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Fortress and Frontier in American Health Care

America’s health care policy debate has long been framed as Left versus Right, Democrat versus Republican, federal versus state, and public versus private. This paper offers an alternative demarcation: Fortress versus Frontier.

Health care is mostly in the Fortress, meaning that public policy focuses on protecting patients from risks and providers from competitors. Information technology (IT) is mostly on the Frontier, meaning that all Americans—even industry outsiders like Steve Jobs and Mark Zuckerberg—have been free to experiment and innovate with computers, telecommunications, and the Internet despite enormous risks to personal finances, privacy, safety, health, and well-being. The Fortress discourages creative destruction and disruptive innovation, and the Frontier tolerates both. Health care provision and innovation generally require official sanction; meanwhile, costs have risen. IT innovators have not needed permission to create and have thus been able to tap into serendipitous genius; the result has been plummeting costs.

Written by health care economist Robert F. Graboyes, this paper suggests some potential policy actions to shift health care from Fortress to Frontier—and toward a goal of producing better health for more people at lower cost on a continuous basis.

About the Author

Robert F. Graboyes is a senior research fellow for the Mercatus Center at George Mason University. He specializes in the economics of health care and teaches in master’s and doctoral programs at Virginia Commonwealth University and the University of Virginia. He has also taught at George Mason University, the George Washington University, and the University of Richmond. Previously, he was a sub-Saharan Africa economist at Chase Manhattan Bank and, in that capacity, traveled extensively in Africa and Europe. He has also served as a regional economist at the Federal Reserve Bank of Richmond and twice visited the Republic of Kazakhstan as a health care scholar. Graboyes earned his PhD in economics from Columbia University.

Author: Robert F. Graboyes

Edition: 1

Binding: Kindle Edition

Manufacturer: Mercatus Center at George Mason University

Number of pages: 84

Product group: eBooks

Studio: Mercatus Center at George Mason University

Publication Date: 2015-07-14

Publisher: Mercatus Center at George Mason University

Pages: 84

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Robert Graboyes
Robert Graboyes is a senior research fellow and healthcare scholar with the Mercatus Center at George Mason University and is the author of the study “Fortress and Frontier in American Health Care.” He earned his PhD in economics from Columbia University. An award-winning teacher, Graboyes holds teaching positions at Virginia Commonwealth University and the University of Virginia.