is hard to overstate the intense political and media attention given
to health care. New medical discoveries and technologies are front-page
news stories. In many communities, health care is either the largest
or a substantial employer, and rising employee health care costs are
a major concern for individual families and employers alike. That
we, a wealthy society, invest more in health care than in subsistence
goods signifies the value we place on high technology and specialized
health services. The United States spends nearly 17% of its gross
domestic product (GDP) on health care (a combination of public and private
financing), or over $7000 on each American annually.
This amount of health care financing is nearly double the investment
made in any other highly developed country. As such,
economic and political factors explain the salience of health care in
the expansion of the health care enterprise, it is not surprising that
the American political community is deeply focused on it. For
a generation, health reform has been a dominant domestic political issue.
The nation recently went through the politically grueling passage of
the first comprehensive health care reform since the 1960s, with cavernous
political divides on the role of government in financing and delivery
of care. Critics portrayed modest proposals for cost-effectiveness
comparisons—routinely accepted in other advanced democracies—as
“death panels,” and the final law inhibits the use of quality cost-effectiveness
analysis in coverage, reimbursement, and incentive structures.
Within weeks of the law’s passage, twenty states filed lawsuits challenging
the constitutionality of the individual mandate—a fundamental component
of the reform.