CAMBRIDGE, Mass. — With the 2020 U.S. presidential election quickly approaching, many Democratic hopefuls have already begun advocating a “Medicare for All” initiative. In response, political opponents and analysts have predicted that an all-encompassing medicare system would overwhelm the U.S. medical infrastructure and cause a sharp increase in hospital costs and wait times. Interestingly, a study by researchers at Harvard Medical School and the City University of New York at Hunter College has found that it is unlikely a Medicare for All policy would cause a surge in hospital use.
Analysis by the research team found no increase in hospitalizations after previous large coverage expansions. Increased care for the newly-insured was offset by small decreases in care for the healthy and wealthy.
The study analyzed changes in hospital use among those who gained new coverage and those whose coverage remained unchanged after the implementation of Medicare and Medicaid in 1966 and the Affordable Care Act (ACA) in 2014. These programs provided new coverage to roughly 10% of the U.S. population, about the same portion expected to gain coverage in a potential Medicare for All initiative.
Researchers reviewed large-scale national surveys from the Medicare/Medicaid and ACA eras and examined hospital use before and after coverage expansions. They found that, in the '60s, for every 100 Americans an average of 12.8 were admitted to a hospital in the three years prior to Medicare's implementation. In the four years following Medicare's arrival, that average actually dropped slightly to 12.7 people per every 100.
Results were similar almost 50 years later; hospital admissions averaged 9.4 people per 100 in the six years before the ACA coverage expansion, and 9 people per 100 in the two years following.
Surprisingly, the study revealed no overall changes in hospital use following both expansions, but a redistribution of care did take place: the elderly, poor, and sick were able to receive medical care more often. Following the institution of Medicare, hospital admissions among the elderly increased by 3.7 per 100, and by 0.7 per 100 among the poorest one third of the U.S. population. Conversely, younger and wealthier people visited the hospital less often.
Following the ACA, sick Americans were able to visit the hospital more frequently, with admissions rising by 1.5 per 100. Generally-healthy people also cut back on their hospital visits; a 0.6 per 100 decrease was observed among healthy Americans.
“The good news is that even big coverage expansions didn’t increase hospitalizations overall, indicating that universal coverage won’t cause a surge in care, and that Medicare for All is affordable,” explains study author Dr. Steffie Woolhandler, a distinguished professor of public health at CUNY's Hunter College, in a statement. “On the other hand, it implies that overturning the ACA would deprive millions of needed care without saving any money.”
Researchers believe that implementing a Medicare for All would mean more healthcare for people who really need it. While they admit that this may mean wealthier, healthier people aren't able to visit hospitals as often as they may like, this effect will ultimately be harmless in the context of the greater medical needs of the nation.
“The fact that coverage expansions shift hospital care to those who need it, and reduce care for groups currently getting excessive and possibly harmful interventions, means that universal coverage could help everyone,” Lead author Dr. Adam Gaffney comments.
The study is published in the Annals of Public Medicine.
