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Victor R. Fuchs
Journal Articles

Is Single Payer the Answer for the US Health Care System?

Victor R. Fuchs
JAMA, 2018 January 2, 2018

The recent challenges to the Affordable Care Act (ACA), which has increased the number of individuals with health insurance in the United States but has had little effect on cost, has revived the debate about a single-payer health care system.

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Journal Articles

The weaker sex? Vulnerable men and women's resilience to socio-economic disadvantage

Mark R. Cullen, Michael Baiocchi, Karen Eggleston, Pooja Loftus, Victor R. Fuchs
SSM - Population Health, 2016 September 1, 2016

Sex differences in mortality vary over time and place as a function of social, health, and medical circumstances. The magnitude of these variations, and their response to large socioeconomic changes, suggest that biological differences cannot fully account for sex differences in survival. Drawing on a wide swath of mortality data across countries and over time, we develop a set of empiric observations with which any theory about excess male mortality and its correlates will have to contend.

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Working Papers

The New Demographic Transition: Most Gains in Life Expectancy Now Realized Late in Life

Karen Eggleston, Victor R. Fuchs
Asia Health Policy Program working paper # 29, 2012 June 11, 2012

The share of increases in life expectancy realized after age 65 was only about 20 percent at the beginning of the 20th century for the United States and 16 other countries at comparable stages of development; but that share was close to 80 percent by the dawn of the 21st century, and is almost certainly approaching 100 percent asymptotically. This new demographic transition portends a diminished survival effect on working life. For high-income countries at the forefront of the longevity transition, expected lifetime labor force participation as a percent of life expectancy is declining.

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Policy Briefs

The Dedicated VAT Solution

Victor Fuchs, Shoven JB
SIEPR Policy Brief, 2010 August 1, 2010

The National Commission on Fiscal Responsibility and Reform, co-chaired by former Clinton White House Chief of Staff Erskine Bowles and former Republican Senate Whip Alan

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Journal Articles

Health Care Is Different—That's Why Expenditures Matter

Victor Fuchs
Journal of the American Medical Association, 2010 May 12, 2010

Health care expenditures in the United States have been increasing much more rapidly than the rest of the economy over the past 30 years. The average gap, 2.8% per annum, results in health care's share of the economy doubling every 26 years.1 Why does this matter? Would it matter if expenditures for personal computers were increasing 2.8% per annum more rapidly than the rest of the economy?

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Working Papers

A Collection of Articles on U.S. Health Reform

Victor Fuchs
SIEPR, 2010 January 1, 2010

A collection of core faculty Victor Fuchs' articles on actions needed for meaningful health care reform in the United States.

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Journal Articles

The Proposed Government Health Insurance Company -- No Substitute for Real Reform

Victor Fuchs
New England Journal of Medicine, 2009 May 28, 2009

As pressure builds on the White House and Congress to deliver on their promise of health care reform, the idea of a government health insurance company to compete with for-profit and not-for-profit private companies is gaining political momentum. Advocates claim that this new company would be more efficient, honest, and successful in forcing lower reimbursement rates on physicians and hospitals. However, a close look at how the present health care system functions, what its major problems are, and what reforms are needed to solve them suggests that this new idea is not the answer.

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Journal Articles

Toward a 21st-Century Health Care System: Recommendations for Health Care Reform

Kenneth J. Arrow, Auerbach A, Bertko J, Brownlee S, Casalino LP, Cooper J, Crosson J, Alain C. Enthoven, Falcone E, Feldman RC, Victor R. Fuchs, Alan M. Garber, Gold MR, Goldman D, Hadfield GK, Hall MA, Horwitz RI, Hooven M, Jacobson PD, Stoltzfus Jost T, Kotlikoff LJ, Levin J, Levine S, Levy R, Linscott K, Harold S. Luft, Marshal R, McFadden D, Mechanic D, Meltzer D, Newhouse JP, Noll RG, Pietzsch JB, Pizzo P, Reischauer RD, Rosenbaum S, Sage W, Schaeffer LD, Sheen E, Siilber BM, Skinner J, Stephen M. Shortell, Thier SO, Sean R. Tunis, Wulsin L, Yock P, Nun GB, Stirling Bryan, Luxenburg O, van de Ven PMM
Annals of Internal Medicine, 2009 April 7, 2009

The coverage, cost, and quality problems of the U.S. health care system are evident. Sustainable health care reform must go beyond financing expanded access to care to substantially changing the organization and delivery of care. The FRESH-Thinking Project held a series of workshops during which physicians, health policy experts, health insurance executives, business leaders, hospital administrators, economists, and others who represent diverse perspectives came together.

