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d. Insurance providers

d. Insurance providers are not allowed to deny coverage based on pre-existing conditions or to charge higher premiums based on pre-existing conditions or gender. (This provision makes the individual mandate necessary in order to avoid an adverse selection problem.) Premium differences based on age cannot exceed a factor of three. e. The Medical Loss Ratio rule requires health insurance providers to spend at least 80 percent of premiums collected on medical care and activities to improve health care quality. The ratio is 85 percent in the large group market. 3. Provisions that help pay for the Affordable Care Act; a. Medicare reimbursements to hospitals will be reduced by about $260 billion over 10 years. b. Government payments to Medicare Advantage will be reduced by about $156 billion over ten years. c. A nondeductible annual fee (of about $85 billion dollars total through 2018) is imposed on health insurance providers and branded prescription pharmaceutical manufacturers. d. A reduced limit is placed on contributions to health flexible spending arrangements under cafeteria plans. e. For most individuals, the threshold for deducting unreimbursed medical expenses increases from 7.5% of their adjusted gross income to 10% of their adjusted gross income. f. For high income taxpayers an increased Medicare tax rate and an additional Medicare tax on unearned income is imposed. g. A 10 percent tax is imposed on indoor tanning services. h. A 2.3 percent excise tax on medical devices is imposed. i. Starting in 2018, a 40 percent excise tax will be imposed on high-cost employer-provided health insurance plans. The Goal is Good Health What we really want is not good health care, but good health. Despite the concerns about health care in America, there have been significant improvements in health outcomes in America: 1. Life expectancy for Americans increased from 47 years in 1900 to 79 years in 2012. 2. In the twentieth century, the infant mortality rate in America decreased by 95%. 3. Tuberculosis, which killed three times as many Americans as cancer in 1900, was only .1% as likely to cause the death of an American in 2011 as in 1900. 4. Influenza and pneumonia were only 9% as likely to cause the death of an American in 2011 as in 1900. 5. Heart disease was half as likely to cause the death of an American in 2011 as in 1960. 6. AIDS deaths in America peaked at 51,414 in 1995 then fell to 15,529 in 2010. The improvement in outcomes is due not only to improvements in the effectiveness of health care but also due to improvements in nutrition, hygiene, sanitation, workplace safety, etc. Some of the improvement in health outcomes is due to improvements in personal lifestyle choices. Example 16: The percentage of adult Americans who smoke decreased from 42.8% in 1965 to 18.1% in 2012. Personal lifestyle choices play a large role in determining health outcomes. A 2009 study by the Harvard School of Public Health detailed the leading preventable risk factors for premature mortality in America. The table below shows the five leading preventable risk factors and the number of annual premature deaths attributed to each. Risk Factor Annual Premature Deaths Smoking 467,000 High blood pressure 395,000 Overweight-obesity 216,000 Inadequate physical activity 191,000 High blood sugar 190,000 FOR REVIEW ONLY - NOT FOR DISTRIBUTION 30 - 11 Agriculture and Health Care

