The Freedom to Spend Your Own Money on Medical Care: A Common Casualty of Universal Coverage

Most people would agree that a patient should always be able to spend his own money on the health care services he desires. Yet that freedom is often threatened or denied when government tries to provide universal health insurance coverage, as in the U.S. Medicare program, which provides health insurance to seniors and people with disabilities. Over the past 20 years, the Medicare bureaucracy -- and to a lesser extent Congress itself -- has limited the freedom of Medicare beneficiaries to purchase medical services with their own money. Those limitations violate beneficiaries' right to privacy, undermine a tool that could reduce the burden Medicare imposes on taxpayers, and may deny care to Medicare beneficiaries outright, or deny them access to the highest quality care available. Ironically, as the U.S. government has restricted the ability of patients to spend their own money on medical care, Canada's socialized health care system is moving in the opposite direction. In a landmark case handed down in 2005, the Supreme Court of Canada ruled that the province of Quebec could not prohibit its citizens from purchasing covered services through private health insurance. That ruling recognized that imposing limits on a patient's freedom to spend his own money can result in his being denied crucial and even life-saving medical services. This threat to patients' rights would grow under many proposals to have the federal or state governments provide universal coverage. Congress and the state legislatures should avoid universal coverage schemes that would undermine this fundamental human right, or tempt future legislatures and bureaucrats to do so. Instead, Congress should restore to American seniors the unfettered right to spend their own money on medical care

"Productivity, Technical Efficiency, and Farm Size in Paraguayan Agriculture"

This essay assesses the relationship between farm size and productivity. Both parametric and nonparametric methods are used to derive efficiency measures. Smaller farms are found to have higher net farm income per hectare, and to be more technically efficient, than larger farms.

Beyond Metropolitan Startup Rates: Regional Factors Associated with Startup Growth

Understanding what fosters -- and hinders -- firm formation and growth at the metropolitan level across the United States is a challenge. Entrepreneurship can be measured by a variety of indicators, and they each can tell somewhat different stories. Furthermore, because entrepreneurship can refer to the growth of firms from a startup stage to mid- or large-scale, no one dataset covers the full range of companies that fall in this category. This report contributes to the Kauffman Foundation's recent series of analyses on the rate of business creation in metropolitan areas. Going beyond identifying metropolitan areas with higher rates of entrepreneurship, we analyze what regional factors are associated, or unassociated, with entrepreneurial activity. Understanding what drives entrepreneurship at the regional level -- especially high-growth business creation -- will help policymakers and entrepreneurship supporters know where to invest their efforts

The Return of Business Creation

Freshly released government data show that new business formation rebounded in 2011, after four years of decline, from the depths of the Great Recession. This is a welcome development -- new businesses are the engine of job creation in the United States economy and an important source of innovation and productivity. Perhaps most importantly, the rise in new business formation between 2010 and 2011 was geographically dispersed throughout the United States.While the rise of new business creation in 2011 is a significant development -- it is the first annual gain in five years and the largest percentage annual increase in nearly a decade -- the bulk of this paper examines two classes of new businesses that most closely resemble entrepreneurship: companies less than one year old with one to four employees and those with fine to nine. This analysis finds that the smallest of these new firms represent most of the increase in firm formation in 2011:* New companies with one to four employees comprise the vast majority of new businesses formed each year, accounting for, on average, 86 percent of new firms since the late 1970s in the BDS data. * Job creation at new businesses of all sizes increased by 4.3 percent, and rose by 5.4 percent in new companies with one to four employees, reversing four consecutive years of decline for those smallest companies. * Companies less than one year old with one tofour employees have created, on average, more than 1 million jobs per year over the past three decades; those with five to nine employees have added, on average, half a million jobs per year. * With a promise of more detailed analysis infuture reports, this paper presents maps that illustrate the increased share of new business formation in most states and metro areas across the nation

"An Empirical Analysis of Gender Bias in Education Spending in Paraguay"

Gender affects household spending in two areas that have been widely studied in the literature. One strand documents that greater female bargaining power within households results in a variety of shifts in household production and consumption. An important source of intrahousehold bargaining power is ownership of assets, especially land. Another strand examines gender bias in spending on children. This paper addresses both strands simultaneously. In it, differences in spending on education are examined empirically, at both the household and the individual level. Results are mixed, though the balance of evidence weighs toward pro-male bias in spending on education at the household level. Results also indicate that the relationship between asset ownership and female bargaining power within the household is contingent on the type of asset.

"Quality of Match for Statistical Matches Used in the 1992 and 2007 LIMEW Estimates for the United States"

The quality of match of four statistical matches used in the LIMEW estimates for the United States for 1992 and 2007 is described. The first match combines the 1992 Survey of Consumer Finances (SCF) with the 1993 March Supplement to the Current Population Survey, or Annual Demographic Supplement (ADS). The second match combines the 1985 American Use of Time Project survey (AUTP) with the 1993 ADS. The third match combines the 2007 SCF with the 2008 March Supplement to the CPS, now called the Annual Social and Economics Supplement (ASEC). The fourth match combines the 2007 American Time Use Survey with the 2008 ASEC. In each case, the alignment of the two datasets is examined, after which various aspects of the match quality are described. Also in each case, the matches are of high quality, given the nature of the source datasets.Statistical Matching; Wealth Distribution; Time Use; Household Production; United States; LIMEW