Relocalizing Health

Out-of-control health care spending exacts an enormous and growing toll on Americans.

As of 2020, the health care system in the United States consumes a full fifth of the American economy. It has become a machine that does not improve health, but proves perfectly attuned to extracting money. Every year, more than any other factor, health care bankrupts Americans, even though 70% of them have insurance. It sucks so much money out of cities, towns and communities that public education, policing and social services have atrophied in many places across America. 

Almost by accident, a system of employer-provided health insurance resides at the heart of US health care problems today. This uniquely US model blinds workers to the real costs of health care, and creates a perverse incentive that discourages preventive and chronic care while rewarding far more expensive acute and reactive care.

For workers, health care costs have caused wages to decline or remain stagnant in real terms for decades. Spiraling health spending consume funds employers might use to improve worker benefits and salaries, and to help fund community initiatives – as many once...