هزینه های رفاه و میزان مرگ و میر برای سالمندان قبل از دوران تامین اجتماعی
|کد مقاله||سال انتشار||مقاله انگلیسی||ترجمه فارسی||تعداد کلمات|
|24349||2010||27 صفحه PDF||سفارش دهید||محاسبه نشده|
Publisher : Elsevier - Science Direct (الزویر - ساینس دایرکت)
Journal : Explorations in Economic History, Volume 47, Issue 1, January 2010, Pages 1–27
We analyze the impact of the original means-tested old-age assistance (OAA) programs on the health of the elderly prior to the first Social Security pension payments. Before 1935 a number of states had enacted their own OAA laws. After 1935 the federal government began offering matching grants and thus stimulated the adoption of OAA programs by the states. A new panel data set of 75 cities for each year between 1929 and 1938 combines mortality rates for older age groups with three measures of the OAA programs, spending on non-age-specific relief and a rich set of correlates. The data are analyzed using difference-in-difference-in-difference and instrumental variables methods. Our results suggest that old-age assistance in the 1930s had little impact on the death rate of the elderly. Our sense is that the OAA programs in the 1930s transferred the elderly from general relief programs without necessarily increasing the resources available to them.
During the Great Depression, the Roosevelt Administration faced substantial pressure to make special provisions to aid the elderly poor. The elderly tended to have the highest poverty rates among age groups, and several advocates received extensive publicity and support in opinion polls when they lobbied for expansive programs to help the elderly.2 When the Roosevelt Administration turned to the issue in late 1934 and 1935 they faced a set of choices. One was to help the states expand their old-age assistance programs that paid benefits to the elderly poor. A second was to provide an old-age pension plan for all workers, who would pay taxes into a fund while working and then receive benefits based on their contributions after age 65. The Social Security Act of 1935 chose both, an old-age assistance (OAA) matching-grant program that aided the states in paying benefits to the needy elderly and the national Old Age Security Income (OASI) old-age pension for the working population. The problems with funding OASI pensions, widely known as Social Security, have led to a variety of debates over restructuring the OASI tax and benefit structure to favor lower income retirees. In the debates, few people mention that the U.S. presently has means-tested old-age assistance programs under the Supplemental Security Income system, which is based on the original state old-age assistance programs. The debates over the OASI program raise a question about government action for old-age security. What would have happened had the federal government never adopted the OASI old-age pension and the U.S. had just continued forward with the state-based old-age assistance programs? In hindsight, it may seem odd to rely on the states, but it should be remembered that workers’ compensation, unemployment insurance, aid to children, and aid to the blind still remain state-based programs.3 Prior published work on OAA focused on labor force participation and living arrangements. Parsons (1991) found that OAA benefits account for about half of the decline in the elderly work force between 1930 and 1950, while Friedberg (1999) showed that labor force participation would have risen slightly in the absence of OAA programs. Costa (1999) found that the 27% increase in average OAA benefits between 1940 and 1950 explains about 80% of the decrease in the proportion of older non-married women living with family members. Further, states that disallowed benefits to women with family who could care for them and states with lien requirements increased the share of women living with relatives. We examine the impact of the old-age assistance state programs on elderly mortality rates during the period from 1929 through 1938 before the first OASI payments were issued.4 The state programs made cash payments to the needy elderly to allow them to live on their own rather than among the needy population in almshouses provided by local governments. 5 Between the late 1920s and 1934 more than half the states adopted old-age assistance. After the Social Security Act of 1935 offered matching grants, all of the states eventually began paying old-age assistance benefits. We take advantage of the timing of the implementation of old-age assistance programs across states and the different benefits offered in the programs to assess their impact on the mortality rates of the elderly.6 We create a new panel data set for 75 cities with annual data for the years 1929 through 1938 that combines data on mortality rates for different age groups and information on OAA benefits and other forms of government relief spending. To avoid confounding effects, we stop the analysis before the national Social Security pension system started to pay benefits. The relationship between old-age assistance and mortality is estimated using three measures of the program, several specifications, and multiple procedures ranging from difference-in-difference to difference-in-difference-in-difference analysis to instrumental variables. The results suggest that other relief programs did not reduce elderly mortality. After investigating several hypotheses about differences in the types of deaths experienced, the findings lead us to believe that the introduction of OAA in the 1930s was primarily an administrative shift that moved the elderly who most likely to be at risk of dying from the general relief rolls to the OAA relief rolls without changing the access to resources for the elderly poor.
