Wait! Defenders of Medicare have a point

And I’m not sure Matt Miller articulated defenders of current Medicare’s point properly. I’ll get to that. First, Miller’s main point is that we should keep premium support on the table as an option. I agree, provided we recognize that the precise nature of that support matters and matters a lot. For what types of plans will it be available (public option included?) and how is it set and indexed (will it keep pace with health care costs?)? These are crucial questions.

Now to Miller’s critique of Medicare defenders.

[T]he Democratic case on Medicare (as well as the GOP’s case last election) is therefore caught between two claims that can’t both be true: (1) we spend much more on health care than anybody else without better results; and (2) if we cut the growth of this spending to below the rate of GDP growth, we’d have to curtail Americans’ access and quality of care. No matter how often and how loud the interest groups, politicians and other forces of the status quo scream the latter, it cannot be true if the former is a fact.

Sorry. Wrong. Both (1) and (2) can be true. Let’s take (1) as given. How can (2) still be true? It’s true in the sense that we have no idea how to cut spending and, crucially, spending growth, without harming access to both health protecting and preserving care and unnecessary care.

Every real-world study I can recall that has examined how broad changes in health care financing play out (by which I mean changes that might actually bend the cost curve, not just shift the level of spending) concludes that, at a minimum, some groups get less of both necessary and unnecessary care. The stylized fact is that half of forgone care was actually valuable care that should have been delivered. That’s a loss in access to care and to the quality of care received. That’s point (2).

Just because (1) and (2) are both true, despite what Miller says, does not mean we should not make changes to Medicare or that we should stop looking for ways to deliver more necessary, high quality care and less unnecessary care, hopefully saving money by doing so. In that, I think both Miller and I agree.

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