Yet for all the innovation, Americans have been singularly unsuccessful in restraining health care spending. The United States has moved through fads at a dizzying pace in recent decades — from managed to consumer-driven to accountable care — but they have thus far failed to produce reliable cost control. Rising health care costs are an issue throughout the industrialized world, though other countries manage to spend much less while insuring their entire populations. Still, lessons from international experience are largely ignored by U.S. policymakers and analysts intent on fashioning a “uniquely American solution.” The United States has not adopted the cost-containment policies that work in other countries: global budgeting, systemwide fee schedules and payment rules, monopsony purchasing, and supply-side controls on expensive technologies. Instead, America continues to abide high prices and the staggering administrative costs imposed by our byzantine insurance system.


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