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Comment & Response
September 12, 2017

Behavioral Economics and Health Insurance Reform

Author Affiliations
  • 1Stanford University Medical Center, Stanford, California
JAMA. 2017;318(10):964-965. doi:10.1001/jama.2017.10548

To the Editor In a Viewpoint, Drs Skinner and Volpp1 discussed principles for health insurance reform drawing on behavioral economics. One principle was to shift high-cost enrollees into Medicare rather than creating new taxes to pay for subsidies. However, there is an unspoken consequence of this recommendation.

They pointed out that “inpatient private insurance reimbursements are 75% higher than Medicare reimbursements” so that “overall health care spending would immediately decline.” The immediate decline in spending would come mostly from lower payments to hospitals and physicians. Taxation would have to increase to fund these new Medicare payments, but the brunt of this method of cost reduction would be borne by those providing the care.

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