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Inequality-Aware Market Design

Paper Session

Sunday, Jan. 5, 2025 10:15 AM - 12:15 PM (PST)

Hilton San Francisco Union Square, Union Square 1 and 2
Hosted By: Econometric Society
  • Chair: Piotr Dworczak, Northwestern University

Waiting or Paying for Healthcare: Evidence from the Veterans Health Administration

Anna Russo
,
Massachusetts Institute of Technology

Abstract

Healthcare is often allocated without prices, sacrificing efficiency in the interest of equity. Wait times then typically serve as a substitute rationing mechanism, creating their own distinct efficiency and distributional consequences. I study these issues in the context of the Veterans Health Administration (VA), which provides healthcare that is largely free but congested, and the Choice Act, a large-scale policy intervention that subsidized access to non-VA providers to reduce this congestion. Using variation in Choice Act eligibility in both patient-level and clinic-level difference-in-differences designs, I find that the price reduction for eligible veterans led to substitution away from the VA, an increase in overall healthcare utilization and spending, and reduced wait times at VA clinics in equilibrium. I then use the policy-induced price and wait time variation to estimate the joint distribution of patients’ willingness-to-pay and willingness-to-wait. I find that rationing via wait times redistributes access to healthcare to lower socioeconomic status veterans, but at a large efficiency cost (-23%). By contrast, I find that a coarsely targeted, modest increase in copayments increases consumer surplus by more than the Choice Act, at lower cost to the VA, while disproportionately benefitting low-income veterans.

Optimal Redistribution via Income Taxation and Market Design

Mohammad Akbarpour
,
Stanford University
Pawel Doligalski
,
University of Bristol
Piotr Dworczak
,
Northwestern University
Scott Duke Kominers
,
Harvard University

Abstract

Policymakers around the world frequently distort goods markets via price controls, differential taxation, or by providing in-kind transfers---oftentimes motivated by redistributive goals. Such policies conflict with conventional economic wisdom (based on results like the second welfare theorem or the Diamond-Mirrlees and Atkinson-Stiglitz theorems) that redistribution should take place primarily through lump-sum transfers and income taxation. In this project, we study a model in which the social planner maximizes a utilitarian welfare function (with social welfare weights) over a population of agents who are heterogenous in both their ability to generate income and their taste for goods. We allow the planner to use an arbitrary incentive-compatible mechanism subject to a resource constraint. We first uncover a generalization of the Atkinson-Stiglitz theorem by showing that goods should be provided at prices proportional to marginal costs if (i) individual utility functions feature no income effects, (ii) redistributive preferences depend only on agents’ ability, and (iii) there is no statistical correlation between ability and taste for goods. Second, however, we show that the conclusion of the Atkinson-Stiglitz theorem fails if any of the three assumptions is relaxed. In a special case of our model in which the ability type is binary and the taste type is continuous, we derive the optimal mechanism and characterize the nature of optimal distortions introduced in the goods market.

Should the Government Sell You Goods? Evidence from the Milk Market in Mexico

Diego Javier Jimenez Hernandez
,
Chicago Federal Reserve
Enrique Seira
,
Michigan State University

Abstract

Governments spend considerable resources providing goods directly. We show that such behavior may increase welfare when private suppliers have market power. We do this by studying the staggered rollout of hundreds of government milk "ration stores"" in Mexico using a proprietary panel of household food purchases. The rollout lowered the price per liter of privately supplied milk by 2.4% and increased household consumption. To compare direct provision with budget-neutral alternatives

Taxing Externalities without Hurting the Poor

Mallesh M. Pai
,
Rice University
Philipp Strack
,
Yale University

Abstract

We consider the optimal taxation of a good that exhibits a negative externality in a setting where agents differ in their value for the good,
their disutility from the externality, and their value for money, while the planner observes neither. Pigouvian taxation is the unique Pareto efficient mechanism, yet it is only optimal if the planner puts higher Pareto weights on richer agents. We derive the optimal tax schedules for both narrow allocative and utilitarian objectives of the planner. The optimal tax is generically nonlinear and Pareto inefficient. The optimal mechanism might take a “non-market” form and cap consumption or forbid it altogether. We illustrate the tractability of our model by deriving closed-form solutions for the log-normal and Rayleigh distribution. We show that the idea of Atkinson and Stiglitz (1976), i.e., that a utilitarian planner should solely use income taxes and not commodity taxes, does not apply in our setting except under very specific circumstances. Finally, we calibrate our model and derive optimal taxes for the case of air travel.

Discussant(s)
Vasiliki Skreta
,
University of Texas-Austin and University College London
Dmitry Taubinsky
,
University of California-Berkeley
Mohammad Akbarpour
,
Stanford University
Dan Waldinger
,
New York University
JEL Classifications
  • D47 - Market Design
  • H42 - Publicly Provided Private Goods