Top Coast: Ezekiel Emanuel on why health care costs so much

The Affordable Care Act isn't intended to bring down the cost of health care in the United States, Dr. Ezekiel Emanuel told an audience at MPR's Top Coast Festival last weekend.

Emanuel, one of the key architects behind the health reform effort, said the ACA may make care less expensive than it would otherwise be — but not less expensive than it is now.

"Health care industry in the United States is a $3 trillion industry. Trillion," he said. "No one has any idea how big $3 trillion is. I worked at the one agency in the world that regularly deals in trillions, that's the Office of Management and Budget, and we had no idea how big $3 trillion was. It's bigger than the economy of France. ...

"The average health insurance for a family in the United States is $16,000 per year now, and no one — there's no health economist, there's no health policy expert — thinks we're going from 3 trillion to 2.8 or 2.6. The issue is, how fast are we going to get to 3.5 and 4 trillion? It's about the rate of growth, and can we slow that rate of growth so that it grows at the same rate as the economy? That's the big difference."

Emanuel said doctors and hospitals get paid fees according to services: "They get paid to do things, and if they don't do things, they don't get paid. So it's no surprise you get more CAT scans or more surgeries under such a circumstance. ... The real thing we want is a change in the delivery system, a transformation of how we deliver care.

"Now you've heard this since we've been debating the health care reform from 2008: We have a sick-care system; what we need is a health-care system. Why do we have a sick-care system? Because we pay people to care for the sick, not to keep them healthy. When we begin to pay for people to keep people healthy, we'll have a different system."

Emanuel's latest book is "Reinventing American Health Care."