Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, USA.
Health Aff (Millwood). 2013 May;32(5):882-90. doi: 10.1377/hlthaff.2012.1260.
The US Medicare program consumes an ever-rising share of the federal budget. Although this public spending can produce health and social benefits, raising taxes to finance it comes at the cost of slower economic growth. In this article we describe a model incorporating the benefits of public programs and the cost of tax financing. The model implies that the "one-size-fits-all" Medicare program, with everyone covered by the same insurance policy, will be increasingly difficult to sustain. We show that a Medicare program with guaranteed basic benefits and the option to purchase additional coverage could lead to more unequal health spending but slower growth in taxation, greater overall well-being, and more rapid growth of gross domestic product. Our framework highlights the key trade-offs between Medicare spending and economic prosperity.
美国的医疗保险计划消耗了联邦预算中越来越大的份额。尽管这种公共支出可以带来健康和社会效益，但为其提供资金而提高税收会以经济增长放缓为代价。在本文中，我们描述了一个包含公共计划效益和税收融资成本的模型。该模型表明，每个人都由相同的保险政策覆盖的“一刀切”的医疗保险计划将越来越难以维持。我们表明，具有保证基本福利和购买额外保险选项的医疗保险计划可能导致医疗支出更加不平等，但税收增长更慢、整体福利更大以及国内生产总值增长更快。我们的框架突出了医疗保险支出和经济繁荣之间的关键权衡。
