The Rashomon Approach to Medicare

The May 28 number of the New England Journal of Medicine published three perspective pieces which show how hard it is to discuss anything to do with federal funding of medical care. The authors, all PhDs, were invited to write these articles presumably because they know a lot about the subject.

I’ve already stated my position about Medicare and federal health insurance here many times so there’s no need to repeat it. But the basic facts of Medicare’s finances ought not to be a point of disagreement.

Jacob Hacker, professor at UC Berkley writes: “Furthermore, experience with Medicare suggests that public insurance is better equipped to control spending…”

Mark Pauly, professor at the University of Pennsylvania states: “[T]here is no evidence that Medicare has been successful at controlling spending growth.”

The venerable Victor Fuchs of Stanford declares: “Medicare, despite its assured buying power, is headed for insolvency.”

It’s okay to disagree about policiy, but Medicare can’t simulatneously be a model for cost containment and be unsuccessful at controlling spending growth and be headed for insolvency. Didn’t the editors of the NEJM see some disconnect here? Where’s the basis for a dispassionate and informed discussion of national health insurance when the experts can’t even agree about how many feet are in a yard. I’d be glad to venture an opinion if there’s further need for clarification.

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