Follow the Money: Money Matters in Health Care,Just like in Everything Else

Abstract

I suspect that our collective search for villains — for someone to blame — has distracted us and our political leaders from addressing the fundamental causes of our nation's health-care crisis. All of the actors in health care — from doctors to insurers to pharmaceutical companies — work in a heavily regulated, massively subsidized industry full of structural distortions. They all want to serve patients well. But they also all behave rationally in response to the economic incentives those distortions create. Accidentally, but relentlessly, America has built a health-care system with incentives that inexorably generate terrible and perverse results. Incentives that emphasize health care over any other aspect of health and well-being. That emphasize treatment over prevention. That disguise true costs. That favor complexity and discourage transparent competition based on price or quality.¹