How Medicare's low prices inflate health costs
Steven Brill's recent Time magazine cover story, “Bitter Pill: Why Medical Bills Are Killing Us,” is an extraordinarily well-reported look at medical pricing, demonstrating that high health-care prices have little relationship to underlying cost. For many commentators, the much lower prices paid by Medicare suggest an obvious solution to our health-care problems — “Medicare for all.” There's only one problem: Medicare has been a primary driver of the explosion of health-care costs in the United States despite — and perhaps because of — the low prices it pays.
Over the past decade, Medicare's spending per beneficiary has risen at roughly the same rate as spending for privately insured patients. Medicare's supporters have a simple explanation: Americans are living longer and this is driving up the program's costs. But Medicare's own data say that a much more important factor is the growing intensity of use: more demand for care at every age.
In the mainstream of our health-care debate, this growth in seniors' demand is considered organic — a need to be fulfilled. But this extraordinary growth in volume is better understood as a provider reaction to the perverse incentives of low prices.
Medicare beneficiaries get a lot of health care, and these amounts grow every year. In 10 years, the number of CT and MRI scans per beneficiary more than doubled; hip replacements increased by 36 percent between 1997 and 2007. The average 75-year-old is on five prescription drugs. Annual spending just on those in excellent or very good health was an astonishing $5,437 per person in 2008.
“Diagnosis creep,” the substitution of expensive drugs for cheaper ones and an increasing number of more expensive procedures seem like common yet subtle responses to Medicare's efforts to manage by price. Medicare claims that hospitals and other institutions lose money on services provided to Medicare beneficiaries and have suffered losses every year since 2003. Yet the number of hospitals taking Medicare patients has grown in every one of those years.
Brill referred several times in his Time article to the “protection” Medicare offers its beneficiaries from high prices. But the massive expansion of care unleashed by Medicare's perverse incentives means that just the tiny sliver of care paid directly by seniors — at the low prices established by Medicare — now accounts for a higher share of their income than before Medicare existed.
Single-payer advocates contend that other nations have managed to better control health-care spending by enforcing a true budget for cost. But any review of how our Medicare system works illustrates why a single-payer system would be so difficult here: Our government has a pervasive inability to say “no.” Our government promises to pay for any care seniors need and providers respond by relentlessly expanding the definition of need. It's no coincidence.
Medicare is a major source of votes and campaign contributions, both of which reinforce our politicians' unwillingness to address exploding volumes. The program's low administrative costs aren't an accomplishment; they're a refusal to discipline excess care. The program's low prices are a mirage. As any businessperson knows, with enough market power — not to mention political power — you can always make it up in volume.
David Goldhill, chief executive of GSN, a media company, is the author of “Catastrophic Care: How American Health Care Killed My Father — and How We Can Fix It.”
Show commenting policy
TribLive commenting policy
You are solely responsible for your comments and by using TribLive.com you agree to our Terms of Service.
We moderate comments. Our goal is to provide substantive commentary for a general readership. By screening submissions, we provide a space where readers can share intelligent and informed commentary that enhances the quality of our news and information.
While most comments will be posted if they are on-topic and not abusive, moderating decisions are subjective. We will make them as carefully and consistently as we can. Because of the volume of reader comments, we cannot review individual moderation decisions with readers.
We value thoughtful comments representing a range of views that make their point quickly and politely. We make an effort to protect discussions from repeated comments either by the same reader or different readers.
We follow the same standards for taste as the daily newspaper. A few things we won't tolerate: personal attacks, obscenity, vulgarity, profanity (including expletives and letters followed by dashes), commercial promotion, impersonations, incoherence, proselytizing and SHOUTING. Don't include URLs to Web sites.
We do not edit comments. They are either approved or deleted. We reserve the right to edit a comment that is quoted or excerpted in an article. In this case, we may fix spelling and punctuation.
We welcome strong opinions and criticism of our work, but we don't want comments to become bogged down with discussions of our policies and we will moderate accordingly.
We appreciate it when readers and people quoted in articles or blog posts point out errors of fact or emphasis and will investigate all assertions. But these suggestions should be sent via e-mail. To avoid distracting other readers, we won't publish comments that suggest a correction. Instead, corrections will be made in a blog post or in an article.
- McCutchen, Pirates hitters increasingly in crosshairs
- Locke pitches 8 scoreless innings as Pirates edge Indians
- Pirates minor league report: Ramirez more mindful while at plate
- Woman shot outside Kennywood Park in West Mifflin
- Starting 9: Pirates missing out on young bat
- Pirates trust eye test when voting for all-stars
- Gameday: Pirates vs. Indians, July 5, 2015
- Starkey: Bring back the Brawl!
- Keystone Markers give insights about towns but have fallen victim to time, theft or traffic accidents
- Pittsburgh’s tech startup activity rates last of 40 metro areas in report
- Grandmother of boy dropped at Uniontown Hospital says he’s in ICU