Tag: Budget

Latest Data on Transfers and Income

In a series of posts (most recent here), I’ve documented that Americans are getting an increasing portion of their income from the government.

BEA released new data on incomes a couple weeks ago, including revisions back to 1995. These data reinforce the story I’ve described in my previous posts:

  • Transfers accounted for 17.3% of personal income in June. That’s the second highest in history, topped only by the 18.2% recorded in May, when transfers were boosted by one-time payments from this year’s stimulus act:

Transfers June 2009

  • The increasing importance of transfers reflects both short-run developments and long-run trends. In the past year, the importance of transfers has grown because of (a) weakness in other forms of income, (b) the natural expansion of transfers due to economic weakness (e.g., increases in unemployment insurance payments), and (c) policies to expand benefits (e.g., as an attempt at stimulus). Over the longer run, however, the growth of transfers has been driven by the expansion of entitlement programs.

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Prevention, Health Costs, and Value

Cost has played a leading role in the policy debate over health care / health insurance. That’s appropriate since private health costs put such a burden on workers and families, and public health costs place such a burden on state and federal budgets.

I worry, however, that the focus on costs and spending sometimes overshadows what ought to be the real goal: getting as much value as possible from our health care system.

A case in point is the debate over preventative care.

Policymakers are desperate for painless ways to pay for expanded health care coverage. Many of them have therefore become enamored of the idea that increased spending on preventative care could reduce overall health spending. As I noted yesterday, however, there’s a problem with that idea: it generally isn’t true.

If your only goal is paying for expanded health care, that finding is both unwelcome and fatal – the search for painless pay-fors will have to look elsewhere.

If your goal is increasing the value we get from our health system, however, your inquiry isn’t done. Instead, you should say “That’s too bad; I was hoping it would save money. But while we’re talking about it, do the benefits of preventative care justify the higher spending?”

Good question.

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Does Prevention Reduce Costs?

One of the common memes in the health debate is the claim that increased spending on preventative medical care (e.g., cancer screening) can reduce overall health spending.

That idea is very attractive, since it seems to offer a free lunch: greater health at lower cost. It has just one small problem, though: it isn’t true.

As the Congressional Budget Office describes in an analysis released on Friday:

Although different types of preventive care have different effects on spending, the evidence suggests that for most preventive services, expanded utilization leads to higher, not lower, medical spending overall.

That result may seem counterintuitive. For example, many observers point to cases in which a simple medical test, if given early enough, can reveal a condition that is treatable at a fraction of the cost of treating that same illness after it has progressed. In such cases, an ounce of prevention improves health and reduces spending—for that individual. But when analyzing the effects of preventive care on total spending for health care, it is important to recognize that doctors do not know beforehand which patients are going to develop costly illnesses. To avert one case of acute illness, it is usually necessary to provide preventive care to many patients, most of whom would not have suffered that illness anyway. Even when the unit cost of a particular preventive service is low, costs can accumulate quickly when a large number of patients are treated preventively. Judging the overall effect on medical spending requires analysts to calculate not just the savings from the relatively few individuals who would avoid more expensive treatment later, but also the costs for the many who would make greater use of preventive care.

In short, an ounce of prevention may save a pound of cure for the patients it helps. But those ounces of prevention can add up to tons of costs when spread over millions of patients.

And that’s not all.

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Budget Deficit Likely Lower Than Forecast

As I’ve noted in a series of posts, the budget deficit this year will be gigantic. Indeed, it’s already reached almost $1.3 trillion. That’s big money, even in Washington.

As Stan Collender points out over at Capital Gains and Games, however, the absolute amount of the deficit is not the only thing that matters politically. Also important is how the deficit stacks up relative to expectations. And, as Stan says, there’s good reason to believe that the deficit will come in less than original forecasts.

Back in May, the Obama administration projected that this year’s deficit would come in at $1.84 trillion, assuming enactment of the President’s policies. In June, the Congressional Budget Office came up with a very similar estimate.

Now it’s looking as though the deficit could come in several hundred billion dollars lower than that.

The evidence for this is two-fold:

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Federal Deficit Up to $1.3 trillion

On Thursday, the Congressional Budget Office released its latest snapshot on the federal budget. The headlines:

  • The budget deficit was almost $1.3 trillion during the first ten months of the fiscal year (through July). That’s up from $389 billion at this point last year.
  • Spending has risen 21% over last year, while tax revenues have fallen by 17%.
  • CBO estimates that $125 billion of the increased spending and decreased revenues are the result of this year’s stimulus act.

Deficit July

The chart shows the main drivers of the exploding deficit:

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Collapsing Tax Revenues

The Office of Debt Management at Treasury has released another fascinating set of charts about the government’s finances and debt outlook. One that particularly caught my eye was this depiction of the collapse in tax revenues:

Treasury Revenue DeclinesFittingly, the red lines represent the current fiscal year.

As you can see, corporate income taxes are lagging far behind the pace of recent years, as are non-withheld individual tax payments (those payments typically stem from capital gains, other investment income, and business income rather than regular wages and salaries).