نتیجه گیری انگلیسی
Simple correlations suggest that the means-tested OAA programs introduced by the states in the 1920s and 1930s were associated with lower mortality rates for the elderly. Given the emphasis on reporting the equivalent of simple correlations by public agencies at the time, OAA assistance could easily have been portrayed as a success in its early years. Unfortunately, the heart-warming story is not supported by more rigorous examination of the data for cities during the period 1929 through 1938. The results from difference-in-difference, difference-in-difference-in-difference and IV difference-in-difference-in-difference analysis show no statistically significant negative relationship between OAA and elderly mortality. We had speculated that the OAA program goal of allowing the elderly to live on their own rather than in almshouses had led to offsetting changes in death rates from specific causes. By moving out of almshouses the elderly might have experienced less exposure to contagious diseases but by living alone they might have become isolated and more depressed with less access to medical care. Estimations with suicide rates were inconsistent with the view that deaths due to depression had risen, while estimations with deaths from contagious diseases were inconsistent with the view that deaths from contagious diseases had fallen. Our sense is that the move to OAA was largely an administrative move that did not do much to increase the resources for the elderly poor relative to the resources they received as participants in relief programs targeted at the entire population. There may have been important ties between the poverty program for the elderly and access to new medical technologies that prolonged life. We use similar analytical techniques to those used by Finkelstein and McKnight (2005) for Medicare in the 1960s and Balan Cohen (2007) for OAA in the 1940s and 1950s. When the stream of work is considered in total, it suggests the following time path for the impact of old-age programs. We find statistically insignificant effects of OAA on mortality in the 1930s, possibly because OAA in the 1930s was really more an administrative change than a true change in access to relief benefits for the elderly poor. This was also a period when medical care was relatively rudimentary. Balan Cohen (2007) finds that OAA benefits reduce mortality in the 1940s and 1950s when OAA payments could be used to make use of more effective medical techniques than those available in the 1930s. Although medical practice continued to improve in quality in the 1960s, Finkelstein and McKnight find no effect of the introduction of Medicare coverage of hospitalization and availability of subsidized health insurance for other procedures.27 The lack of a Medicare effect on mortality may be a result of differences in the targeting of benefits. Medicare is a universal insurance program for the entire elderly population, while OAA is a means-tested program focused on the poor elderly. Even if mortality did not fall with the introduction of Medicare, there were other benefits to the elderly population. Finkelstein and McKnight (2005) find that people in the upper fourth of the medical spending distribution experienced a decline of 40% in their out-of-pocket costs. One question remains. We suggest that OAA programs had little effect on elderly mortality in the 1930s because the OAA programs were an administrative shift that did not necessary increase the amount of benefits available to the elderly at risk of dying. If it was just an administrative shift, why do scholars like Friedberg and Leora, 1999 and Costa, 1999, and Parsons (1991) find that higher OAA benefits in the 1940s allowed more women to live separately and men to reduce their labor participation. The OAA administrative shift was specifically designed to allow the poor elderly to live alone more readily than they could under the prior regime or through the New Deal relief programs in the 1930s. Once the extra costs of living alone are accounted for, the disposable income available to the poor elderly women receiving OAA might have been no different than if they were receiving smaller benefits while living in an almshouse or with a relative. Meanwhile, OAA gave elderly men who owned their own homes a new opportunity to live at home without working. OAA allowed the men to essentially take out a “loan” against the value of their home. They could obtain OAA benefits in return for giving the state a lien against (or ownership of) their home. They could stop working and their heirs would then receive the residual value of the home left over after the value of the stream of OAA benefits was repaid to the state. Since the elderly men who chose not to work even though they were able would be the group least likely to be at risk of mortality, the administrative shift could lead to a reduction of labor supply without a decline in mortality.