To the Editor: Drs Emanuel and Fuchs1 overlooked a major element contributing to the high cost-benefit ratio of the US health care system: government regulation. Given a system that must deal with such things as ERISA, EMTALA, HIPAA, Sarbanes-Oxley, the FDA and DEA, state health departments, licensing agencies, the Joint Commission, and many others, this needs to be factored into the cost structure. A 2005 analysis concluded that there was a regulatory cost of $3000 to $4000 per health care employee.2
Pilcher CA. Health Care Overutilization in the United States. JAMA. 2008;300(19):2250–2251. doi:10.1001/jama.2008.604
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