Refunds have also increased (denoted by a larger negative figure — i.e., larger cash outflows). Refunds also spiked in the middle of last year due to the first economic stimulus.

Treasury: More Borrowing, Less Short-Term

The Treasury released its quarterly update on its borrowing needs yesterday. The headline is that Treasury expects to borrow $406 billion during July, August, and September. That’s a gigantic figure, but it is down from the roughly $530 billion that Treasury borrowed during those three months last year.

When combined with $1.4 trillion in borrowing during the previous nine months, the $406 billion will bring total borrowing to $1.8 trillion during this fiscal year (Oct. 2008 to Sept. 2009).

The Treasury release includes a number of fascinating charts about the size and composition of our nation’s debt. One that particularly caught my eye was this chart showing the percentage of outstanding debt that is scheduled to mature in the next 12, 24, or 36 months:

Debt MaturitiesAs you can see, Treasury has relied heavily on very short-term maturities to finance the recent burst of borrowing. Most notably, the fraction of debt that matures within 12 months (the blue line) reversed its decline and rose to levels not seen since the mid-1980s.

Students of financial crises, past and present, will recall that over-reliance on short-term debt is a classic precursor of financial distress. Think, for example, of the major financial firms that had to roll over significant fractions of their financing every week … or even every day.

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The Budget Battle Over Student Loans

Summary: President Obama and congressional Democrats have good reasons for wanting to eliminate federal guarantees for private student loans. They should keep in mind, however, that the resulting budget savings will likely be much smaller than official estimates suggest.

Health care and defense spending have grabbed most of the budget headlines lately, but they aren’t the only budget battles in Washington.

The latest tussle? Student loans.

The federal government supports college loans in two ways: by making loans directly to students and by guaranteeing loans made by private lenders. The current budget battle has arisen because President Obama and many congressional Democrats want to kill the guarantee program in favor of the direct program. Many Republicans, on the other hand, support private lenders, and thus want the guarantee program to continue.

There are three things you should know about this debate:

1. The guarantee program has experienced two crises in recent years. In 2007, the problem was kickbacks. Private lenders were being overpaid by the program, and some of them started competing for business by giving goodies to student loan officers. President Bush and Congress put an end to that by reducing payments to private lenders. Then the financial crisis hit, and we had the reverse problem: private lenders stopped lending. So President Bush and Congress stepped in with some duct tape and paperclips to keep the guaranteed loan market working. (Actually they gave private lenders a put option — the right to sell the loans back to the government — which many lenders used; in essence, the lenders got paid for originating loans, but didn’t hold them very long.)

In short, the guarantee program has been a headache for policymakers in recent years.

2. Guaranteed loans cost the government more than direct loans. There’s no law of nature that says that has to be the case. In principle, one can imagine a guarantee program that would cost less than direct loans. That could happen, for example, if the private sector is more efficient than the government in making the loans or if the private sector is willing to use student loans as a loss leader to promote other financial products (e.g., credit cards). In practice, however, the government has never been able to calibrate guarantees to the private lenders so that (a) lenders are willing to make the loans and (b) the guarantees cost less than direct loans.

When you put points 1 and 2 together, you can understand why many budget analysts and lawmakers want to kill the guarantee program and have the government make all the loans directly. That’s certainly the way that I am leaning. (If readers have any compelling arguments in favor of the guarantee program, however, I’m all ears.)

In fairness, though, opponents of the guarantee program should acknowledge one complication to their position:

3. Congressional budget procedures are biased in favor of direct student loans over guaranteed loans. As a result, the budget case against guaranteed loans is overstated. It isn’t wrong — we are still talking tens of billions of dollars over the next ten years — but it isn’t as strong as the official numbers suggest. One implication is that eliminating the guarantee program may not save as much money as lawmakers think. That’s important, particularly if lawmakers want to spend those savings on other programs.

This third point is the key to current budget brouhaha over student loans. To understand it fully, we need to delve into a bit of budget arcana.

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Follow-up: Defense, Mortgage Modifications, and Yahoo/Microsoft

This morning’s headlines include some important follow-ups to recent posts:

Good and Bad News for the House Health Bill

In my recent paper about how the Congressional Budget Office analyzes health proposals, I noted that one of the most important things that CBO does is to provide additional information about its cost estimates. Cost estimates often can’t speak for themselves, so it’s important that members of Congress and other interested observers ask for additional clarification about key issues.

Well, four leading House Republicans recently took this step, and CBO’s response is a doozy. It contains too much to summarize here, so let me focus on the two most important points:

  • CBO reiterated its conclusion that the introduction of a public plan (as specified in the bill) would not undermine private health insurance markets. Most Americans would continue to get their health insurance through employers.
  • CBO confirmed that the bill would worsen future deficits.

Supporters of the bill will emphasize the first finding as evidence that the public plan won’t gut private insurance markets. Opponents of the bill will emphasize the second finding as evidence that the bill is fiscally reckless.

Neither of these conclusions should be a surprise to anyone, since the basic facts were reported in CBO’s original cost estimate. However, the new letter does provide useful context.

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