And so it also is for Washington DC's attempt to offer a generous public insurance health benefit inside of a limited budget. Writing in this week's New England Journal of Medicine, Drs. Baiker and Chandra review the numbers and the politics of Uncomfortable Arithmetic - Whom to Cover versus What to Cover. While it could be argued that we have a) a moral obligation and/or b) a long term return on investment to be gained from covering 'everyone,' the authors point out that a) there is only so much Federal budget and b) covering everyone for everything is a poor use of money.
Given this uncomfortable reality, the authors argue that a more rational approach may be to ration low 'value' care by promoting the coverage of services that lead to a) higher numbers or b) higher quality years life gained at an attractive cost (a figure in Table 2 quotes $100,000 per year of additional high quality life expectancy).