We hear all the time that technology is driving up the cost of health care — a weird claim on its own terms, since technology has elsewhere tended to reduce costs while improving quality — but has the fundamental structure of any industry, much less a tech-driven one, changed less in the past 50 years than that of health care? Doctors remain the gateway into the system. Hospitals — even if now largely through their outpatient services — are still the providers of much of the major care. Drug, device, and equipment companies are the source of most technological innovation. And insurers and public agencies continue to be the payers, driving — in theory, if not in practice — improvements in value, quality, and safety.
However, all this unusual industry stability has been accompanied by a lot of change in the nature of health and of care. To begin with, Americans have gotten much healthier in the past 50 years. We smoke less, drink less, eat better, enjoy a cleaner environment, have far fewer accidents, and are wealthier (itself a major contributor to health). Health care has gotten better, too — more conditions can be controlled with pharmaceuticals, and fewer surgeries require long-term hospitalizations.