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In this election year, don’t expect to hear a lot from politicians about what’s wrong with U.S. health care and how to fix it — even though medical costs top the list of financial issues Americans worry most about.

But health care experts speaking at the 2024 SIEPR Economic Summit addressed that political third rail head on, with both pragmatism and research-based perspectives. They discussed what could be done to fix a $4.5 trillion system that accounts for more than 17 percent of U.S. GDP. That’s the largest of any U.S. sector and represents the biggest share of the economy of any industrialized country.

The discussion, moderated by , the Tad and Dianne Taube Healthcare Fellow at SIEPR and an assistant professor at the ��ɫApp School of Medicine, delved into solutions — both big and small — for improving access to medical care while also containing costs.

First, there’s a long-shot fix. Amy Finkelstein, an economics professor at the Massachusetts Institute of Technology, summarized the radical 2-part fix that she and Liran Einav, a SIEPR senior fellow and chair of the economics department in the ��ɫApp School of Humanities and Sciences, detailed in their 2023 book, : Guarantee consumers automatic and free basic level of essential medical services, but also the option of buying supplemental insurance for a higher level of care.

Finkelstein emphasized that their proposal, while politically infeasible in the short run, simply codifies what already exists.

“The history of U.S. health policy, as well as our current policies, makes very clear that there is an unwritten, but very real, social contract to provide access to essential medical care regardless of resources,” she said.

Her hope, shared by Einav, is that the day will come when, as economist Milton Friedman famously said, “the politically impossible becomes the politically inevitable.”

Identifying practical steps

The panel discussion explored, too, what can be done now to improve U.S. health care.

Gui Woolston, who runs Connecticut’s Medicaid program, offered up three policies that he said are readily implementable. The first is to give U.S. health care insurers incentives to invest in preventative care. The second is to embrace the role of randomized control trials to better understand which practices work or not.

“Many ideas that sound really good on paper don’t actually work,” Woolston said.

Woolston’s third idea is to build technology tools that help patients select the best primary care doctor, health care plan or end-of-life living situation that works best for them. “Making it easy for people to make smart choices, especially when the choices are hard, could be applied much more broadly,” Woolston said.

Todd Park, the co-founder of Devoted Health, an all-encompassing health care service for the elderly, emphasized that improving patient care in the U.S. isn’t just about better policies. The private sector has a role to play in thinking outside the health care box.

Between 30-40 percent of an individual’s health status is determined by non-medical factors like their level of education, where they live and how much money they make. To help address that, Park said Devoted Health’s insurance policy gives members a “Food and Home Card” to spend on healthy food or other non-health services like utilities or rent.

The evidence is clear, said Park, who served as CTO of the U.S. Department of Health and Human Services under President Barack Obama. “If someone has healthy food, can afford air conditioning, electricity or heat and has a stable home, they’re going to be a hell of a lot healthier than if they don’t.”