Why America Pays More for Worse Healthcare | Dr. John E. McDonough

Why does the United States spend more on healthcare than any other advanced nation while producing some of the poorest health outcomes? In this episode of The Rational View, I speak with Dr. John E. McDonough about the history behind America's uniquely expensive healthcare system and the argument at the center of his new book, America's Wrong Turn: US Health Care in the Neoliberal Era. John E. McDonough, DrPH, MPA, is Professor of the Practice of Public Health in the Department of Health Policy and Management at the Harvard T.H. Chan School of Public Health. He previously served in the Massachusetts House of Representatives and played a key role in Massachusetts health reform and the development of the Affordable Care Act. John traces the shift from the New Deal era to the free-market philosophy that gained political power under Ronald Reagan. We discuss deregulation, Milton Friedman's influence, shareholder value, the rise of for-profit healthcare and private equity, and why these ideas had a different impact in the United States than in countries with universal healthcare. We also look at what actually works. John explains why neither public nor private healthcare is automatically efficient, what the U.S. can learn from other countries, and why seemingly promising models like capitation can create their own perverse incentives.