Healthcare_NN1 Costs_NN2 and_CC U.S._NP1 Competitiveness_NN1 Introduction_NN1 The_AT United_NP1 States_NP1 spends_VVZ an_AT1 estimated_JJ $2_NNU trillion_NNO annually_RR on_II healthcare_NN1 expenses_NN2 ,_, more_RRR than_CSN any_DD other_JJ industrialized_JJ country_NN1 ._. 
According_II21 to_II22 data_NN from_II the_AT Organization_NN1 for_IF Economic_JJ Cooperation_NN1 and_CC Development_NN1 (_( OECD_NP1 )_) ,_, the_AT United_NP1 States_NP1 spends_VVZ two-and-a-half_MF times_NNT2 more_RRR than_CSN the_AT OECD_NP1 average_NN1 ,_, and_CC yet_RR ranks_VVZ with_IW Turkey_NP1 and_CC Mexico_NP1 as_II the_AT only_JJ OECD_NP1 countries_NN2 without_IW universal_JJ health_NN1 coverage_NN1 ._. 
Some_DD analysts_NN2 say_VV0 an_AT1 increasing_JJ number_NN1 of_IO U.S._NP1 businesses_NN2 are_VBR less_RGR competitive_JJ globally_RR because_II21 of_II22 ballooning_VVG healthcare_NN1 costs_NN2 ._. 
U.S._NP1 economic_JJ woes_NN2 have_VH0 heightened_VVN the_AT burden_NN1 of_IO healthcare_NN1 costs_VVZ both_RR on_II individuals_NN2 and_CC businesses_NN2 ._. 
The_AT U.S._NP1 healthcare_NN1 reform_NN1 law_NN1 signed_VVN by_II President_NNB Barack_NP1 Obama_NP1 on_II March_NPM1 23_MC ,_, 2010_MC ,_, includes_VVZ measures_NN2 aimed_VVN at_II making_VVG healthcare_NN1 less_RGR expensive_JJ and_CC more_RGR accessible_JJ ,_, including_II upgrades_NN2 to_TO government-run_VVI Medicare_NP1 and_CC Medicaid_VVD ._. 
Still_RR ,_, reforming_JJ healthcare_NN1 has_VHZ proved_VVN politically_RR divisive_JJ ,_, especially_RR over_II the_AT option_NN1 to_TO expand_VVI social_JJ medicine_NN1 ,_, as_II31 well_II32 as_II33 new_JJ mandates_NN2 on_II employers_NN2 and_CC individuals_NN2 ._. 
Whether_CSW these_DD2 reforms_NN2 will_VM reduce_VVI the_AT healthcare-cost_JJ burden_NN1 on_II U.S._NP1 industry_NN1 remains_VVZ under_II debate_NN1 ._. 
Competitive_JJ Disadvantage_NN1 The_AT United_NP1 States_NP1 spent_VVD more_DAR than_CSN 17_MC percent_NNU of_IO its_APPGE GDP_NN1 in_II 2009_MC on_II healthcare_NN1 ,_, higher_JJR than_CSN any_DD other_JJ developed_JJ nation_NN1 ._. 
The_AT nonpartisan_JJ Congressional_JJ Budget_NN1 Office_NN1 (_( CBO_NP1 )_) estimates_VVZ that_DD1 number_NN1 will_VM rise_VVI to_II 25_MC percent_NNU by_II 2025_MC without_IW changes_NN2 to_II federal_JJ law_NN1 (_( PDF_NP1 )_) ._. 
Employer-funded_JJ coverage_NN1 is_VBZ the_AT structural_JJ mainstay_NN1 of_IO the_AT U.S._NP1 health_NN1 insurance_NN1 system_NN1 ._. 
According_II21 to_II22 the_AT U.S._NP1 Bureau_NN1 of_IO Labor_NN1 Statistics_NN ,_, about_RG 71_MC percent_NNU of_IO private_JJ employees_NN2 in_II the_AT United_NP1 States_NP1 had_VHD access_NN1 to_II employer-sponsored_JJ health_NN1 plans_VVZ in_II 2006_MC ._. 
