"If health care's chronic IT failure is steeped in economic reality, then the solution should be as well viet Union, our military and ideological rival, launch the first satellite into orbit We saw in this a threat not just to our national security but to our national pride, to our belief(then and now)that democracy, capitalism, and political freedom were the hallmarks of civilization and led, inevitably, to greater technical ingenu ity. When Sputnik pierced Earth's atmosphere, it also pierced the national smug ness of 1950s America In all three cases Americans solved the problem, and in all three cases we did so not by waiting for the invisible hand of a market that would never appear but by working centrally through a federal government with the resources to get the job done. The details of how this worked-how the government planned, financed, and contracted with private firms to achieve these three goals-provide a tem plate for how we could find our way around the intractable HIT infrastructure problems laid bare in this paper. In the three historical cases, no one commercial actor or any consortium of commercial actors was large or well-financed enough to achieve society's goals through sheer capitalist effort. In all three cases, society what private enterprise simply could not finance and bula tive externalities)of rather than shareholders enjoyed enormous benefits(posit So too with the building of a national, ubiquitous, interoperable HIT system The federal government can and should write the huge check and be done with it. Even with the inevitable graft and corruption that would ensue, this massive pub lic investment would pay for itself many times over. Walker and colleagues have shown that the direct cost of building a national HIT system is $276 billion(in to- day s dollars)over ten years but that the investment would generate direct savings of $613 billion during those same years and $94 billion per year thereafter. These savings do not include any of the ancillary benefits, such as massive reductions in endless administrative rework or the vast savings gained through better manage- ment of chronic disease. As Walker and colleagues point out, "The clinical payoff in improved patient safety and quality of care could dwarf the financial benefits projected from our model, 34 What they do not point out is that we are already burning that money today, a few dollars at a time, with every unnecessary medical test, procedure, and drug that an interoperable system would preclude. These costs are bundled into all of our provider payments and then again into all of our health insurance premiums This is why government, as gest health care payer and insurer of last resort, should fund the solution itself, the same way it funded the many great public works projects that came to define the United States at its finest moments HEALTH AFFAIRS Volumc 24, Number 5 1257D o T - G o V "If health care's chronic IT failure is steeped in economic reality, then the solution should he as well." Viet Union, our military and ideologicai rival, launch the first satellite into orbit. We saw in this a threat not just to our national security but to our national pride, to our belief (then and now) that democracy, capitalism, and political freedom were the hallmarks of civilization and led, inevitably, to greater technical ingenu￾ity. When Sputnik pierced Earth's atmosphere, it also pierced the national smug￾ness of 1950s America. In all three cases Americans solved the problem, and in all three cases we did so not by waiting for the invisible hand of a market that would never appear but by working centrally through a federal government with the resources to get the job done. The details of how this worked—how the government planned, financed, and contracted with private firms to achieve these three goals—provide a tem￾plate for how we could find our way around the intractable HIT infrastructure problems laid bare in this paper. In the three historical cases, no one commercial actor or any consortium of commercial actors was large or well-financed enough to achieve society's goals through sheer capitalist effort. In all three cases, society rather than shareholders enjoyed enormous benefits (positive externalities) of what private enterprise simply could not finance and build. So too with the building of a national, ubiquitous, interoperable HIT system. The federal government can and should write the huge check and be done with it. Even with the inevitable graft and corruption that would ensue, this massive pub￾lic investment would pay for itself many times over. Walker and colleagues have shown that the direct cost of building a national HIT system is $276 billion (in to￾day's dollars) over ten years but that the investment would generate direct savings of $613 billion during those same years and $94 billion per year thereafter.^^ These savings do not include any of the ancillary benefits, such as massive reductions in endless administrative rework or the vast savings gained through better manage￾ment of chronic disease.^^ As Walker and colleagues point out, "The clinical payoff in improved patient safety and quality of care could dwarf the financial benefits projected from our model."^'' What they do not point out is that we are already burning that money today, a few dollars at a time, with every unnecessary medical test, procedure, and drug that an interoperable system would preclude. These costs are bundled into all of our provider payments and then again into all of our health insurance premiums. This is why government, as the largest health care payer and insurer of last resort, should fund the solution itself, the same way it funded the many great pubhc works projects that came to define the United States at its finest moments. HEALTH AFFAIRS - Volume 24, Number 5 , 1257