The majority of economists trained in the classical tradition believe there is a public policy tradeoff between distributional equity and economic efficiency; to get more of one, you get less of the other. But the U.S. health care finance system is an exception to that rule, as it is both inequitable and inefficient. You read about the inequities in my prior post; this post is about the economic damage. By tying the availability of affordable health insurance to group plans provided by employers, the current system prevents many workers from moving to jobs where they could be better compensated. It also dissuades them from becoming entrepreneurs, or becoming freelancers by choice, if that is what they would prefer. Therefore, the link between employment and health insurance has created a kind of economic serfdom for millions of Americans. For low, moderate, and middle income households lacking health insurance, since an serious illness or injury would wipe them out, the lack of such insurance means it is irrational to save. And, the burden of providing health insurance for middle-aged and older people has made older companies — and communities — uncompetitive with newer, growing firms and taxing jurisdictions. This sets up a merry-go-round in which the former are abandoned for no other reason than the age distribution of their employees, stranding those employees and residents and wasting capital, infrastructure and other resources. That issue is going to become critical as large swaths of suburban and Sunbelt America go into decline in the wake of the housing bust, and confront fiscal crises similar to what older northern cities faced in the 1970s.