COMMENTS AND RESPONSES Implications of Regional Differences in Spending

TO THE EDITOR: Fisher and colleagues ’ study (1) questioned “the notion that additional growth in health care spending is primarily driven by advances in science and technology... ” in the United States. Shine’s accompanying editorial (2) suggested that “poorer access to care may increase costs. ” I agree and offer further evidence to support their statements. When the uninsured population and Medicare costs are exam-ined in the 50 states (Table 1), higher uninsured rates (3) correlate with higher per capita Medicare costs (4). In addition, states with the largest percentage of uninsured people have nearly 50 % more per capita Medicare expenditures compared with the “low uninsured” states. Some of the extra costs might be explained by cost shifting, ethnic or racial backgrounds, or costs of graduate medical education programs, but these reasons alone cannot explain all of the differ-ences. Of interest, it also appears that more people are living longe