Health Care Spending III: Alice in Health Care Land

AliceWhen Alice tumbled down the rabbit hole, she entered a world (“Wonderland”) reminiscent of her own—but in which everything seemed upside-down, and nothing worked as expected.

After spending over a year researching the economics of the health care industry, I’ve concluded that health care is its own economic Wonderland.  If you were given the hypothetical task of designing an economic system in which the laws of ‘economic physics’ had been miraculously suspended, you could not do a better job than the current US healthcare system.

As a result, health care costs continue to escalate considerably faster than most other household expenses.  Our $2.6 trillion in 2010 health care spending represented nearly 18% of GDP, a proportion that has doubled during the past 30 years.

Economic fundamentals

Most of my knowledge of economics comes, not from academics, but from working as a researcher and adviser to businesses over a period of 40 years.   As a result, I always err on the side of empiricism (i.e., what is) and pragmatism (i.e., how to improve it).

For reference I always come back to capital fundamentalism—the basics of supply, demand, and market exchange.  A ‘pure’ economic exchange works something like this:  you own a product or service that I want to acquire.  You name your price (or we negotiate and agree on a price), I decide whether it’s ‘worth it’ or not, then I decide whether I want to buy, and (if appropriate) in what quantity.  In the purest form, I am also the consumer or user of the product or service, so I can make this value choice first-hand.

Then we ‘do the deal’. I pay you and acquire the product or service, and everyone’s immediate economic needs and goals are presumably satisfied.  We all live happily ever after.  Or if not, and I’m not happy with the result you provided relative to the price I paid you, I buy from another provider next time.

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