title: U.S. health care: a conundrum and a challenge.
abstract: BACKGROUND
  This report was conceived as a contribution to the national debate regarding U.S. health care (HC) and as a means of explaining the challenges facing U.S. HC to the international readers of WORLD NEUROSURGERY.
  
  
  METHODS
  The basic economic concepts pertinent to health care, including fundamentals of economic theories, gross domestic product (GDP), U.S. revenues and expenditures and the U.S. federal deficit and national debt, are discussed at the outset of this study. This is followed by a review of the U.S. health insurance paradigms and a detailed analysis of the escalating cost of U.S. health care. Finally, the efforts designed to reverse the paradigm of escalating health care costs will be discussed.
  
  
  RESULTS
  This study reveals that should the U.S. HC cost continue to escalate at the same rate, HC would consume the entire gross domestic product by 2070. The root causes for this trend are overutilization of HC, inappropriate allocation of HC costs at the end of life, defensive medicine, high-end technology and prescription drugs, failure of competitive market forces, and administrative costs, inefficiency, and waste. The proposed means of reversing this paradigm, including the Patient Protection and Affordable Care Act, are discussed in light of their economic and social impact.
  
  
  CONCLUSIONS
  The reversal of the current paradigm of escalating cost of U.S. HC will require extraordinary leadership across the entire spectrum of HC delivery. It is concluded that neither the Affordable Care Act nor the Path to Prosperity will succeed unless the escalating cost of U.S. HC is reversed. It is hoped that this report contributes to that end.
authors.affiliation: Department of Neurosurgery, NorthShore University HealthSystem, Evanston, Illinois, USA. Electronic address: iciric@northshore.org.
authors.forename: Ivan S
authors.initials: IS
authors.lastname: Ciric
mesh_terms: D000367:Age Factors; D003695:Delivery of Health Care / Q000191:economics / Q000706:statistics & numerical data* / Q000639:trends*; D016527:Drug Costs; D004465:Economic Competition; D004467:Economics; D059066:Gross Domestic Product; D017048:Health Care Costs / Q000706:statistics & numerical data / Q000639:trends; D005102:Health Expenditures / Q000706:statistics & numerical data; D006295:Health Resources; D006801:Humans; D016365:Liability, Legal; D009310:National Health Insurance, United States; D058991:Patient Protection and Affordable Care Act; D010686:Philosophy, Medical; D014481:United States
keywords: ACA; Affordable Care Act; Escalating cost; GDP; Gross domestic product; Health care; MRI; Magnetic resonance imaging; Opposing views; Patient Protection and Affordable Care Act; Root causes; U.S.; United States; United States of America