Why does health care cost so much?

Some of the things that drive health care spending in the United States include our fractured health care delivery system, and the pace of technological change and the kind of new technologies that we're able to use in our health care system because we have so many providers and hospitals and other ways to get health care, and we have so many different organizations paying for health care, that you get a lot of lack of coordination and different kind of behaviors that increase cost. But one of the other things that really drives health care spending in the United States is how healthy Americans are, and the high degree of chronic illness that we have, the increasing rates of obesity. We have other factors that drive our need for health care services.

What is "affordable" health care?

Well I think the best way to understand what is affordable health care is to look at a family and what their income and resources are and how much they're spending overall for health care. So between the premiums that they pay, or the share of the share of their premiums that they pay if their employers pay part of it, and how much they pay in cost-sharing, and the kind of deductibles and co-payments that they have to pay, and then just what they have to pay out of pocket for uncovered services, and how that relates to their income. One of the thresholds that a lot of people use is if families are spending more than 10 percent of their income on health care, then that's really unaffordable. I think that's one of the best ways to look at whether health care is affordable or not.

What steps can we take to make health care more affordable?

I think the major ways of improving value in health care and making health care more affordable are first to use the market power of large groups to pool people into purchasing pools and give everybody greater leverage against the insurance companies, and finding good coverage at a good price. I think another important thing is to provide the kind of subsidies that people need in order to provide insurance so that related to income, they're not paying more than is affordable for their total spending in health care. And then another thing is to work on improving the value of what we get for our health care dollar. So, understanding what kinds of drugs and treatments and devices work best. And using health information technology to reduce not only administrative costs, which is certainly one thing that it will do, but to improve quality of care so that all the physicians you see understand what drugs you are getting, what your condition is, what king of treatments you've had, so that within a hospital that information is shared and labs are shared, and all of that kind of information, as well, so that your care is best coordinated. And then I think also improving how we provide care and coordinate care for people with chronic illness so that instead of the patient being so responsible for ensuring that kind of communication between all of their providers, so that we have a more cohesive, centered on the patient, but with all of the providers working together, as well, to best coordinate care for people with diseases like asthma, or diabetes, or depression, or any of the other chronic diseases that really affect people's lives.