Health care reform: identifying some cost culprits

In terms of both total cost and fraction of the gross national product, the cost of health care in the United States is considerably greater than anywhere else in the world. The reasons for the excessively high cost are complex and include issues of administration, issues of quality, and issues peculiar to American culture. Some contributing factors are the demographics of the population, the cost of defensive medicine and litigation, costly regulation, extensive application of technology in response to public demand and expectations, and finally, waste and abuse of the system. Control of costs cannot realistically be achieved by simply changing the way we finance health care, but will require changing the economic incentives for both providers and patients. Reforming the system will necessarily include compromising some of our expectations about health care, changing unhealthy lifestyles, and more realistically analyzing the costs of litigation and regulations.