A_AT1 November_NPM1 2008_MC Kaiser_NNB Foundation_NP1 report_NN1 says_VVZ access_NN1 to_II employer-sponsored_JJ health_NN1 insurance_NN1 has_VHZ been_VBN on_II the_AT decline_NN1 (_( PDF_NP1 )_) among_II low-income_JJ workers_NN2 ,_, and_CC health_NN1 premiums_NN2 for_IF workers_NN2 have_VH0 risen_VVN 114_MC percent_NNU in_II the_AT last_MD decade_NNT1 (_( PDF_NP1 )_) ._. 
A_AT1 March_NPM1 2010_MC report_NN1 by_II Thomson_NP1 Reuters_NP1 ,_, a_AT1 business_NN1 intelligence_NN1 service_NN1 ,_, found_VVD that_CST employers_NN2 '_GE healthcare_NN1 costs_NN2 rose_VVD 7.3_MC percent_NNU in_II 2009_MC (_( PDF_NP1 )_) compared_VVN with_IW 4.8_MC percent_NNU in_II overall_JJ U.S._NP1 health_NN1 spending_VVG that_DD1 year_NNT1 ._. 
Small_JJ businesses_NN2 are_VBR less_RGR likely_JJ than_CSN large_JJ employers_NN2 to_TO be_VBI able_JK to_TO provide_VVI health_NN1 insurance_NN1 as_II a_AT1 benefit_NN1 ._. 
At_II 12_MC percent_NNU ,_, healthcare_NN1 is_VBZ the_AT most_RGT expensive_JJ benefit_NN1 paid_VVN by_II U.S._NP1 employers_NN2 ,_, according_II21 to_II22 the_AT U.S._NP1 Chamber_NN1 of_IO Commerce_NN1 ._. 
Some_DD economists_NN2 say_VV0 these_DD2 ballooning_JJ dollar_NNU1 figures_NN2 place_VV0 a_AT1 heavy_JJ burden_NN1 on_II companies_NN2 doing_VDG business_NN1 in_II the_AT United_NP1 States_NP1 and_CC can_VM put_VVI them_PPHO2 at_II a_AT1 substantial_JJ competitive_JJ disadvantage_NN1 in_II the_AT international_JJ marketplace_NN1 ._. 
For_IF large_JJ multinational_JJ corporations_NN2 ,_, footing_VVG healthcare_NN1 costs_NN2 presents_VVZ an_AT1 enormous_JJ expense_NN1 ._. 
General_JJ Motors_NN2 ,_, for_REX21 instance_REX22 ,_, covers_VVZ more_DAR than_CSN 1.1_MC million_NNO employees_NN2 and_CC former_DA employees_NN2 ,_, and_CC the_AT company_NN1 says_VVZ it_PPH1 spends_VVZ roughly_RR $5_NNU billion_NNO on_II healthcare_NN1 expenses_NN2 annually_RR ._. 
GM_NP1 says_VVZ healthcare_NN1 costs_NN2 add_VV0 between_II $1,500_NNU and_CC $2,000_NNU to_II the_AT sticker_NN1 price_NN1 of_IO every_AT1 automobile_NN1 it_PPH1 makes_VVZ ._. 
Health_NN1 benefits_NN2 for_IF unionized_JJ auto_NN1 workers_NN2 became_VVD a_AT1 central_JJ issue_NN1 derailing_VVG the_AT 2008_MC congressional_JJ push_NN1 to_TO provide_VVI a_AT1 financial_JJ bailout_NN1 to_II GM_NP1 and_CC its_APPGE ailing_JJ Detroit_NP1 rival_NN1 ,_, Chrysler_NP1 ._. 
Some_DD economists_NN2 say_VV0 these_DD2 ballooning_JJ dollar_NNU1 figures_NN2 place_VV0 a_AT1 heavy_JJ burden_NN1 on_II companies_NN2 doing_VDG business_NN1 in_II the_AT United_NP1 States_NP1 and_CC can_VM put_VVI them_PPHO2 at_II a_AT1 substantial_JJ competitive_JJ disadvantage_NN1 in_II the_AT international_JJ marketplace_NN1 ._. 
