• Medicare reform and insurance expansions

    Andrew Sullivan yesterday pointed to an op-ed by the Sec. of State for Health in the U.K. discussing their need to address health care cost-inflation in the NHS in order to make that system sustainable. And in doing so, Andrew usefully underlined the fact that all countries struggle with the cost of paying for health care, no matter how much less they spend than we do. We spend around $2 dollars per capita on health care for every $1 per capita spent in the U.K.

    One key fact that seems to have become lost in the narrative of the Ryan plan v. the ACA is that Ryan’s plan would repeal the insurance expansions to be financed by Medicare cuts and new taxes in the ACA and replaces them with NOTHING to expand insurance coverage for the uninsured. Therein lies the most profound difference between the struggle in the U.S. and other nations to address health care costs: they have a system of providing some amount of health insurance to all their citizens. We are struggling with costs while also trying to figure out whether we will simply move toward universal coverage.

    The debate should not only be on the future of Medicare, but on whether we will seek to address costs while also expanding insurance coverage, or not. Some say we cannot do both. I disagree and think the two can and must be linked, because the groups in question are linked. In any event, this aspect of the debate is being lost.


    • Great point. The debate has turned completely away from trying to achieve universal coverage. The ACA is being attacked and if it is taken apart, assuming a GOP sweep in 2012, there is no chance for a replacement that would also broaden coverage.


    • The concern (hysteria?) about the deficit is clearly leading people to ignore the potential impact of health insurance on the death rate. If the 2009 study published in the American Journal of Public Health (see below) estimating that the lack of universal coverage causes 45,000 a year is even close to correct, expanding coverage could save half a million lives over the next 10-15 years. Looking at the legitimate methodological concerns about this study (such as the single point-in-time measure of insurance coverage), all of which the authors acknowledge, suggests to me that, if anything, the study may have underestimated the impact of insurance. The increase in the population and cost of insurances that we can expect over the next decade suggests that without a significant increase in coverage we can expect the death rate attributable to the lack of coverage to increase.