Medicare and Medicaid Unifying or Crushing? This is the Dilemma

Introduction: The increase in medical spending by the United States is unmatched in other developed countries, as evidenced by OECD analyses. The Medicare spending grew 4.5% to 646.2 billion, 20% of total NHE. The Medicaid spending grew 9.7% to 545.1 billion in 2015 or 70% of the total National Health Expenditure (NHE), private health insurance 7.2% to 1,072.1 billion compared to 33% of the total NHE. These increases, while disturbing, cannot be interpreted in and of themselves because the spending increments depend upon inflation, the overall status of the economy, and the growth of population. To view matters from a long-term perspective, such that decisions might better be made, we posited that analyzing the proportions of health care expenditures over time would better inform policy makers. Methods: Table NHE2015, provided the data for this analysis. Using a linear equation and the grid search method, permitting the data itself to correct for autocorrelation. Evaluated and compared were 1966-2015 annual percent of total health care expenditures represented by 1) Out of Pocket and Insurance Expenditures, 2) Private Insurance and CMS (Medicare, Medicaid, CHIP), 3) Medicare and Medicaid Expenditures, 1966-2015 4) Hospital and Physician/Clinical Expenditures. Results: Whereas private health insurance stopped increasing in 1990, CMS entities (Medicare, Medicaid, CHIP) continued to rise throughout the period. Hospitals costs rose rise may have reflected the ability of hospitals to capitalize on their captive patient market. For physicians and care givers there was a steady decline in the proportion of health care spending. Adoption of nurse practitioners and physician's assistants did not decrease the expenditure. Affordable Care Act included an increase beginning in 2013 in Private Insurance and a decrease beginning in 2013 in Hospital care. Conclusion: The ACA likely will not forestall the increase in government spending that is required. The similarity of the rise in Medicare and Medicaid spending argue for combining the two into a single program. The role of private health insurance in this respect would then be to provision non-catastrophic coverage for the working public. A solution to the funding problem associated with such a chance lies in making the Medicare tax rate, which would cover this, 4% on the first $200,000 and add 6% above $200,000. Medicaid and Medicare thus united will have better streamlined protocols and a stronger financial base.