Paul Krugman: Obama must lead on debt ceiling Medicare

Paul Krugman: Obama must lead on debt ceiling

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"For Medicare, with all its flaws, works better than private insurance. It has less bureaucracy and, hence, lower administrative costs than private insurers. It has been more successful in controlling costs. While Medicare expenses per beneficiary have soared over the past 40 years, they've risen significantly less than private insurance premiums. And because Medicare-type systems in other advanced countries have much lower costs than the uniquely privatized U.S. system, there's good reason to believe that Medicare reform can do a lot to control costs in the future.

In that case, you may ask, why didn't the 2010 health care reform simply extend Medicare to cover everyone? The answer, of course, is political realism. Most health reformers I know would have supported Medicare for all if they had considered it politically feasible. But given the power of the insurance lobby and the knee-jerk opposition of many politicians to any expansion of government, they settled for what they thought they could actually get: near-universal coverage through a system of regulation and subsidies.

It is, however, one thing to accept a second-best system insuring those who currently lack coverage. Throwing millions of Americans off Medicare and pushing them into the arms of private insurers is another story.


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