In Reply Dr Colloff correctly points out that moving high-cost patients from private exchanges to Medicare would save money immediately for the federal government, but potentially at the expense of hospitals and physicians. The alternatives currently being debated in Congress to replace the Affordable Care Act, however, would be far worse.
With 22 million newly uninsured people seeking health care under the bill recently considered by the Senate,1 hospitals and physicians would be faced with treating uninsured patients who cannot pay anything. Under that alternative, the relatively generous Medicare reimbursements, especially for the more profitable medical procedures,2 would be far more appealing.
Skinner J, Volpp KG. Behavioral Economics and Health Insurance Reform—Reply. JAMA. 2017;318(10):965. doi:10.1001/jama.2017.10556