Recommendations On Health Care Spending And Value From 21 Experts: Why We Should Implement This Road Map For Action Now (Health Affairs)

HEALTH AFFAIRS | Four years ago, an ambitious group of twenty-one diverse health care experts came together at the invitation of Health Affairs to collectively develop recommendations to maximize our nation’s investment in health care. With national health care spending levels reaching nearly a fifth of our economy, it was the right time to evaluate our spending priorities and the value we receive from those expenditures. 

At the time, we anticipated that the Health Affairs Council on Health Care Spending and Value, which we co-chaired, would be a three-year effort.  We did not foresee the first global pandemic in decades, leading to trillion-dollar federal investments in public health, nor the national reckoning on racial and gender-based disparities that brought to light many of the inequities in health care today.  The council continued to meet throughout, although our in-person meetings became virtual, and we continued to adjust and hone our analysis and recommendations as the world around us shifted. 

Even with these changes, we remained steadfast that this work needed to be done. As physicians first, we recognize that patients still struggle with the cost of care, despite policy changes like the Affordable Care Act. We’re seeing increased care avoidance, as a shocking 47 percent of U.S. adults say that it is very or somewhat difficult for them to afford their health care costs. One in 10 Americans has medical debt, which continues to be the number one cause of bankruptcy. Despite the United States outstripping all other nations in per capita health care spending, our life expectancy is surprisingly on the decline. And in the midst of a crisis, when our physicians and nurses were our frontline defense against COVID-19, our health care systems needed billions in federal dollars to keep them afloat. Finally, our health spending continues to grow as a percentage of gross domestic product (GDP) and our federal budget. Taken together, this paints a picture of a system that is failing its people and where change is needed now. 

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