Reducing U.S. health care spending: is it realistic or even desirable?

Many people believe that U.S. health care spending (16.3 percent of gross domestic product) and especially the health care spending growth rate (6.7 percent) are unsustainable by our economy and must be reduced. Its tremendous cost, along with indisputable quality and other problems, has led to the judgment that our health care system is in crisis. Performance improvement initiatives and public policy changes, it is hoped, will result in a "high-performance" health care system that simultaneously improves quality and reduces cost. The assumptions (1) that it is necessary and desirable to reduce U.S. health care spending and (2) that current performance improvement initiatives or politically and socially acceptable alternatives can successfully reduce expenditures are explored.

Current relevant health care economics and health care policy literature and position articles were reviewed.

Initiatives to improve health care quality, access, efficiency, and efficacy are needed. Although health care expenditure reductions may be achieved by optimizing performance, significant and sustainable reductions in aggregate health care spending and spending growth rate are unlikely and may not be desirable.

The economic and societal benefits associated with health care spending are underappreciated and must be recognized. Politicians, business leaders, and taxpayers should accept the reality that even if an efficient high-performance health care system is actually achieved in the United States, a major reduction in spending growth is unlikely unless Americans accept currently unacceptable restrictions and limitations in access to technology and services.