Resident Fellow Thomas P. Miller

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I. Introduction

A comprehensive examination of distributive injustice within the U.S. health care system should move well beyond quantitative measures of differences in the flow of finances to acquire health care services. It requires a more concentrated emphasis on differences in health outcomes for lower- versus higher-income Americans and the key non-financial factors that produce them. Specifically, this article highlights the importance of education as a powerful contributor to significant differences in health outcomes. Expanding our vision to capture factors--such as education--outside the narrow scope of conventional health care financing and delivery provides an opportunity to discover better targeted policy interventions to narrow the existing income inequality in overall health outcomes.

Part II of this article explains the evidence that education may be a powerful driver of disparities in health outcomes. Part III illustrates how a more limited distributional analysis of health-services spending in recent studies of the Medicare program has produced sharply conflicting conclusions on whether Medicare financing is regressive or progressive. Part IV then offers a possible [*pg 232] reconciliation of these studies by focusing on the differences in health outcomes that various types of Medicare beneficiaries experience, rather than on the levels of health care spending that they receive. And finally, Part V builds on the preceding findings to suggest how policy interventions may be retargeted to be more effective in narrowing income-related gaps in health.

Thomas P. Miller is a resident fellow at AEI.

 The full text of this article is available here as an Adobe Acrobat PDF.