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" ... The efforts to slow down growth in healthcare spending have run into difficulties because they are entirely focused on fixing a spending problem at a given point in time without considering how reforms influence future spending patterns. This is perhaps understandable because the implication of today’s policies on future spending is not as straightforward as one might assume. Pioneered by the work of Joe Newhouse at Harvard, research suggests that medical innovation is central to growth in healthcare costs. Innovation itself is driven by the returns to R&D, and the extent of these future financial returns depends on future spending. Therefore, in rich countries, where a large portion of healthcare spending comes from the public purse, reforms to public programs have a direct effect on these innovative returns. Depending on the scope of public reforms and the populations affected, an expansion or reduction in public healthcare coverage impacts future spending growth in both the public and the private sector. Put simply, reforms have two separate spending effects. The first is how they affect spending on existing innovations. The second is how they affect the flow of new innovations that contribute to cost growth and the size of unfunded liabilities. ... "