INDEX

NOTE: Page numbers in italics refer to figures and tables. Note information is indicated by n and note number following the page reference.

• Aaron, Henry, 32
• ACA (Affordable Care Act). See Obamacare
• actuarially fair insurance premiums: ethical perspective on, 85, 88–92, 89–90, 93, 95, 96–97, 97; reform proposals on, 111, 132, 135–37
• administrative overhead: Congress as driver of, 38–40; drug-related, 32–38, 33–36; growth of administrative workforce, 27–28, 28; health care costs driven by, 16, 23–40; health care providers and hospitals incurring, 29–30, 30; insurance-related, 23–26, 25–26, 28–30; medical underwriting raising, 91; patients incurring, 30, 30–32; reduction of, 158, 164–65; value chain and, 26–27, 26–27
• adverse risk selection, 97, 97, 125, 133
• Affordable Care Act (ACA). See Obamacare
• aging population: health care costs among, 17–21, 18–20; insurance for, 25, 45, 46 (see also Medicare); reform proposals’ effects on, 110–11, 113, 114, 123, 124, 128–29, 131
• AHCA. See American Health Care Act
• AHIP (American Health Insurance Plans) data, 28–29, 53, 54–56
• Alexander, Lamar, 142
• all-payer systems, 50–51, 158–60
• Altman, Drew, 118, 144–45
• American Health Care Act (AHCA): actuarially fair insurance premiums under, 111; CBO analysis of, 83, 112, 113, 114, 115, 116, 130; community-rated insurance premiums under, 111; essential health benefits under, 111; ethical perspectives on, 83, 95, 110–17, 112, 114, 116–17; insurance premiums under, 95, 110–17; job creation or depletion under, 58; Medicaid changes under, 112, 116, 130; summary of, 110; tax changes under, 110–11, 112–13, 114, 116–17, 130; waivers under, 111
• American Health Insurance Plans (AHIP) data, 28–29, 53, 54–56
• Arrow, Kenneth, 77
• Australia: demographics of, 21; health care costs in, 2, 14, 15, 17; health care prices in, 23–24; health status indicators in, 72; self-rationing of health care in, 71
• Austria: health care costs in, 14

• BCRA. See Better Care Reconciliation Act
• Belgium: social health insurance system in, 93
• Better Care Reconciliation Act (BCRA): actuarially fair premiums under, 132; administrative overhead under, 29; CBO analysis of, 83, 122, 125–27, 126, 128–30; community-rated premiums under, 121–22, 124–25; Cruz Amendment to, 132–33; ethical perspectives on, 83, 95, 118–34, 120, 123, 126, 128–30; insurance premiums under, 95, 118–34, 123; job creation or depletion under, 58; mandated coverage under, 121, 124–25; Medicaid changes under, 118–21, 127, 130; out-of-pocket expense percentages under, 122, 123, 124; subsidized individuals under, 121, 124, 125, 128–29, 131; tax changes under, 121, 124, 125, 128–30, 131; waivers under, 124, 185n26
• Bismarck, Otto von, 93, 140
• Bismarckian model, 93
• boutique medicine, 25, 45, 164
• Brill, Steven, 49
• Brooks, David, 40, 131
• Brooks, Mo, 94

• Canada: administrative overhead in, 30; demographics of, 21; health care costs in, 2, 14, 15, 17, 30; health status indicators in, 72, 75; private insurance in, 81–82; self-rationing of health care in, 71; single-payer system in, 30, 63–64, 81, 154–55, 179n1; social health insurance system in, 30, 63–64, 65, 81–82, 154–55, 179n1; social role of health care in, 81, 82; timeliness of services in, 70; value for health care spending in, 70, 71, 72, 75, 77
• cancer, 74–75, 75
• Cassidy, Bill, 101
• CBO. See Congressional Budget Office
• Centers for Disease Control and Prevention (CDC): obesity and diabetes metrics, 72, 73
• Centers for Medicare and Medicaid Services (CMS): drug payment proposal by, 38; health spending data, 14, 146, 175n1; Innovation Center of, 14, 160. See also Medicaid; Medicare
• Cheng, Tsung-Mei, 111, 139
• children and adolescents. See younger population
• China: demographics of, 21. See also Taiwan
• citizen engagement, in health care, 142–43
• CMS. See Centers for Medicare and Medicaid Services
• coinsurance, 37, 52, 70, 103, 122, 131, 145
• community-rated insurance premiums: ethical perspective on, 85, 91–95, 97–98, 97; income redistribution via, 45, 46; under Obamacare, 46, 86, 92, 93, 108, 109; reform proposals on, 111, 121–22, 124–25, 135–37
• Congress: as administrative overhead driver, 38–40; insurance for, 8, 46; reform proposals of (see reform proposals)
• Congressional Budget Office (CBO): on real GDP, 5, 6, 146; reform proposal analysis by, 83, 101, 112, 113, 114, 115, 116, 122, 125–27, 126, 128–30, 151
• Consumer Price Index for All Urban Consumers (CPI-U): health care cost growth relative to, 8, 119–20, 120; Medicaid constraints based on, 7–8, 119–21
• Cooper, Zachary, 47
• costs of health care. See health care costs; prices
• CPI-U. See Consumer Price Index for All Urban Consumers
• Cruz, Ted, 132
• Cruz Amendment, 132–33

