The Decline and Fall of the American Empire
The most important factor in this analysis doesn&#x27;t get called out by name: healthcare costs.  When Cowen mentions entitlement growth forcing spending reduction and tax increases, healthcare is both the most certain and the biggest culprit by a wide margin.<p>If you were going to do one thing to extend American prosperity, it would be disruptive structural improvements to our healthcare system.  That&#x27;s structural reform, not new biotech (except as allows you to disintermediate care).  The fact that our total expenditure is so high relative to other countries with similar quality of care is evidence that the economic models, not the technology available, are to blame.