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Editors Note: Our health care debate, Robert Graboyes says, is trapped. Caught in the back-and-forth over insurance coverage, both the proponents and opponents of the Affordable Care Act are missing the point. To Graboyes, a senior research fellow at the Mercatus Center, distribution of health care is not the problem. Its the creation of better health care that will save more lives and cut costs.

And while his thesis resonates with the laissez-faire, pro-market attitude most often heard on the political right, he implicates both sides in holding Americas health care hostage in his recently published paper Fortress and Frontier in American Health Care. Americas health care has been allowed to languish, denied the opportunities to take the risks what Graboyes and his colleague call permissionless innovation that have allowed the information technology industry to flourish, and with it, all Americans. To get health care caught up to IT, he argues, we should rethink federal grants for innovation (theyre often counterproductive, he thinks) and decentralize regulatory institutions.

But Graboyes assessment of how and why IT has made such strides isnt universally accepted. We need to rebalance the story we tell about who the innovators really are, says Mariana Mazzucato. Author of The Entrepreneurial State, Mazzucato wrote on Making Sen$e last year that Apple didnt build your iPhone; the government and your taxes did. How is technology fostered, she asked? Far from the obscure figures in garages Graboyes credits with IT success, more often than not, down through history, Mazzucato argued, innovation has stemmed from government investment, from the roads of ancient Rome to the Internet of modern America.

Graboyes paper, out a year after Mazzucatos essay, sees consumers and producers taking the risks, leading the way toward a changing health care industry. Graboyes teaches at the medical centers at Virginia Commonwealth University and the University of Virginia. He produces a twice-a-month health care policy newsletter and is on Twitter at @Robert_Graboyes. Read more from him below.

Simone Pathe, Making Sen$e Editor

Health care is the surliest corner of American politics. For decades, a bitterly partisan debate dueling monologues, really has hung like smog over public discourse. Facts, misconceptions, half-truths and non sequiturs have congealed into conflicting sets of pre-packaged talking points.

Nearly five years after President Barack Obama signed the Affordable Care Act (ACA) into law, the rancor and accusations still swirl, turbulent but immovable, like the Great Red Spot of Jupiter. Maddeningly, the perpetual storm barely touches the great issues that actually determine our health and what we spend to acquire that health.

This is a pity, but the upside is that it suggests an enormous opportunity to shift the debate, dissipate reflexive partisanship, and in doing so, save lives, ease suffering and cut costs.

In short, since World War II, the health care debate has focused almost exclusively on coverage the number of people with insurance cards. Quality of care and improvements in health have been afterthoughts.

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Why we need to liberate Americas health care