• deductibles, insurance, 52, 70, 103, 122, 131, 145
• demographics: health care costs effects of, 17–21, 18–20; insurance availability based on, 24–25, 25
• Denmark: health care costs in, 2, 14, 15, 17
• diabetes, 71–72, 73
• doctors. See health care providers and hospitals
• Douthat, Ross, 131
• drugs: distribution system, 32–38, 35–36; income distribution and ability to pay for, 44; prices of, 21, 22, 32–38, 33–34, 36, 145, 150; rebates on, 37

• economic perspectives: on commercial health insurance, 85–98; GDP figures (see gross domestic product); on health care costs (see health care costs; prices); on income distribution (see income distribution); on Medicaid and Medicare, 3–9, 5, 6, 8, 66, 175n10, 175n12; per capita figures (see per capita figures); on prices (see prices)
• elderly adults. See aging population
• employment: growth of health care workforce, 27–28, 28; health care job creation or depletion, 57–59, 58; insurance provided via, 25, 25–26, 37, 42, 62, 66–68, 93, 157, 165
• ethical perspectives: on commercial health insurance, 85–98; distributive social ethics, 1, 81–84, 151; on Obamacare, 102–9; on reform proposals, 9, 81–84, 95, 99–101, 110–34, 139–67; social good perspective, 100–101, 102; on social role of health care, 81–84, 82

• Flack, Roberta, 120
• Flexible Spending Accounts (FSAs), 39, 177n24
• Frakt, Austin, 60
• France: health care costs in, 2, 14, 15, 17; health care prices in, 50–51; health status indicators in, 72, 75, 76; self-rationing of health care in, 71; social health insurance system in, 93; value for health care spending in, 71, 72, 75, 76, 77
• FSAs (Flexible Spending Accounts), 39, 177n24

• Gaba, Charles, 105
• GDP. See gross domestic product
• Germany: administrative overhead in, 30, 31–32; all-payer system in, 159; demographics of, 19; health care costs in, 2, 14, 15, 17, 19, 30, 31–32; health care prices in, 50–51, 159; health status indicators in, 75, 76; private insurance in, 81, 156, 181n2; risk-adjustment mechanisms in, 156; self-rationing of health care in, 71; social health insurance system in, 65, 81, 93, 139–40, 144, 155, 156, 159, 181n2; social role of health care in, 81; value for health care spending in, 71, 75, 76, 77
• Goethe, Johann Wolfgang von, 139, 143–44
• Gorman, Linda, 111
• Graham, Lindsey, 101
• gross domestic product (GDP): growth of real, 5, 6; health care costs as percentage of, 3, 13, 14, 14, 60–61, 146, 159; health care costs growth exceeding growth of, 146; Medicare costs as percentage of, 4–5, 6; per capita, and ability to pay, 16, 17; personal income vs., 61