Still_RR ,_, other_JJ experts_NN2 debate_VV0 the_AT degree_NN1 to_II which_DDQ healthcare_NN1 affects_VVZ U.S._NP1 industries_NN2 ._. 
"_" Health_NN1 benefits_NN2 are_VBR largely_RR substitutes_NN2 for_IF other_JJ forms_NN2 of_IO labor_NN1 compensation_NN1 ,_, "_" says_VVZ American_JJ Enterprise_NN1 Institute_NN1 Fellow_NN1 Thomas_NP1 Miller_NP1 in_II a_AT1 CFR.org_NP1 roundup_NN1 ._. 
"_" Hence_RR U.S._NP1 firms_NN2 have_VH0 performed_VVN well_RR &lsqb;_( in_II the_AT past_NN1 &rsqb;_) ,_, despite_II rising_VVG levels_NN2 of_IO healthcare_NN1 costs_NN2 ,_, because_CS high_JJ levels_NN2 of_IO productivity_NN1 and_CC a_AT1 favorable_JJ investment_NN1 climate_NN1 were_VBDR (_( and_CC remain_VV0 )_) much_RR more_RGR important_JJ factors_NN2 in_II determining_JJ competitiveness_NN1 ._. "_" 
Healthcare_NN1 is_VBZ one_MC1 of_IO several_DA2 factors_NN2 --_JJ entrenched_JJ union_NN1 contracts_NN2 are_VBR another_DD1 --_NN1 that_CST make_VV0 doing_VDG business_NN1 in_II the_AT United_NP1 States_NP1 expensive_JJ ,_, and_CC it_PPH1 's_VBZ difficult_JJ to_TO parse_VVI the_AT effects_NN2 of_IO each_DD1 factor_NN1 ._. 
Moreover_RR ,_, economists_NN2 disagree_VV0 on_II the_AT number_NN1 of_IO U.S._NP1 jobs_NN2 that_CST have_VH0 been_VBN lost_VVN to_II offshoring_VVG --_NN1 the_AT transfer_NN1 of_IO business_NN1 operations_NN2 across_II national_JJ boundaries_NN2 to_II friendlier_JJR operating_NN1 environments_NN2 ._. 
A_AT1 RAND_NN1 June_NPM1 2009_MC study_NN1 published_VVN in_II the_AT Health_NN1 Services_NN2 Research_VV0 Journal_NN1 found_VVD that_CST industries_NN2 with_IW the_AT highest_JJT level_NN1 of_IO employer-sponsored_JJ healthcare_NN1 (_( such_II21 as_II22 manufacturing_NN1 ,_, telecommunications_NN2 ,_, education_NN1 ,_, and_CC finance_NN1 )_) showed_VVD the_AT slowest_JJT amounts_NN2 of_IO growth_NN1 between_II 1987_MC and_CC 2005_MC compared_VVN to_II industries_NN2 with_IW the_AT smallest_JJT level_NN1 of_IO employer-provided_JJ insurance_NN1 in_II the_AT United_NP1 States_NP1 and_CC compared_VVN to_II their_APPGE industry_NN1 competitors_NN2 in_II Canada_NP1 ,_, where_RRQ insurance_NN1 is_VBZ provided_VVN by_II the_AT state_NN1 ._. 
U.S._NP1 News_NN1 and_CC World_NN1 ReportMoney_NP1 blogger_VV0 Rick_NP1 Newman_NP1 uses_VVZ some_DD of_IO the_AT RAND_NN1 data_NN to_TO project_VVI the_AT decrease_NN1 in_II industry_NN1 growth_NN1 and_CC potential_JJ job_NN1 losses_NN2 for_IF fifteen_MC sectors_NN2 should_VM healthcare_NN1 costs_NN2 rise_VV0 to_II 20_MC percent_NNU of_IO U.S._NP1 GDP_NN1 ._. 
Some_DD analysts_NN2 say_VV0 the_AT healthcare_NN1 situation_NN1 affects_VVZ the_AT ability_NN1 of_IO startup_NN1 companies_NN2 to_TO find_VVI the_AT best_JJT workers_NN2 ,_, impeding_VVG U.S._NP1 innovation_NN1 ._. 
