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This paper studies how society votes on the payroll taxes of a basic income and a social health insurance scheme. Individuals differ along the two most important dimensions when it comes to the design of the two welfare schemes, namely, income and risk. Even though the introduction of a basic income scheme opens up the possibility for additional redistribution, it also crowds out social health insurance. We show that when both welfare schemes are open for debate, the political equilibrium is such that only the basic income scheme prevails. At the constitutional stage we determine which welfare scheme society agrees to implement behind the veil of ignorance and with a Rawlsian objective. Since social health insurance not only redistributes income from rich to poor but also from low-risk to high-risk agents, the doubly disadvantaged in society - low-income and high-risk agents - may lose out in the political process when a basic income scheme is in place. Depending on the amount of health care expenditure and the inequalities in income and risk, it may well be that a society will find it optimal to set up an institutional framework for a social health insurance scheme only.

A common approach to avoid risk selection in health insurance markets is to define and enforce a community-rated basic benefit package. The market for complementary insurance is usually completely separate from the market for basic health insurance. In Switzerland, however, the basic benefit package and complementary insurance are offered by the same insurer. Risk-based premiums are allowed with respect to complementary insurance. In this paper, the Swiss integration approach is compared to the separation approach. It is shown that under the integration approach insurers creamskim by selling complementary insurance to low risks at a discount. Nevertheless, the integration approach can be Pareto-superior if the cost savings due to the integration of basic and complementary insurance are sufficiently large. -- health insurance ; risk selection ; complementary insurance

We analyze the effects of a permanent increase in life expectancy and of a permanent decline in the rate of population growth on intergenerational redistribution in a pay-as-you-go pension system with a constant contribution or constant replacement rate. We show that under these policies both demographic changes increase the implicit tax rate of later-born generations to the pension system. In addition, we characterize policies which smooth the implicit tax rate. To reach this objective, generation-specific contribution or replacement rates are necessary. Partial funding of the pension system is indispensable if the rate of population growth falls. If life expectancy increases, the contribution rate fluctuates and may not converge to a new steady state value unless funded elements are introduced. -- Pay-as-You-Go ; implicit tax rate ; life expectancy ; population growth

A reply to Wolfram Richter's article based on Mathias Kifman's model on "health insurance in a democracy'. Adapted from the source document.

Dieser Beitrag untersucht aus verfassungsökonomischer Sicht den Reformvorschlag, die Gesetzliche Krankenversicherung durch Kopfbeiträge zu finanzieren. Dabei wird davon ausgegangen, dass sich die Bürger im Verfassungszustand einem nicht versicherbaren Prämienrisiko gegenübersehen. Das Niveau des öffentlichen Gesundheitswesens wird im demokratischen Entscheidungsprozess festgelegt. Ein Vergleich des politischen Gleichgewichts bei einer Finanzierung durch Kopfbeiträge und bei einer einkommensabhängigen Finanzierung zeigt, dass eine Verbindung von Einkommensumverteilung und der Umverteilung zwischen Gesunden und Kranken im Verfassungszustand von allen Bürgern vorgezogen werden kann. Bei einer Einführung von Kopfbeiträgen ist deshalb darauf zu achten, dass die Einkommensumverteilung und die Umverteilung zwischen Gesunden und Kranken nicht vollständig entkoppelt werden.