Public Option To Cut Health Costs? Medicare’s Record Says Dream On

“First, the rising cost of health care must be brought down.” That’s what President Obama recently declared when outlining the basic principles of his health care plan.

His supporters have echoed his emphasis. The New York Times writes that, when it comes to health policy, “The president’s main focus is on starting to reduce the soaring cost of health care.”

Speaker Pelosi concurs: Health care reform “is about cost — taking down the cost of health care.”

But can the president’s plan succeed, even on his own terms? If history is any guide, it cannot — and will instead make matters much worse.

The centerpiece of President Obama’s plan is a “public option,” described by Tom Daschle as “a government-run insurance program, modeled after Medicare.” The president asserts that this new Medicare-like program would cut costs.

But there are nearly 40 years of experience to consult, and they offer a resounding rebuttal. Across the years, Medicare’s costs have risen far more than the costs of privately purchased care.

A new study I’ve completed, published by the Pacific Research Institute, takes all health-care spending in the United States and subtracts the costs of the two flagship government-run programs, Medicare and Medicaid. It then takes that remaining spending and compares its cost increases over time with Medicare’s cost increases over time.

The results are clear: Since 1970 — even without the prescription drug benefit — Medicare’s costs have risen 34% more, per patient, than the combined costs of all health care in America apart from Medicare and Medicaid, the vast majority of which is purchased through the private sector.

Since 1970, the per-patient costs of all health care apart from Medicare and Medicaid have risen from $364 to $7,119, while Medicare’s per-patient costs have risen from $368 to $9,634. Medicare’s costs have risen $2,511 more per patient.

These conclusions are true despite very generous treatment of Medicare. My study counts Medicare’s prescription drug expenditures as part of privately purchased care, rather than as part of Medicare. It counts health care purchased privately by Medicare and Medicaid beneficiaries (including Medicare copayments and Medigap insurance) among the costs of private care, without counting its recipients among those receiving private care — thereby magnifying private care’s per-person costs. And it doesn’t adjust for cost-shifting from Medicare to private entities.

The New York Times and others have quoted studies claiming that private insurance has failed to contain costs as well as Medicare. Such studies are deeply misleading, for they omit any consideration of out-of-pocket spending, thereby neglecting a major shift in the private health care market.