"_" In_II the_AT cradle_NN1 of_IO American_JJ innovation_NN1 ,_, workers_NN2 are_VBR making_VVG career_NN1 choices_NN2 based_VVN on_II co-payments_NN2 ,_, preexisting_VVG conditions_NN2 ,_, and_CC other_JJ minutiae_NN2 of_IO health_NN1 insurance_NN1 ,_, "_" writes_VVZ David_NP1 Leonhardt_NP1 in_II theNew_NN1 York_NP1 Times_NNT2 ._. "_" 
They_PPHS2 are_VBR not_XX necessarily_RR making_VVG decisions_NN2 based_VVN on_II what_DDQ would_VM be_VBI best_JJT for_IF their_APPGE careers_NN2 and_CC ,_, in_II turn_NN1 ,_, for_IF the_AT American_JJ economy_NN1 ._. "_" 
Health_NN1 Reform_NN1 's_GE Impact_NN1 on_II Business_NN1 and_CC the_AT Economy_NN1 The_AT healthcare_NN1 reform_NN1 legislation_NN1 passed_VVN by_II Congress_NN1 largely_RR focuses_VVZ on_II decreasing_VVG the_AT number_NN1 of_IO uninsured_JJ --_JJ projections_NN2 estimate_VV0 reducing_VVG these_DD2 numbers_NN2 by_II about_RG 60_MC percent_NNU ,_, but_CCB it_PPH1 is_VBZ less_RGR clear_JJ how_RGQ much_RR these_DD2 reforms_NN2 would_VM affect_VVI the_AT U.S._NP1 economy_NN1 ._. 
Overall_RR ,_, the_AT new_JJ law_NN1 would_VM produce_VVI close_RR to_II $1_NNU trillion_NNO in_II new_JJ government_NN1 spending_NN1 ._. 
Although_CS the_AT CBO_NP1 found_VVD that_CST the_AT final_JJ law_NN1 would_VM reduce_VVI the_AT federal_JJ deficit_NN1 (_( PDF_NP1 )_) by_II as_RG much_RR $138_NNU billion_NNO by_II 2019_MC ,_, the_AT Centers_NN2 for_IF Medicare_NP1 and_CC Medicaid_NP1 Services_NN2 ,_, a_AT1 U.S._NP1 government_NN1 agency_NN1 ,_, also_RR found_VVN that_CST the_AT legislation_NN1 would_VM do_VDI little_DA1 to_TO stem_VVI the_AT rise_NN1 in_II healthcare_NN1 expenditures_NN2 --_NN1 expected_VVD to_TO increase_VVI to_II more_DAR than_CSN 20_MC percent_NNU of_IO GDP_NN1 in_II the_AT next_MD decade_NNT1 ._. 
The_AT Senate_NN1 Finance_NN1 Committee_NN1 's_GE Democratic_JJ majority_NN1 says_VVZ its_APPGE reforms_NN2 will_VM add_VVI an_AT1 additional_JJ thirty_MC million_NNO people_NN with_IW less_DAR than_CSN a_AT1 1_MC1 percent_NNU rise_NN1 in_II overall_JJ expenditures_NN2 (_( PDF_NP1 )_) ._. 
Democratic_JJ lawmakers_NN2 say_VV0 the_AT law_NN1 is_VBZ paid_VVN for_IF by_II new_JJ taxes_NN2 and_CC lower_JJR Medicare_NP1 payments_NN2 ,_, but_CCB critics_NN2 cast_VV0 doubt_NN1 on_II whether_CSW those_DD2 lower_JJR payments_NN2 --_NN1 roughly_RR half_DB of_IO the_AT spending_NN1 offsets_VVZ (_( WSJ_NP1 )_) --_NN1 would_VM ever_RR come_VVI about_RP ._. 
According_II21 to_II22 former_DA CBO_NN1 head_NN1 Douglas_NP1 Holtz-Eakin_NP1 ,_, if_CS "_" unrealistic_JJ accounting_NN1 "_" for_IF Medicare_NP1 ,_, along_II21 with_II22 a_AT1 number_NN1 of_IO other_JJ "_" gimmicks_NN2 and_CC budgetary_JJ games_NN2 ,_, "_" is_VBZ removed_VVN ,_, the_AT new_JJ law_NN1 would_VM actually_RR cost_VVI $562_NNU billion_NNO in_II new_JJ government_NN1 spending_VVG by_II 2019_MC (_( NYT_NP1 )_) ._. 