• health care: boutique, 25, 45, 164; citizen engagement in, 142–43; costs of (see health care costs; prices); curious facts about U.S., 47–61; economic perspectives on (see economic perspectives); ethical perspectives on (see ethical perspectives); income in relation to (see income distribution); insurance for (see insurance); job creation or depletion, 57–59, 58; multi-tiered system, 162–64, 166–67; payers of (see payers); pre-Obamacare status of, 161–62; providers of (see health care providers and hospitals); reform (see reform proposals); as social good, 100–101, 102; social role of, 81–84, 82; as tax system, 59–61, 61, 69; transformation of, 162–66
• health care costs: ability to pay for, 16, 17, 43–44, 110, 125, 131, 149–50, 177n1; administrative overhead, 16, 23–40, 91, 158, 164–65; concentration of spending on, 86–87, 87, 148; control of, 158–60; demographic structure affecting, 17–21, 18–20; drivers of high, 15–40, 145, 158, 164–65; as GDP percentage, 3, 13, 14, 14, 60–61, 146, 159; growth of, 1, 2, 8, 13, 146–47; high prices driving, 21–23, 22–24, 30, 32–38, 33–34, 36, 145; insurance coverage of (see insurance); international comparisons, 2, 14, 14–15, 15, 175n1; of Medicaid, 3–4, 6–9, 8; medical bills for (see medical bills); of Medicare, 3–6, 5, 6; Milliman Medical Index of, 41–43, 42; payers of (see payers); per capita, 4, 5, 7, 8, 14–15, 17, 17–19, 18–19, 23, 30, 31, 42, 119–21, 120; value for spending on, 69–77; waste from excess, 76–77, 77
• health care providers and hospitals: administrative overhead of, 29–30, 30; growth of workforce, 27–28, 28; prices of, 21–22, 23, 23–24, 30, 45, 46, 47–53, 48–49, 51, 60, 150–51, 158–60, 161–62, 163; shortage of, 150; surprise bills from out-of-network, 53, 54–56, 60, 61; in value chain, 26–27, 26–27
• Health Datapalooza, 165
• health information technology (HIT), 24, 165
• Health Savings Accounts (HSAs), 39
• health status indicators: for cancer, 74–75, 75; concentration of health care spending reflecting, 86–87, 87, 148; insurance premiums based on, 85, 88–92, 89–90, 93, 95–97, 97, 111, 132, 135–37; life expectancy as, 73–74, 74, 180n9; for mortality amenable to health care, 75, 76; for obesity and diabetes, 71–72, 72–73; personal vs. social responsibility for, 94–95; preexisting conditions, 95–96; value of health care and, 70–75, 72–76
• HIT (health information technology), 24, 165
• Hlatshwayo, Sandile, 57
• Hogan, Larry, 160
• hospitals. See health care providers and hospitals
• H.R. 1628: House of Representatives draft (see American Health Care Act); Senate draft (see Better Care Reconciliation Act)
• HSAs (Health Savings Accounts), 39

• income distribution: ability to pay for health care and, 16, 17, 43–44, 110, 125, 131, 149–51, 177n1; health care prices and, 22–23, 45, 46; health care rationed by, 2, 4, 45, 70, 71, 100–101, 110, 125, 131, 148, 149–51; healthy policy choices reflecting, 44–46; inequality of, 1–2, 3, 6, 43–44, 43–46; insurance availability and, 24–25, 25; insurance premiums and, 45, 46, 87–98, 102–9, 110–34; Medicaid eligibility and (see Medicaid); multi-tiered health care system reflecting, 162–64, 166–67; Obamacare applicability by, 102–9; redistribution options, 44, 45–46, 92, 131; statistics on U.S. wealth and, 43–44, 43–44, 177n1
• Institute of Medicine study, 73, 75, 76, 77, 164
• insurance: actuarially fair premiums for, 85, 88–92, 89–90, 93, 95, 97–99, 97, 111, 132, 135–37; administrative overhead of, 23–26, 25–26, 28–30; adverse risk selection for, 97, 97, 125, 133; coinsurance with, 37, 52, 70, 103, 122, 131, 145; community-rated premiums for, 45, 46, 85, 91–95, 96–98, 97, 108, 109, 111, 121–22, 135–37; death spiral of, 98, 104, 125, 133; deductibles, 52, 70, 103, 122, 131, 145; demographics of coverage, 24–25, 25; economic perspectives on, 85–98; employment-based, 25, 25–26, 37, 42, 62, 66–68, 93, 157, 165; ethical perspectives on, 85–98 (see also under Obamacare; reform proposals); mandates for, 85, 98, 104, 109, 125, 135, 149, 182n7; medically underwritten premiums for, 85, 88–92, 89–90, 93, 95, 96–97, 97, 111, 132, 135–37; Obamacare regulation of (see Obamacare); out-of-network lack of coverage, 53, 54–56; as payers for health care, 62–68, 63, 64; for preexisting conditions, 95–96, 162; prices paid by, 48, 48, 49–50, 158–60, 161–62; prices paid for, 45, 46, 85, 87–98, 102–9, 110–34; private, 4, 5, 23–26, 25–26, 28–29, 37, 42–43, 48, 48, 49–50, 62, 66–68, 81–82, 85–98, 155–58, 181nn2–3; reform proposals on (see reform proposals); risk pools, 87–92, 89–90, 95–96, 132–33, 148, 156–57; social (see Medicaid; Medicare; social insurance); tax credits for, 110–11, 113, 114, 116–17, 121, 128–30; tax-financed subsidies for, 39–40, 67–68, 102–3, 105, 106–8, 107, 109, 121, 124, 125, 128–29, 131, 176n21, 179–80n7, 183n9; in value chain, 26, 26
• international comparisons of health care costs, 2, 14, 14–15, 15, 175n1. See also specific countries
• International Federation of Health Plans, price comparisons, 21, 22–24, 37, 160
• Italy: health care costs in, 14; health status indicators in, 72, 75

