Protesters protest the Republican bill in the U.S. Senate to replace the Affordable Care Act in Salt Lake City on June 27. (Rick Bowmer/ASSOCIATED PRESS)

George F. Will’s call to the Republican Party to rein in Medicaid expenditures was silly, smug and sad [op-ed, July 9]. Silly because the core of his argument was based on comparing Medicaid spending over time without recognizing changes in medicine, demographics or inflation. Accounting for these changes shows Medicaid as cost-effective.

Smug because there was no acknowledgment of the benefits to those who have not yet needed Medicaid. Medicaid’s pooling of risk, particularly of high-risk seriously ill people, directly benefits Medicaid enrollees, as well as everyone else by covering costs that otherwise would have eventually been passed on to us. Most people live most of their lives without needing very much medical care. While the risk at each point in time is low, the risk over a lifetime is not. Nearly everyone needs medical care prior to dying. Unlike health insurance or Medicare, only Medicaid covers key aspects of long-term care. Hence, in Medicaid, as well as in employer-provided health insurance, about 5 percent of the group is responsible for 50 percent or more of the group’s medical expenditures.

Sad because he fails to goad Republicans toward an intellectually honest discourse. Insurance is a financial intermediary between individuals and health-care providers, albeit a critical one. The real issue, and the primary reason the Republicans are stuck, is how medical care is organized and delivered. Competition among health-insurance plans will not hold or drive down health expenditures; nor will reducing what health insurance must cover. Only very large payers with a vested interest in how care is organized and delivered, such as Medicaid, have had real success. Neither the House nor the current Senate bill addresses this fundamental issue; the Affordable Care Act did.

Robert Friedland, Potomac

The writer is a former economist at the Maryland Medicaid program.

George F. Will groused about the rising cost of Medicaid and its impact on the federal budget. He lauded Sen. Patrick J. Toomey’s (R-Pa.) attempt to rein in Medicaid costs by capping “the rate of growth” per beneficiary, as if this would save the program from oblivion. He and virtually every Republican ignore that Medicaid will absorb more of the federal budget over time as the U.S. population ages and people live longer. Long-term-care costs continue to rise without Congress attempting to control them. Capping the Medicaid “rate of growth” would put the burden on the states to make up the difference in the cost of long-term care for the elderly.

The solution is to recognize the real problem of the increasing need for long-term care and deal with it at both the federal and state levels, not artificially cap “the rate of growth,” which ignores the fact that more and more people desperately rely on Medicaid and that their numbers are rapidly increasing.

Jared Wermiel, Silver Spring