less dependent upon public funding than the East Coast States, that category
accounting for only just over half the GDP share it does in New York and New
Jersey. As Table 3 shows, California’s ‘mega-budget’ for private health care
expenditure easily outstrips all others among the entrants in Table 2. Hence the
State Personal Health Care Expenditures, 1998 ($mn.)
California |
$110,057 |
New York |
$85,785 |
Texas |
$67,750 |
Florida |
$59,724 |
Pennsylvania |
$51,322 |
Illinois |
$44,305 |
Ohio |
$42,581 |
Michigan |
$35,647 |
New Jersey |
$32,695 |
Massachusetts |
$30,039 |
Table 3: Personal Health Care Expenditures, Top Ten US States, 1998
Source: Health Care Financing Administration (2001), Trends in State Health Care
Expenditure and Funding, 1980-1998, Washington DC.
relatively low share of GDP allocated to direct public expenditure on health is
compensated for by a massive figure of some 10% of GDP being expended on
personal health care.
Keeping in mind that Table 2 represents one-fifth of each State’s health expenditure,
requiring an approximate doubling to include the employer’s contribution, and that
Table 3 accounts for some three-fifths we see the scale of total investment available
annually in the leading States’ economies. Thus California spends at least $160
billion, New York $145 billion and even modestly sized Massachusetts some $46
billion. Three key points flow from this accounting exercise. First, a few key regions,
and in fact cities in those regions have the demographic, financial and scientific scale
to afford the whole of the bioscientific and medical knowledge value chain. This
moves from the most exploratory, fundamental research into genomics and post-
genomics fields like proteomics and molecunomics. This is likely to be conducted at
specialist research institutes such as the Whitehead in Cambridge, Massachusetts
(partnered with the Sanger Institute, in Cambridge, UK and Washington University at
St. Louis for the Human Genome project). Knowledge of this kind will likely be
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