• Japan: administrative overhead in, 30; all-payer system in, 159; demographics of, 18–19, 19, 21; health care costs in, 2, 14, 15, 17, 18–19, 19, 30; health status indicators in, 75; social health insurance system in, 65, 93, 159; value for health care spending in, 75, 77

• Kaiser Family Foundation, 7, 31, 73, 84, 102, 110, 113, 115, 118, 144
• Kimmel, Jimmy, 94
• Klein, Ezra, 153
• Kliff, Sarah, 52
• Kocher, Robert, 27–28
• Korea: administrative overhead in, 30; demographics of, 19, 21; health care costs in, 14, 15, 17, 19, 30; health status indicators in, 72; single-payer system in, 63; social health insurance system in, 63, 65

• Libertarians, reform proposal suiting, 135–37
• life expectancy, 73–74, 74, 180n9
• Luxembourg: health care costs in, 19

• maternity and neo-natal care, 111–12
• McDermott, Jim, 155–57
• McKinsey Global Institute study, 21, 27, 31
• Medicaid: demographics of coverage, 25; economic sustainability of, 3–4, 6–9, 8, 66, 175n10, 175n12; financing of, 175n12; as payer for health care, 63, 161–62; prices paid by, 161–62; reform proposals changes to, 112, 116, 118–21, 127, 130, 137, 184n18; taxes and transfers for, 45
• medical bills: administrative overhead and, 16, 29, 31; billing clerks for, 29; billing consultants for, 31; lack of price transparency on, 52–53, 60; surprise, 53, 54–56, 60, 61
• medically underwritten insurance premiums: ethical perspective on, 85, 88–92, 89–90, 93, 95, 96–97, 97; reform proposals on, 111, 132, 135–37
• Medicare: community-rated premiums under, 93; demographics of coverage, 25; drug costs for, 37–38; economic sustainability of, 3–6, 5, 6, 66; Medicare Advantage program, 64–65, 93; Medicare-for-all system, 152–58; as payer for health care, 62, 63–66, 152–58; prices paid by, 37–38, 48, 50, 158, 160, 175n10; taxes and transfers for, 45
• Medicare Payment Advisory Commission (Medpac), 4, 38
• Medicare Prescription Drug, Improvement, and Modernization Act (2003), 64
• medications. See drugs
• Medpac (Medicare Payment Advisory Commission), 4, 38
• mental health care, 111
• Mexico: health status indicators in, 72
• Meyer, Harris, 152
• military health care, 45, 63. See also Veterans Administration (VA) health care
• Milliman Medical Index, 41–43, 42
• mortality amenable to health care, 75, 76
• Mulligan, Casey B., 57
• Mulvaney, Mick, 94

• National Academy of Medicine (formerly Institute of Medicine) study, 73, 75, 76, 77
• Netherlands: health care costs in, 2, 14; risk-adjustment mechanisms in, 156; self-rationing of health care in, 71; social health insurance system in, 93, 155, 156
• Neuman, Alfred E., 57
• New Zealand: health care costs in, 2; health care prices in, 23–24; health status indicators in, 71, 72; self-rationing of health care in, 71
• Norway: demographics of, 19; health care costs in, 2, 14, 19; self-rationing of health care in, 71