In evaluating the two primary health care reform options, an important factor is the potential of each option to reduce these major risk factors. National health insurance might lead to an improvement in personal lifestyle choices that affect health outcomes. It would be in the best interest of the government to limit total health care spending over the life of each person. Thus, the government might invest heavily in preventive care, including attempts to alter unhealthy lifestyle choices, like smoking. On the other hand, NHI would mean that individuals would be largely shielded from the medical costs resulting from their unhealthy lifestyle choices. Consumer-driven health care might lead to an improvement in personal lifestyle choices that affect health outcomes. It would be in the best interest of each person to limit their total health care spending over their lifetime. Unhealthy choices, like smoking, would lead to higher health care costs to the individual, both in terms of out-of-pocket costs for normal health care expenses and in terms of the premiums paid for catastrophic health insurance. Thus the individual might invest heavily in preventive care, like a stop-smoking program. Appendix: Adverse Selection and the Individual Mandate A very controversial provision of the ACA is the individual mandate; the requirement that most people who do not have employer-provided or government-provided health insurance must purchase health insurance or pay a penalty. The individual mandate was made necessary by another provision of the ACA; the provision that insurance providers may not deny coverage or charge higher premiums based on pre-existing conditions. This provision would lead to an adverse selection problem if most individuals were not required to purchase health insurance. If there were no individual mandate requiring most individuals to purchase health insurance, a person could wait until they developed a health problem before purchasing health insurance. A person could not be denied coverage or charged higher premiums based on this pre-existing condition. Individuals in good health would have no incentive to purchase health insurance, since they could always purchase the health insurance that they need after they develop a health problem. Thus, only those with health problems would purchase health insurance. This adverse selection of purchasers would mean that health insurance premiums would have to be very high. By requiring that most people purchase health insurance, the individual mandate is intended to assure that a normal selection of healthy people as well as unhealthy people will purchase health insurance. The inclusion of healthy people will keep insurance premiums lower than they would be if only unhealthy people were purchasing health insurance. Research by Hackmann, Kolstad, and Kowalski indicated that the individual mandate included in the Massachusetts health care reform law of 2006 successfully reduced adverse selection. Appendix: Future Growth in Health Insurance Exchanges The health insurance exchanges were intended to supplement not replace employer-provided health insurance. It was anticipated that some employers would drop health insurance, but that the large majority would not. If the percentage of employers who drop health insurance is much higher than expected, the cost to provide the refundable tax credits to those purchasing health insurance through the exchanges will also be much higher than expected. Research by Douglas Holtz-Eakin and Cameron Smith indicates that for workers with income below 250% of the poverty level, it would make sense for their employers to drop health insurance, increase the employee’s pay enough to replace the value of the lost health insurance benefit, and have the employee purchase insurance through a health insurance exchange. The refundable tax credits are generous enough that both the employer and employee can benefit by taking advantage of the government subsidy. The research indicates that around 40 million workers (along with their employers) would be better off financially by dropping employerprovided health insurance and taking advantage of the refundable tax credits available through the health insurance exchanges. If this happens, the cost of the refundable tax credits will be far greater than the $460 billion anticipated for the years 2014-2019, and for years that follow. FOR REVIEW ONLY - NOT FOR DISTRIBUTION Agriculture and Health Care 30 - 12

  • Page 2 and 3:

    PRINCIPLES OF ECONOMICS JEFF HOLT S

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    Principles of Economics, 6th Editio

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    16. Study Guide for Chapter 7 17. C

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    11. Appendix: Book Review - “The

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    20. Appendix: The NCAA Cartel 21. S

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    Introduction: A Brief History of U.

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    In the twentieth century, per capit

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    Appendix: The 35 Largest National E

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    Multiple Choice: ___ 1. The Jamesto

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    2. Describe the economic cost of th

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    Chapter 1 Scarcity and Choices The

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    Example 5B: At the end of 1982, the

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    Example 11: When Cindy quits her jo

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    consequences may result in failure

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    An upward sloping curve (as in Exam

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    In making decisions, humans tend to

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    5. ______________________ _________

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    ___ 13. If the value of one variabl

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    Y Point X Y A 0 1 B 3 3 C 6 5 D 9 7

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    Chapter 2 Trade and Economic System

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    Example 4B: The following quantitie

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    1. An increase in the quantity of r

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    3. For whom to produce? This is det

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    The graph below illustrates the shi

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    The two primary economic systems ar

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    ___ 12. The capitalist vision sees

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    ___ 25. According to the book “Ca

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    Chapter 3 Demand, Supply, and Equil

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    . For inferior goods, income and de

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    The same information can be placed

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    Not only does a free market elimina

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    $7 - 6 - 5 - S 3 S1 S 2 Price 4 - 3

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    Example 17: The graph below illustr

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    Questions for Chapter 3 Fill-in-the

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    ___ 12. Assuming a market originall

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    $8 - 7 - 6 - 5 - Price 4 - 3 - 2 -

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    Chapter 4 Inflation and Unemploymen

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    Computing the Rate of Inflation The

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    Full Employment Though unemployment

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    3. Cyclical unemployment - due to d

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    During the Great Depression, the ec

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    Appendix: Think Like an Economist -

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    Answer questions 8. and 9. based on

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    ___ 25. The extension of unemployme

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    Chapter 5 Measuring Total Output: G

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    5. Leisure. Leisure time is by defi

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    The U.S. is a high per capita GDP c

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    Example 17: In “An International

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    The simple circular flow diagram be

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    ___ 3. Which of the following would

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    2. Explain what nonproduction trans

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    Chapter 6 The Aggregate Market The

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    Example 2C: Assume the same facts a

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    Example 5B: The price of crude oil

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    Price Level Real GDP SRAS AD 2 AD 1

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    Appendix: Why the Aggregate Demand

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    ___ 3. DEF Company can invest in ne

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    2. List and explain the two factors

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    Chapter 7 Classical Economic Theory

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    Notice that the investment demand c

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    Long-Run Equilibrium If Real GDP is

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    Example 6B: When the economy is in

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    Laissez-faire If the economy is sel

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    ___ 5. According to Say’s Law: a.

