Would insuring near-elderly persons reduce Medicare spending in patients aged 65 years or older?

摘要

McWilliams and colleagues (1) find that Medicare spending is higher for previously uninsured persons and suggest that nearly half of the cost of expanding health insurance coverage to uninsured near-elderly adults might be offset by reduced spending in patients aged 65 years or older. We do not believe their research supports the notion of cost savings from insuring the uninsured, because a large proportion of higher Medicare expenditures observed for the previously uninsured cannot be avoided by insuring people earlier. As Bhattacharya points out (2), this may be particularly true if poor health caused them to be uninsured rather than lack of insurance causing them to have poor health.