EEA Presidential Address: The Past, Present and Future of Health Care Reform

Abstract

The starting point for my speech is the explosive growth in the field of health economics. In 1990, the American Economic Review published just two articles in health economics; now it publishes about five per year. In the American Economic Journal: Economic Policy and American Economic Journal: Applied Economics, major new general-interest journals in health economics, about one in eight articles published in 2017 was in health economics. And what has made health economics so fascinating is that its impact was felt not just in the scholarly world but also in the policy world as well, most notably through the Affordable Care Act (ACA) in 2010. One of the most frustrating aspects of being a health economist is that expectations for health care suffer from extreme black and white thinking. Is the ACA a failure or a success? Are health care costs under control or not under control? Is health care reform over or still going? The answer to all of these is yes! When you have a sector that is 18% of the US economy, there are never simple yes and no answers. And in particular, one of the most frustrating aspects of working on health care reform is the idea that we have ever “done” health care reform. Health care reform is not a single battle; it is an ongoing war that will never be fully resolved. So when thinking about health care reform, it is important to understand where we have been, where we are, and where we need to go next – and that’s what I’ll try to cover in this lecture.