By David A. Kindig, MD, PhD
A front page article in today’s New York Times discusses the controversy over the yet to be appointed Medicare Payment Board. Readers may recall that I have previously and strongly advocated for eliminating Medicare (and non Medicare) expenditures that are wasteful and ineffective (see Controlling Healthcare Expenditures and Can Rationing Be Rational?). Yesterday, New York Times columnist David Leonhardt was awarded a 2011 Pulitzer Prize for work that included his deficit reduction interactive puzzle. Of 39 choices provided by the puzzle, a cap to Medicare spending (tied to 1% over GDP per capita) yielded the greatest projected cost savings and eliminated over 40% of the deficit. This option was an overwhelming favorite among those who preferred spending cuts over tax increases.
Most serious commentators have indicated that Medicare cost savings of some kind are necessary. Population health advocates see the potential for using these savings in part to rebalance our health investments and expand resources for prevention and the social determinants of health. Those opposing regulatory intervention when and where market forces are inadequate have a responsibility to show how other approaches will produce the needed results.
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