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    3. On the graph below, draw an aggr

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    Chapter 8 Keynesian Economic Theory

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    Example 2B: The graph below illustr

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    Example 5: Assume that the table be

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    Notice on the graph on the previous

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    According to Keynesian theory, a ch

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    “The General Theory” also inclu

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    ___ 8. If the consumption function

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    3. If the MPC is .667, and investme

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    Chapter 9 Fiscal Policy The basic e

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    Keynesian Fiscal Policy Theory and

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    Example 5A: The federal government

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    The Laffer Curve What will happen t

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    Appendix: The Importance of Incenti

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    ___ 4. A decrease in government exp

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    2. Explain what automatic stabilize

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    Chapter 10 Money, Money Creation, a

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    Example 4B: The castaways on Gillig

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    Looking at the balance sheet below,

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    Demand-side One-shot Inflation Exam

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    4. Inflation increases uncertainty

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    life; it came into existence not by

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    calculated by using the potential d

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    ___ 12. If the required-reserve rat

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    4. Referring to the balance sheet f

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    Chapter 11 The Federal Reserve Syst

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    5. After Bank X sells the $300,000

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    Low Mortgage Interest Rates Mortgag

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    Relaxed Standards for Mortgage Loan

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    The Bursting of the Housing Bubble

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    On February 17, 2009, the federal g

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    Fed policies caused short-term inte

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    ___ 10. The Fed’s most important

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    ___ 25. In response to the recessio

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    Chapter 12 Monetary Policy The basi

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    2. A change in aggregate demand (AD

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    Monetarist Transmission Mechanism C

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    3. Borrowers do not have to seek ou

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    Appendix: Book Review - “The Age

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    Questions for Chapter 12 Fill-in-th

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    ___ 16. The primary source of incom

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    7. According to Alan Greenspan, wha

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    Chapter 13 Taxes, Deficits, and the

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    Example 5: In 2015, Taxpayer A had

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    of $5 and a quantity of 10 units. T

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    The complexity of the tax law also

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    the current government spending and

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    cut of 1964. The top rate was lower

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    ___ 6. Federal excise taxes: a. are

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    3. How would eliminating the loopho

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    Chapter 14 Economic Growth The basi

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    2. Labor. Labor can contribute to e

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    estricting international trade (e.g

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    An improvement in technology (e.g.

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    The table below shows the economic

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    will increase both Real GDP and per

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    ___ 8. Which of the following is co

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    ___ 26. The opinion that economic g

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    Chapter 15 Less Developed Countries

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    Example 8: Countries A, B, C, and D

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    Obstacles to Economic Development f

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    c. Restrictions on international tr

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    Appendix: Book Review - “The Powe

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    Example 25: In Brazil, about half t

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    Study Guide for Chapter 15 Chapter

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    ___ 13. Among the counterproductive

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    4. List four ways that governments

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    Chapter 16 International Trade The

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    Other Benefits of Free Internationa

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    Example 6: The graph below illustra

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    competitive disadvantage. But dumpi

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    is only 25% as productive as before

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    Smith was skeptical of government a

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    ___ 4. For Country X, what is the o

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    ___ 18. Frédéric Bastiat’s “P

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    4. On the graph below: (1) What is

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    Chapter 17 Elasticity We are often

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    Example 4A: What is price elasticit

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    Example 5A: Gertie’s Gas and Go i

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    Example 10A: When the price of Good

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    Example 13B: On the graph below, su

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    $7 - 6 - 5 - Price 4 - 3 - 2 - 1 -

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    In the long run, would the deadweig

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    ___ 7. The factors that determine w

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    3. a. Which price (or prices) from

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    Chapter 18 Utility The basic econom

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    Nonetheless, society generally assu

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    Example 9: Capital City operates a

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    Marginal rate of substitution - the

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    The diamond-water paradox is the ob

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    Complete the table below to answer

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    4. The graph below shows indifferen

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    Chapter 19 The Firm The basic econo

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    than contributing to team productio

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    1. Difficulty in raising large amou

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    Corporations also use self-financin

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    Example 24: A blacksmith who produc

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    For financing needs, proprietorship

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    ___ 13. Corporations: a. are comple

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    5. List two things that the absence

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    Chapter 20 Production and Costs The

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    In Example 5B, Birdwell finds that

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    variable cost initially decreases,