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Journal Articles

Health Reform: Getting The Essentials Right

Victor R. Fuchs
Health Affairs, 2009 January 16, 2009

Fuchs argues that health reform must encompass the Four Cs in order to succeed: coverage, cost control, coordinated care and choice. While details are certainly important, Fuchs writes, Congress and the Obama Administration must remember that "God is in the essentials." Without the essentials, no reform plan can succeed.

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Journal Articles

Who Really Pays for Health Care? The Myth of "Shared Responsibility"

EJ Emanuel, Victor R. Fuchs
Journal of the American Medical Association, 2008 March 5, 2008

When asked who pays for health care in the United States, the usual answer is "employers, government, and individuals." Most Americans believe that employers pay the bulk of workers' premiums and that governments pay for Medicare, Medicaid, the State Children'sHealth Insurance Program (SCHIP), and other programs.

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Journal Articles

Health Care Reform -- Why So Much Talk and So Little Action?

Victor R. Fuchs
New England Journal of Medicine, 2008 January 15, 2008

As promised during his campaign, and under pressure from many quarters, President-elect Barack Obama may seek badly needed changes in the way the United States finances and delivers health care. Responding to public interest and perceived need, several previous presidents have attempted to enact some kind of national health insurance: Harry Truman in the 1940s, Richard Nixon in the 1970s, and most recently Bill Clinton in the 1990s. These attempts went nowhere.

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Journal Articles

Employment-Based Health Insurance: Past, Present, and Future

Alain C. Enthoven, Victor R. Fuchs
Health Affairs, 2006 December 31, 2006

We review the rise, stabilization, and decline of employment-based insurance; discuss its transformation from quasi-social insurance to a system based on actuarial principles; and suggest that the presence of Medicare and Medicaid has weakened political pressure for universal coverage. We highlight employment-based insurances flaws: high administrative costs, inequitable sharing of costs, inability to cover large segments of the population, contribution to labor-management strife, and the inability of employers to act collectively to make health care more cost-effective.

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Journal Articles

Health Care Reform: Why? What? When?

Victor R. Fuchs, Ezekiel Emanuel
Health Affairs, 2005 November 1, 2005

Dissatisfaction with the U.S. health care system is widespread, but no consensus has emerged as to how to reform it. The principal methods of finance -- employer-based insurance, means-tested insurance, and Medicare -- are deeply and irreparably flawed. Policymakers confront two fundamental questions: Should reform be incremental or comprehensive? And should priority be given to reforming the financing system or to improving organization and delivery?

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Journal Articles

Health Care Expenditures Reexamined

Victor R. Fuchs
Annals of Internal Medicine, 2005 July 5, 2005

Concern about health care expenditures is not a new phenomenon. Seventy-five years ago, President Herbert Hoover appointed a committee to investigate the cost of medical care under the chairmanship of Ray Lyman Wilbur, MD, president of Stanford University. Thirty-eight years ago, John Gardner, Secretary of Health, Education, and Welfare, convened a national conference on medical care costs. Since then, not a year has passed without professional and lay periodicals addressing this subject.

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Journal Articles

Health Care Vouchers - A Proposal for Universal Coverage

Ezekiel Emanuel, Victor R. Fuchs
New England Journal of Medicine, 2005 March 24, 2005

Dissatisfaction with the financing of U.S. health care is widespread. The system is inefficient, inequitable, and increasingly perceived to be unaffordable. Because only incremental reform is deemed politically feasible, inordinate attention is devoted to treating the institutional symptoms rather than diagnosing systemic problems that require major surgery. As an alternative, we propose a voucher system for universal health care, an efficient, fair, and relatively simple approach that might elicit broad support.

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Journal Articles

More variation in use of care, more flat-of-the-curve medicine

Victor R. Fuchs, Victor R. Fuchs
Health Affairs, 2004 October 7, 2004

Variation in use of health care is ubiquitous in the United States. It is attributable to exogenous differences in supply of medical resources; to identified and unidentified economic, social, and cultural factors; and to the idiosyncratic beliefs of physicians. It is perpetuated by the parochial character of much clinical practice.

