On January 8, 2008, the New York Times captioned a major article: "Health Spending Exceeded Record $2 Trillion in 2006". It observed that health care spending nearly doubled in the last decade, amounting to an average of $7,000 a person. The Times reported that health spending accounts for 16% of "the total amount of good (sic) and services". Paradoxically, health spending by businesses showed the slowest rate of increase since 1997 - 5.7% in 2006, which could be accounted for by employers shuffling off payments for private health insurance (i.e., prescription benefits) to Medicare which provided a new drug benefit. So where were the significant increases? Predictably retail spending on prescription drugs increased by 8.7% to $216.7 billion (related to the Medicare Part D program). But administrative costs "increased more than twice as fast" while spending on hospitals, doctors and nursing homes deaccelerated.

Health care is very big business (and a major employer) in the United States and before anyone tries to make a dramatic change in the structure or payment system of health care by political fiat, we all have to understand that a hiccup in health care will have a major economic impact on the country. That "hiccup" may cause "dislocations" which is an economist's way of describing bankruptcies, job loss and business disruption.

One consideration is that health care costs can be viewed on a global scale. Another is that those who can't afford to buy insurance and pay health care bills are often not the poorest, who receive help from Medicare and Medicaid, but those in the lower middle class and those who operate marginally profitable businesses. Why don't we tie these concepts together by recognizing that when we purchase goods and services from countries which do not invest in health care for their citizens (or when we allow our businesses to 'offshore' production to those countries), and insist that our citizens and employers provide insurance and pay health care costs for Americans, we are creating two problems. We are importing low cost goods and services and losing American jobs through unfair competition and we are subsiding foreign governments and businesses which refuse to provide a real system of health care for their own people because then they would have to compete on an equal playing field with American business and labor.

Why don't we consider constructing a health care cost index of per capita spending for the countries we trade with. Those countries that are significantly lower in the index than we are, should pay an import "health" premium (a tax on each imported item from that country) to be used to offset the cost of health care for Americans. That levels the playing field and reduces the unfair competitive advantage that some countries now enjoy. And when those countries spend more on their own citizens' health, they can benefit from a higher relative index and a lower health care "tax". We can provide an incentive to improve global health, give American businesses the opportunity to compete fairly, provide health care to the 47 million uninsured in America, and perhaps create some jobs at the same time.