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Bankrupt Healthcare
What Do We Know About Health Care?

Good news and bad news: Medicare spending continues to decelerate, but we have no idea why. According to the Upshot, a CBO report today has revised down the percentage of GDP consumed by Medicare in 25 years from 4.9 to 4.6. This is enough to keep the program alive for six more years, but nobody has a good account of where the program’s new lease on life is coming from:

C.B.O. points out that it can’t pinpoint the cause of the recent slowdown or its durability, which is why it’s not changing its fundamental view of where Medicare spending is heading over the very long term. “How long the slowdown might persist is highly uncertain,” the report says.

That’s probably smart. Even economists who are most enthusiastic about the recent numbers still aren’t sure whether the trend is here to stay. At a Tuesday meeting of health economists in Washington on the subject, Uwe Reinhardt, a Princeton professor (and occasional Upshot contributor), cautioned against overinterpreting the recent good news.

“We don’t know what the hell is going on,” he said at the Altarum Symposium on Sustainable U.S. Health Spending.

Of course, even the good news here is qualified. Six more years of Medicare existence may give would-be reformers a bit more time to work on the problem, but it’s hardly a permanent solution. Medicare will still become unsustainable in the lifetimes of most of those who are alive today. But the fact that our greatest health care wonks, who have spent years studying the system, have no idea what’s causing this trend, or how long it will last, shows just how blind our health care policy practice is. And this raises a further point: something this unknowable has a tendency to thwart and resist all attempts at top-down control.

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