Health Affairs BlogConsidering Health Spending
Health Affairs Launches New Series On Health Spending
Health spending has been a topic of interest to Health Affairs starting with our very first issue in 1981 which included a paper by Caspar Weinberger, former Secretary of Health, Education, and Welfare, asking: “Can We Control Health Care Costs?” Claims that health spending is “unsustainable” have been made for decades, yet spending growth continues apace.
The United States is an outlier not only in how much we spend on health care, but in the absence of formal mechanisms to consider how much we spend or how we allocate our spending. Payment levels and methods in the United States are determined separately by public and private actors without any coherent framework and often without any transparency. As purchasers move from paying for volume to paying for value, most changes are incremental and they rarely disrupt long-standing resource allocation decisions rooted in fee-for-service payment methods.
With support from the National Pharmaceutical Council, we are pleased to launch a series of papers in Health Affairs and a featured topic on Health Affairs Blog focusing on health spending. More traditional empirical analyses will appear in the journal, while the blog will provide an opportunity for commentary, policy proposals, criticism, and the like. The Blog topic launches today in conjunction with our annual retrospective report on National Health Expenditures; the journal series will launch in early 2018 in conjunction with our annual release of the National Health Expenditures projections.
Aggregate health spending of $3 trillion may seem abstract, but the implications of changes in how much or how we spend our health care dollars are quite concrete. Those trillions of dollars are someone’s income or profit, and they are paid for by patients, taxpayers, and employees. Any discussion of spending constraints raises the specter of rationing—a term politicians use at their peril.
Considerations of health spending require a conversation, not a shouting match, a finger-pointing game, or the hurling of epithets. Regardless of whether or not one views health care as a right, limited resources must be allocated somehow. In the United States we use a combination of market forces and regulatory power. If our goal is optimal health, we need to think critically about whether the current allocation of resources furthers that goal. And if it does not, we need to examine alternatives, even as we acknowledge the natural resistance to change by institutions and individuals. We hope the new featured topic on the blog will advance critical thinking on this topic.
In addition to reading, we invite you to submit your own posts. Read the first posts in the series from Joseph Antos and James C. Capretta, and Melinda Buntin. All blog posts submitted for this topic are subject to Health Affairs’ standard vetting and selection process. We hope you find the new material interesting and enlightening.