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Journal Articles

Reflections on the socio-economic correlates of health

Victor R. Fuchs
Journal of Health Economics, 2004 July 1, 2004

Income, education, occupation, age, sex, marital status, and ethnicity are all correlated with health in one context or another. This paper reflects on the difficulties encountered in deriving robust scientific conclusions from these correlations or drawing reliable policy applications. Interactions among the variables, nonlinearities, casual inference, and possible mechanisms of action are discussed. Strategies for future work are suggested, and researchers are urged to pay special attention to possible interactions among health, genes, and socio-economic variables.

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Journal Articles

Floridian Exceptionalism

Victor R. Fuchs
Health Affairs, 2003 August 13, 2003

Elderly Floridians use much more medical care and have much lower mortality rates than do their peers in other regions of the country. After demographic and other variables are controlled for, the differential between Florida and the rest of the United States is 25 percent for utilization and 10 percent for mortality among whites ages 65-84.

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Journal Articles

Medical Innovation: Promise and Pitfalls

Victor R. Fuchs, Alan M. Garber
Brookings Review, 2003 January 1, 2003

The second half of the 20th century witnessed spectacular advances in health care. Innovations such as magnetic resonance imaging, genetically engineered growth factors, and highly effective drugs for the treatment of depression, gastroesophageal reflux, high blood cholesterol, and HIV disease greatly improved the detection and treatment of both rare and common diseases.

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Books

Financial Problems of the Elderly: Holistic View, The

Victor R. Fuchs
Johns Hopkins Press in "Policies for an Aging Society: Confronting the Economic and Political Challenges", edited by Stuart B Altman and David Shactman, 2002 December 31, 2002

One in eight Americans today is over the age of 65, and the proportion will increase dramatically in the future. The aging of the population has begun to drive tax and budget decisions and the federal policy agenda, as policy makers and voters look ahead to enormous demands on the health and income security programs. Indeed, it is projected that Medicare and Social Security will constitute nearly half the federal budget in the year 2030, when one in five Americans will be over 65. In Policies for an Aging Society, Stuart H. Altman and David I.

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Books

Eli Ginzberg: Man of Many Parts

Victor R. Fuchs
Transaction Publishers (New Brunswick, NJ) in "Eli Ginzberg: The Economist as a Public Intellectual", edited by Louis Horowitz, 2002 December 31, 2002

The world of Eli Ginzberg can readily be thought of as a triptych-a career in three parts. In his early years, Ginzberg's work was dedicated to understanding the history of economics, from Adam Smith to C. Wesley Mitchell, and placing that understanding in what might well be considered economic ethnography. His studies took him on travels from Wales in the United Kingdom to California in the United States. For example, the poignant account of Welsh miners in an era of economic depression and technological change remains a landmark work.

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Journal Articles

Air Pollution and Medical Care Use by Older Americans: A Cross-Area Analysis

Victor R Fuchs, SR Frank
Health Affairs, 2002 November 1, 2002

The case for reduction of air pollution has been predicated primarily on the frequently observed relationship between pollution and mortality and morbidity. Because pollution control usually involves costs, a rational public policy will weigh the benefits against the costs. This study investigates another potential benefit from pollution reduction: namely, decreased use of medical care. We find a strong relationship between particulate matter and inpatient and outpatient care at ages 65-84 across 183 metropolitan statistical areas (MSAs).

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Journal Articles

What's Ahead for Health Insurance in the United States?

Victor R. Fuchs
New England Journal of Medicine, 2002 June 1, 2002

The ethical case for the social insurance model will be strengthened as people realize that most health problems have at least in part a genetic basis. The efficiency case will benefit from recognition that employment-based insurance has high administrative costs but provides no advantages to society as a whole. The desire to exert more direct control over rising expenditures will provide an additional reason to introduce some form of national health insurance.

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Journal Articles

Reflections on Economic Research and Public Policy

Victor R Fuchs, Victor R. Fuchs
The American Economist, 2002 April 1, 2002
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Journal Articles

Physicians' Views of the Relative Importance of Thirty Medical Innovations

Victor R. Fuchs
Health Affairs, 2001 September 1, 2001

In response to a mail survey, 225 leading general internists provided their opinions of the relative importance to patients of thirty medical innovations. They also provided information about themselves and their practices. Their responses yielded a mean score and a variability score for each innovation. Mean scores were significantly higher for innovations in procedures than in medications and for innovations to treat cardiovascular disease than for those to treat other diseases.

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