The_AT law_NN1 mandates_NN2 that_CST employers_NN2 either_RR provide_VV0 insurance_NN1 for_IF their_APPGE employees_NN2 or_CC pay_VV0 a_AT1 penalty_NN1 that_CST would_VM go_VVI toward_II government_NN1 subsidies_NN2 so_RR employees_NN2 could_VM buy_VVI their_APPGE own_DA insurance_NN1 ._. 
In_II a_AT1 December_NPM1 report_NN1 (_( PDF_NP1 )_) ,_, the_AT Lewin_NP1 Group_NN1 ,_, a_AT1 private_JJ consulting_JJ firm_NN1 ,_, found_VVD that_CST employers_NN2 currently_RR providing_VVG insurance_NN1 will_VM see_VVI a_AT1 reduction_NN1 of_IO $223_NNU per_II employee_NN1 in_II healthcare_NN1 spending_VVG under_II the_AT Senate_NN1 's_GE version_NN1 of_IO the_AT bill_NN1 ,_, which_DDQ became_VVD the_AT basis_NN1 for_IF the_AT new_JJ reform_NN1 law_NN1 --_NN1 "_" primarily_RR because_CS the_AT employer_NN1 penalty_NN1 is_VBZ low_RR enough_RR that_CST employers_NN2 can_VM afford_VVI to_TO discontinue_VVI their_APPGE plans_NN2 ._. "_" 
Non-insuring_JJ companies_NN2 will_VM pay_VVI $316_NNU per_II worker_NN1 in_II new_JJ health_NN1 spending_NN1 ,_, according_CS the_AT Lewin_NP1 report_NN1 ._. 
The_AT 'Triple_NN1 Tax'_VV0 Many_DA2 company_NN1 officials_NN2 say_VV0 a_AT1 wasteful_JJ public-private_JJ system_NN1 is_VBZ pushing_VVG costs_NN2 much_RR higher_JJR than_CSN they_PPHS2 should_VM be_VBI ._. 
Jeffrey_NP1 Rideout_NP1 ,_, a_AT1 medical_JJ doctor_NN1 and_CC former_DA head_NN1 of_IO the_AT Internet_NN1 Business_NN1 Solutions_NN2 Group_NN1 at_II Cisco_NP1 Systems_NN2 '_GE Healthcare_NN1 Practice_NN1 ,_, says_VVZ the_AT amount_NN1 businesses_NN2 pay_VV0 for_IF employee_NN1 insurance_NN1 is_VBZ just_RR one_MC1 element_NN1 of_IO their_APPGE total_JJ healthcare_NN1 costs_NN2 ._. 
Rideout_NP1 says_VVZ businesses_NN2 incur_VV0 a_AT1 "_" triple_JJ tax_NN1 ._. "_" 
First_MD ,_, they_PPHS2 pay_VV0 for_IF insurance_NN1 programs_NN2 through_II health_NN1 benefits_NN2 ._. 
Second_MD ,_, businesses_NN2 indirectly_RR subsidize_VV0 Medicare_NP1 and_CC Medicaid_NP1 ,_, the_AT federally_RR supported_VVN programs_NN2 for_IF primarily_RR poor_JJ and_CC elderly_JJ Americans_NN2 ._. 
&lsqb;_( T_ZZ1 &rsqb;_) he_PPHS1 Centers_NN2 for_IF Medicare_NP1 and_CC Medicaid_NP1 Services_NN2 ,_, a_AT1 U.S._NP1 government_NN1 agency_NN1 ,_, found_VVD that_CST the_AT legislation_NN1 would_VM do_VDI little_DA1 to_TO stem_VVI the_AT rise_NN1 in_II healthcare_NN1 expenditures_NN2 -_- --_JJ expected_JJ to_TO increase_VVI to_II more_DAR than_CSN 20_MC percent_NNU of_IO GDP_NN1 in_II the_AT next_MD decade_NNT1 ._. 
