Sherry A. Glied (
Health Aff (Millwood). 2018 Jul;37(7):1073-1078. doi: 10.1377/hlthaff.2018.0008.
One often-discussed option for controlling Medicare spending is to switch to a premium-support design. This would shift part of the risk of future health care cost increases from the federal treasury to Medicare beneficiaries. The economics of risk bearing suggests that this would be a mistake for three reasons. First, political decisions, not beneficiary choices, are the critical determinants of future health care costs. Second, only Congress can take into account the consequences of cost-containment decisions for both current and future generations. Third, the federal government is best able to diversify against the risk of future cost growth. Tying Medicare spending to the government's budget so that Congress sees the benefits of tough cost containment choices is the only way to force the program to make those politically difficult decisions. Economic efficiency is served by retaining the program's current structure instead of shifting risk to beneficiaries.
一种经常被讨论的控制医疗保险支出的方案是转为保费补贴设计。这将部分地把未来医疗成本增加的风险从联邦财政转移到医疗保险受保人身上。从经济学角度来看，承担风险有三个原因表明这将是一个错误。首先，决定未来医疗成本的关键因素是政治决策，而不是受保人的选择。其次，只有国会可以考虑成本控制决策对当前和未来几代人的影响。第三，联邦政府最有能力分散未来成本增长的风险。将医疗保险支出与政府预算挂钩，使国会看到严格控制成本选择的好处，这是迫使该计划做出这些具有政治难度的决策的唯一途径。通过保留该计划的现行结构，而不是将风险转移给受保人，效率将得到提高。