• Obamacare: administrative overhead under, 28–29; common misconceptions about, 147–48; community-rated insurance premiums under, 46, 85, 92, 93, 108, 109; debate on repealing and replacing, 83, 100, 147 (see also reform proposals); deductibles and coinsurance under, 145; ethical perspectives on, 102–9; fixing, 109; job creation or depletion under, 57–58; mandates for insurance under, 85–86, 98, 104, 109, 149; middle class neglected in, 104–5, 105; penalties for noncoverage under, 104, 108, 109; poor population provisions of, 102–4; pre-implementation status of health care, 161–62; subsidized individuals under, 67–68, 102–3, 105, 106–8, 107, 109, 183n9; summary of, 102; tax-financed subsidies under, 67–68, 102–3, 105, 106–8, 107, 109, 183n9; unsubsidized individuals under, 103–4, 105, 108–9; waivers under, 185n26
• obesity and overweight, 71–72, 72–73
• older adults. See aging population
• Organizations for Economic Cooperation and Development (OECD) countries: demographics of, 18–19, 19; health care spending in, 13–15, 14, 15, 17, 18–19, 19, 175n1. See also specific countries
• overhead costs. See administrative overhead

• patients: administrative overhead incurred by, 30, 30–32; in value chain, 26
• Pauly, Mark, 21
• payers: all-payer systems, 50–51, 158–60; identifying, 62–68, 63, 64; price variations depending on, 47–51, 48–49, 51, 60, 158, 161–62, 175n10; single-payer systems, 30, 63–65, 81, 152–55, 179n1; with socialized medicine, 65–66
• per capita figures: administrative overhead, 23, 30, 31; GDP, and ability to pay, 16, 17; health care spending, 4, 5, 7, 8, 14–15, 17, 17–19, 18–19, 23, 30, 31, 42, 119–21, 120; Medicaid, 8, 119–21; Medicare vs. private health insurance, 4–5, 5; real GDP growth, 5, 6
• Peterson Institute, 73
• pharmaceuticals. See drugs
• physicians. See health care providers and hospitals
• preexisting conditions, 95–96, 162
• prices: discriminatory, for income redistribution, 45, 46; health care costs driven by, 21–23, 22–24, 30, 32–38, 33–34, 36, 145; for insurance premiums, 45, 46, 85, 87–98, 102–9, 110–34; lack of transparency, 51–53, 60, 158, 160; reference, 148, 150–51, 163; uniform, 23–24, 45, 50–51, 64, 158–60; variations and differentials in, 47–51, 48–49, 51, 60, 158, 161–62, 175n10. See also health care costs
• public health insurance. See social insurance

• rebates, drug, 37
• reference pricing, 148, 150–51, 163
• reform proposals: administrative overhead increases with, 29, 38–40; American Health Care Act as, 58, 83, 95, 110–17, 112, 114, 116–17, 130; author’s recommendations for, 135–37, 141–67; Better Care Reconciliation Act as, 29, 58, 83, 95, 118–34, 120, 123, 126, 128–30, 185n26; CBO analysis of, 83, 101, 112, 113, 114, 115, 116, 122, 125–27, 126, 128–30, 151; comparisons of, 83–84; complexity of system as challenge for, 24–25; Cruz Amendment to, 132–33; demise of, 133–34; for drug distribution, 38; employment effects of, 57–58; ethical perspectives on, 9, 81–84, 95, 99–101, 110–34, 139–67; future prospects for, 151–52; insurance premiums in, 95, 110–34; Medicaid under, 112, 116, 118–21, 127, 130, 137, 184n18; on social role of health care, 81–84; tax changes under, 67, 110–11, 112–13, 114, 116–17, 121, 124, 125, 128–30, 131, 148, 186n3; uninsured population under, 101, 112, 125–26, 126, 135–37. See also Obamacare
• Reinhardt, Uwe: education of, 140–41; health care for, 139–40, 144; professional standing of, 141, 143–44; reform recommendations of, 135–37, 141–67
• risk: adverse risk selection, 97, 97, 125, 133; risk-adjustment mechanisms, 156–57; risk corridors, 148; risk pools, 87–92, 89–90, 95–96, 132–33, 148, 156–57
• Rosenthal, Elisabeth, 31, 49
• Roy, Avik, 111, 115, 131