Businesses_NN2 pay_VV0 higher_JJR insurance_NN1 premiums_NN2 to_TO make_VVI up_RP for_IF the_AT fact_NN1 that_CST Medicare_NP1 and_CC Medicaid_NP1 reimbursements_NN2 often_RR do_VD0 not_XX match_VVI the_AT total_NN1 costs_VVZ hospitals_NN2 incur_VV0 treating_VVG these_DD2 patients_NN2 ,_, a_AT1 "_" hidden_JJ tax_NN1 "_" confronted_VVN in_II a_AT1 healthcare_NN1 proposal_NN1 (_( PDF_NP1 )_) laid_VVD out_RP by_II California_NP1 Governor_NNB Arnold_NP1 Schwarzenegger_NP1 ._. 
Third_MD ,_, Rideout_NP1 says_VVZ ,_, businesses_NN2 also_RR subsidize_VV0 the_AT strain_NN1 on_II the_AT system_NN1 wrought_VVN by_II the_AT cost_NN1 of_IO treating_VVG America_NP1 's_GE uninsured_JJ ,_, again_RT through_II higher_JJR insurance_NN1 premiums_NN2 ._. 
It_PPH1 is_VBZ unclear_JJ to_II what_DDQ extent_NN1 these_DD2 concerns_NN2 would_VM be_VBI alleviated_VVN under_II the_AT reform_NN1 plan_NN1 ._. 
The_AT new_JJ reform_NN1 law_NN1 expands_VVZ access_NN1 to_II Medicaid_NP1 and_CC the_AT children_NN2 's_GE health_NN1 program_NN1 SCHIP_NN1 ._. 
It_PPH1 also_RR creates_VVZ a_AT1 new_JJ health_NN1 exchange_NN1 program_NN1 that_CST would_VM allow_VVI small_JJ businesses_NN2 and_CC workers_NN2 without_IW employer-provided_JJ health_NN1 insurance_NN1 to_TO purchase_VVI subsidized_JJ private_JJ insurance_NN1 ._. 
In_II total_NN1 ,_, the_AT plan_NN1 is_VBZ expected_VVN to_TO cover_VVI more_DAR than_CSN thirty_MC million_NNO people_NN ,_, but_CCB roughly_RR another_DD1 twenty_MC million_NNO are_VBR expected_VVN to_TO remain_VVI uninsured_JJ (_( one-third_MF of_IO whom_PNQO are_VBR expected_VVN to_TO be_VBI undocumented_JJ workers_NN2 )_) ._. 
One_MC1 of_IO the_AT numerous_JJ ways_NN2 the_AT lawmakers_NN2 hope_VV0 to_TO control_VVI costs_NN2 is_VBZ through_II reforms_NN2 to_II Medicare_NP1 ,_, particularly_RR by_II lowering_VVG payments_NN2 to_II private_JJ insurers_NN2 participating_VVG in_II Medicare_NP1 Advantage_NN1 and_CC some_DD health_NN1 service_NN1 providers_NN2 ._. 
Whether_CSW such_DA measures_NN2 will_VM simplytransfer_VVI higher_JJR costs_NN2 to_II private_JJ plans_NN2 (_( Crain_NN1 's_GE )_) ,_, as_CSA some_DD critics_NN2 suggest_VV0 ,_, remains_VVZ up_RP for_IF debate_NN1 ._. 
A_ZZ1 2010_MC annual_JJ survey_NN1 released_VVN in_II March_NPM1 by_II the_AT National_JJ Business_NN1 Group_NN1 on_II Health_NN1 ,_, a_AT1 coalition_NN1 of_IO big_JJ employers_NN2 ,_, found_VVD that_CST more_DAR than_CSN two-thirds_MF of_IO large_JJ employers_NN2 surveyed_VVN expected_VVD their_APPGE health_NN1 costs_VVZ to_TO increase_VVI (_( WashPost_NP1 )_) as_II an_AT1 impact_NN1 of_IO reform_NN1 ,_, and_CC more_DAR than_CSN a_AT1 quarter_NN1 were_VBDR considering_VVG reducing_JJ benefits_NN2 to_II employees_NN2 to_TO control_VVI costs_NN2 internally_RR ._. 