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    Quantity TC MC AFC AVC ATC 0 240 X

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    If the scale of operation is increa

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    average total cost. Average fixed c

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    ___ 11. Concerning the cost curves:

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    5. Complete the following cost tabl

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    Chapter 21 Perfect Competition The

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    Even though a perfect competitor ca

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    Example 6C: This example builds on

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    At what price will there be neither

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    Appendix: Perfect Competition in th

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    Multiple Choice: ___ 1. A perfect c

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    ___ 17. Perfect competition: a. req

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    Answers for Chapter 21 Fill-in-the-

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    Chapter 22 Monopoly Of the four mar

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    3. Exclusive ownership of an essent

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    maximizing quantity (4 units) creat

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    $22 - 20 - 18 - 16 - 14 - Deadweigh

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    2. Negotiating, beginning at a high

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    Legal barriers are created by gover

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    ___ 8. The slope of the demand curv

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    Price Quantity 3. List some of the

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    Chapter 23 Monopolistic Competition

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    For Percomp (the perfect competitor

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    Example 7A: The graph below represe

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    Example 9: The Organization of the

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    Example 12 illustrates the dilemma

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    its current price and quantity. The

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    ___ 14. Game theory: a. is a method

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    Answers for Chapter 23 Fill-in-the-

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    Chapter 24 Factor Markets The basic

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    $ $240 - 200 - 160 - 120 - 80 - 40

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    Since producers will attempt to equ

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    2. Differences in nonmoney aspects

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    were his strikeouts, walks, and hom

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    ___ 3. To maximize profits, a produ

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    ___ 19. According to the book, “M

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    Multiple Choice: 1. a. 8. c. 15. d.

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    Chapter 25 Labor Unions The primary

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    The elasticity of demand for union

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    Example 4A: Assume that the graph b

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    Notice from the graph in Example 6

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    Wage Factory A Quantity of Labor S

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    As a cartel, a labor union faces a

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    ___ 10. For a monopsony: a. there i

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    3. The graph below represents a lab

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    Chapter 26 Interest, Present Value,

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    An increase in expected rates of re

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    An asset is valuable because we exp

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    Example 13B: General Ordnance prove

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    Appendix: Present Value Table One f

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    ___ 4. An increase in expected rate

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    Problems: 1. List and explain the t

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    Chapter 27 Market Failure The basic

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    External Benefit If a market genera

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  • Page 448 and 449: A common good is nonexcludable. Non
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  • Page 452 and 453: ___ 5. What government policy would
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  • Page 458 and 459: Candidates and the Median Voter Mod
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  • Page 468 and 469: 2. If a certain policy will yield s
  • Page 470 and 471: Chapter 29 Government Regulation of
  • Page 472 and 473: underproduction is the amount that
  • Page 474 and 475: micromanagement results in business
  • Page 476 and 477: market. They may agree with their c
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  • Page 480 and 481: ___ 10. The public interest theory
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  • Page 486 and 487: weather may cause bumper crops. Bad
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  • Page 490 and 491: Example 12: From 1960 to 2013, the
  • Page 492 and 493: 1. NHI would provide universal heal
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  • Page 498 and 499: Answer questions 7. through 10. by
  • Page 500 and 501: ___ 21. If there were no individual
  • Page 502 and 503: Chapter 31 Income Distribution and
  • Page 504 and 505: Income is more equally distributed
  • Page 506 and 507: over a typical career is the accumu
  • Page 508 and 509: Ideal Income Redistribution The ide
  • Page 510 and 511: Poverty - a family whose income fal
  • Page 512 and 513: Appendix: Income Inequality around
  • Page 514 and 515: How is this story an analogy for th
  • Page 516 and 517: ___ 2. In 2013, the Lowest Income 6
  • Page 518 and 519: Problems: 1. Explain the two primar
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  • Page 522 and 523: Fiat money - money by government de
  • Page 524 and 525: Nonrivalrous good - a good for whic
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  • Page 528 and 529: “Company town”, 25-6 Comparativ
  • Page 530 and 531: Eli Lilly and Company, 22-1 Emergen
  • Page 532 and 533: Houston, Texas, 15-10 Human capital
  • Page 534 and 535: Market, 3-1, 3-8-9 Market basket, 4
  • Page 536 and 537: Political bias, 9-4, 12-7 Political
  • Page 538 and 539: Short run production, 20-2-3 Short-
  • Page 540 and 541: Upturns, 9-4 USDA, 27-9, 30-1-2, 30
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