risk to higher ages will not affect lifetime health care expenditures as death occurs only once in every life. We attempt to take this effect into account when we calculate the demographic impact on health care expenditures in Germany. From a Swiss data set we derive age-expenditure profiles for both genders, separately for persons in their last four years of life and for survivors, which we apply to the projections of the age structure and mortality rates for the German population between 2002 and 2050 as published by the Statistische Bundesamt. We calculate that at constant prices per-capita health expenditures of Social Health Insurance would rise from EUR 2,596 in 2002 to between EUR 2,959 and EUR 3,102 in 2050 when only the age structure of the population changes and everything else remains constant at the present level, and to EUR 5,485 with a technology-driven exogenous cost increase of one per cent per annum. A "naïve" projection based only on the age distribution of health care expenditures, but not distinguishing between survivors and decedents, yields values of EUR 3,217 and EUR 5,688 for 2050, respectively. Thus, the error of excluding the "costs of dying" effect is small compared with the error of under-estimating the financial consequences of expanding medical technology.