Improving_JJ Value_NN1 Healthcare_NN1 experts_NN2 agree_VV0 the_AT people_NN with_IW the_AT most_RRT control_VV0 over_RP what_DDQ drugs_NN2 get_VV0 prescribed_JJ and_CC what_DDQ procedures_NN2 get_VV0 done_VDN have_VH0 little_DA1 incentive_NN1 to_TO lower_VVI these_DD2 costs_NN2 (_( indeed_RR ,_, to_II the_AT extent_NN1 that_CST they_PPHS2 get_VV0 paid_VVN by_II the_AT procedure_NN1 ,_, their_APPGE incentives_NN2 are_VBR often_RR quite_RG the_AT opposite_JJ )_) ._. 
Likewise_RR ,_, patients_NN2 often_RR feel_VV0 little_RR need_VV0 to_TO control_VVI the_AT costs_NN2 of_IO their_APPGE own_DA medical_JJ care_NN1 if_CS it_PPH1 is_VBZ covered_VVN by_II insurance_NN1 ._. 
The_AT system_NN1 bears_VVZ the_AT brunt_NN1 of_IO the_AT excess_NN1 ,_, and_CC employers_NN2 make_VV0 up_RP the_AT difference_NN1 in_II the_AT rates_NN2 they_PPHS2 pay_VV0 ._. 
While_CS there_EX is_VBZ competition_NN1 in_II the_AT U.S._NP1 healthcare_NN1 system_NN1 ,_, it_PPH1 operates_VVZ at_II the_AT wrong_JJ level_NN1 ,_, argue_VV0 Harvard_NP1 Business_NN1 School_NN1 Professor_NNB Michael_NP1 E._NP1 Porter_NP1 and_CC Elizabeth_NP1 Olmstead_NP1 Teisberg_NP1 ,_, a_AT1 professor_NN1 at_II the_AT University_NN1 of_IO Virginia_NP1 's_GE Darden_NN1 School_NN1 of_IO Business_NN1 ,_, the_AT authors_NN2 of_IO the_AT book_NN1 Redefining_VVG Health_NN1 Care_NN1 :_: Creating_VVG Value-Based_JJ Competition_NN1 on_II Results_NN2 ._. 
"_" Competition_NN1 is_VBZ both_RR too_RG broad_JJ and_CC too_RG narrow_JJ ,_, "_" Porter_NP1 and_CC Teisberg_NP1 write_VV0 ._. 
"_" Competition_NN1 is_VBZ too_RG broad_JJ because_CS much_DA1 of_IO the_AT competition_NN1 now_RT takes_VVZ place_NN1 at_II the_AT level_NN1 of_IO health_NN1 plans_NN2 ,_, networks_NN2 ,_, hospital_NN1 groups_NN2 ,_, physician_NN1 groups_NN2 ,_, and_CC clinics_NN2 ._. 
It_PPH1 should_VM occur_VVI in_II addressing_VVG particular_JJ medical_JJ conditions_NN2 ._. 
Competition_NN1 is_VBZ too_RG narrow_JJ because_CS it_PPH1 now_RT takes_VVZ place_NN1 at_II the_AT level_NN1 of_IO discrete_JJ interventions_NN2 or_CC services_NN2 ._. 
It_PPH1 should_VM take_VVI place_NN1 for_IF addressing_VVG medical_JJ conditions_NN2 over_II the_AT full_JJ cycle_NN1 of_IO care_NN1 ,_, including_II monitoring_VVG and_CC prevention_NN1 ,_, diagnosis_NN1 ,_, treatment_NN1 ,_, and_CC the_AT ongoing_JJ management_NN1 of_IO the_AT condition_NN1 ._. "_" 
The_AT law_NN1 tries_VVZ to_TO improve_VVI competition_NN1 through_II the_AT creation_NN1 of_IO a_AT1 "_" health_NN1 insurance_NN1 exchange_NN1 "_" (_( PDF_NP1 )_) for_IF small_JJ businesses_NN2 and_CC individual_JJ buyers_NN2 ._. 
