Dr. Ashish K. Jha is former dean of Brown University School of Public Health and a contributing Globe Opinion writer.<\/p>\n
When doctors get the diagnosis wrong, patients pay the price. Unfortunately, that is exactly what has happened with the American health care system: Lawmakers have misdiagnosed the problem, and the American people pay the price.<\/p>\n
For millions of working families, the cost of the misdiagnosis is obvious: Premiums and deductibles now consume so much of household income that many families delay care,<\/a> drain their savings, or make difficult choices between health care, rent, and child care. Small businesses drop coverage they can no longer afford<\/a>, and states divert money <\/a>from schools, roads, and public safety just to keep Medicaid afloat. The United States is on track to spend more than $7.7 trillion per year by 2032.<\/a> That level of spending will further erode coverage, overwhelm public budgets, and force painful tradeoffs with other essential investments.<\/p>\n For decades, policy makers have treated rising health care costs as an unavoidable fact of modern life \u2014 the inevitable byproduct of an aging population, rapid medical innovation, and expanded coverage. That convenient story has allowed Washington to focus almost exclusively on subsidies \u2014 how big they are and where they come from. It\u2019s like arguing over who should pay the restaurant bill while the price of the meal keeps climbing. But if you misdiagnose the disease, you cannot prescribe the right treatment.<\/p>\n Some of the increase in spending does reflect genuine progress. More Americans are living longer. Breakthrough treatments are saving lives that once would have been lost. But a large share of our cost explosion is the result of deliberate policy choices \u2014 choices that tolerate extreme prices<\/a>, reward wasteful care, permit unproductive consolidation, and embed extraordinary inefficiency into the delivery of care.<\/p>\n The misdiagnosis is not just technical. It is ideological.<\/p>\n On the political right, the reflex is to blame government \u2014 and these days, especially the Affordable Care Act \u2014 for health care dysfunction. That story is simplistic. US health care spending was on an unsustainable trajectory long before the ACA<\/a>, and while the law successfully expanded coverage<\/a>, it did little to bend the cost curve. At best, the ACA slowed spending growth in the Medicare program, but it had limited impact on spending, positive or negative, among the commercially insured.<\/p>\n On the political left, the instinct is to blame \u201cthe market\u201d and corporate profiteering. That story is also simplistic. In many American communities, there have been real breakdowns in the market. Patients largely cannot shop because they have too few choices. Prices are opaque. Competition is weak or nonexistent. In too many areas of America, what we call \u201cthe market\u201d is actually a set of government-protected monopolies sustained by policy choices that reward consolidation and shield incumbents from competition.<\/p>\n While both sides argue, the status quo wins. Policy makers fail to take action to address why the health care costs are so high in the first place.<\/p>\n When the domestic argument hits a wall, the debate turns abroad. Liberals point to Denmark or the United Kingdom, two largely publicly funded systems with few out-of-pocket costs. Conservatives point to Singapore, which relies largely on health savings accounts and catastrophic coverage with more of a functioning market. The implication is that if we would simply import someone else\u2019s system, our problems would disappear.<\/p>\n My mentor and friend, the late Uwe Reinhardt \u2014 one of the world\u2019s great health economists \u2014 used to caution against that kind of thinking. During the 2016 presidential campaign, when Bernie Sanders frequently praised the Danish health care system, someone asked Reinhardt what he thought of it.<\/p>\n