• Sanders, Bernie, 152
• Scott, Dylan, 131
• Shimkus, John, 111
• single-payer systems, 30, 63–65, 81, 152–55, 179n1
• social good perspective, 100–101, 102
• social insurance: administrative overhead of, 23–26, 29; demographics of coverage, 25; as payer for health care, 62, 63–66, 152–58; private insurance industry impacts from, 155–58; public option for, 155–58; social role of health care and, 81–82; universal health coverage through, 144–45, 148–49, 155, 164; in value chain, 26, 26. See also Medicaid; Medicare
• socialized medicine, 65–66
• social role of health care, 81–84, 82
• South Africa: health care prices in, 22–24
• Spain: health care costs in, 14; health care prices in, 22–24; health status indicators in, 72
• Spence, Michael, 57
• Starr, Paul, 135
• substance abuse services, 111
• Sweden: health care costs in, 2, 14, 15; self-rationing of health care in, 71
• Switzerland: all-payer system in, 159; demographics of, 19; health care costs in, 2, 14, 14–15, 15, 17, 19; health care prices in, 22–24, 50–51, 159; health status indicators in, 72; risk-adjustment mechanisms in, 156; self-rationing of health care in, 71; social health insurance system in, 93, 155, 156, 159

• Taiwan: administrative overhead in, 30; demographics of, 21; health care costs in, 17, 30; single-payer system in, 63, 81, 152; social health insurance system in, 63, 65, 81, 152; social role of health care in, 81
• taxes: health system as tax system, 59–61, 61, 69; income redistribution via, 45–46; reform proposals on, 67, 110–11, 112–13, 114, 116–17, 121, 124, 125, 128–30, 131, 148, 186n3; social insurance paid via, 62; tax credits, 110–11, 113, 114, 116–17, 121, 128–30; tax-financed subsidies, 39–40, 67–68, 102–3, 105, 106–8, 107, 109, 121, 124, 125, 128–29, 131, 179–80n7, 183n9, 186n3
• technology, 24, 165
• Tobin, James, 141
• Tricare, 45, 63
• Trump administration: on health care reform proposals, 94, 101, 115, 147; Medicaid spending proposal of, 7; on Obamacare, 108, 147; on pharmaceutical industry, 32; pressing health care issues facing, 145

• UHC (universal health coverage), 3, 139, 144–45, 148–49, 155, 164
• undocumented aliens, 162
• uninsured population: demographics of coverage, 25; growth of, 149; income distribution among, 1; insurance availability for, 162; multi-tiered health care coverage of, 166–67; Obamacare effects on, 103, 109, 149; Obamacare penalties for noncoverage, 104, 108, 109; pressing health care issues including, 145; prices paid by, 48, 49; reform proposals’ effects on, 101, 112, 125–26, 126, 135–37; self-rationing of health care among, 70, 71, 150
• United Hospital Fund of New York study, 33
• United Kingdom: demographics of, 19; health care costs in, 2, 14, 15, 17, 19; health care prices in, 22–24; health status indicators in, 71, 72, 75, 76; self-rationing of health care in, 71; socialized medicine in, 65; timeliness of services in, 70; value for health care spending in, 70, 71, 71, 72, 75, 76, 77
• United States: demographics of, 17–21, 18–20, 24–25, 25; GDP of (see gross domestic product); health care in (see health care; health care costs)
• universal health coverage (UHC), 3, 139, 144–45, 148–49, 155, 164

• value: administrative overhead and, 26–27, 26–27; for health care spending, 69–77; health status indicators and, 70–75, 72–76; self-rationing of care diluting, 70, 71; value gap, 77; waste in health system depleting, 76–77, 77
• Veterans Administration (VA) health care: as payer for health care, 63, 65–66; as socialized medicine, 65–66; taxes and transfers for, 46

• waste in health system, 76–77, 77
• wealth and income statistics, 43–44, 43–44, 177n1. See also income distribution

• younger population: health care costs among, 17–18, 18; insurance for, 25, 45, 97, 104, 106, 156; reform proposals’ effects on, 111, 123, 124, 125–26, 126, 128–29, 131