But_CCB new_JJ competition_NN1 in_II the_AT marketplace_NN1 may_VM be_VBI limited_VVN ._. 
The_AT CBO_NP1 found_VVD that_CST premiums_NN2 for_IF individual_JJ plans_NN2 on_II these_DD2 insurances_NN2 exchanges_NN2 would_VM increase_VVI by_II 10_MC percent_NNU to_II 13_MC percent_NNU by_II 2016_MC ._. 
Investment_NN1 analyst_NN1 Julia_NP1 Coranado_NP1 (_( PDF_NP1 )_) argues_VVZ ,_, "_" Most_DAT people_NN covered_VVN by_II employer-sponsored_JJ plans_NN2 will_VM not_XX see_VVI many_DA2 changes_NN2 or_CC benefits_NN2 from_II increased_JJ competition_NN1 ,_, so_CS there_EX is_VBZ little_RR expected_JJ impact_NN1 from_II the_AT &lsqb;_( Senate_NN1 bill_NN1 &rsqb;_) on_II healthcare_NN1 inflation_NN1 ,_, although_CS lower_JJR Medicare_NP1 reimbursements_NN2 will_VM apply_VVI some_DD downward_JJ pressure_NN1 ._. "_" 
Some_DD experts_NN2 say_VV0 companies_NN2 should_VM do_VDI more_DAR than_CSN focus_VV0 their_APPGE attentions_NN2 strictly_RR on_II direct_JJ costs_NN2 of_IO providing_VVG healthcare_NN1 and_CC look_VV0 at_II the_AT benefits_NN2 of_IO reducing_VVG poor_JJ health_NN1 ._. 
Some_DD health_NN1 analysts_NN2 argue_VV0 there_EX are_VBR "_" spin-off_NN1 "_" benefits_NN2 to_II supporting_VVG healthy_JJ employees_NN2 such_II21 as_II22 productivity_NN1 ,_, intellectual_JJ capacity_NN1 ,_, and_CC reduced_JJ absenteeism_NN1 ._. 
Meanwhile_RR ,_, reviews_NN2 have_VH0 been_VBN mixed_VVN on_II whether_CSW the_AT costly_JJ U.S._NP1 health_NN1 system_NN1 leads_VVZ to_II health_NN1 outcomes_NN2 as_RG good_JJ as_CSA developed_JJ countries_NN2 with_IW lower_JJR health_NN1 costs_NN2 ._. 
The_AT law_NN1 contains_VVZ some_DD measures_NN2 that_CST would_VM monitor_VVI the_AT quality_NN1 of_IO health_NN1 outcomes_NN2 of_IO the_AT insured_JJ ._. 
Tapping_VVG Technology_NN1 Technology_NN1 ,_, too_RR ,_, can_VM play_VVI an_AT1 important_JJ role_NN1 in_II minimizing_VVG overall_JJ health_NN1 costs_VVZ by_II improving_JJ efficiency_NN1 and_CC reducing_VVG mistakes_NN2 ._. 
Rideout_NP1 points_VVZ out_RP that_CST the_AT U.S._NP1 healthcare_NN1 industry_NN1 lags_VVZ in_II information_NN1 technology_NN1 (_( IT_NN1 )_) spending_VVG behind_II not_XX only_RR its_APPGE competitors_NN2 internationally_RR ,_, but_CCB also_RR other_JJ industries_NN2 domestically_RR ._. 
Rideout_NP1 says_VVZ the_AT average_JJ company_NN1 outside_II the_AT health_NN1 industry_NN1 spends_VVZ seven_MC times_NNT2 as_RG much_DA1 as_CSA U.S._NP1 healthcare_NN1 companies_NN2 on_II information_NN1 technology_NN1 ,_, and_CC companies_NN2 in_II some_DD wealthier_JJR industries_NN2 like_II banking_NN1 spend_VV0 up_RG21 to_RG22 twenty_MC times_NNT2 as_RG much_DA1 ._. 
U.S._NP1 competitors_NN2 abroad_RL have_VH0 also_RR consistently_RR outspent_JJ the_AT U.S._NP1 government_NN1 on_II healthcare_NN1 IT_NN1 investment_NN1 ._. 
