Pricing the Cure: A Worked Macroeconomic Profit-Efficiency Calculation of the US Healthcare System, 1965–2023

This paper provides a worked application of the Macroeconomic Profit Efficiency Index (MPEI) to the US healthcare system from 1965 to 2023. The MPEI is a diagnostic ratio that asks how much retained community value a sector generates per unit of profit impost. Formally, MPEI = Φ × (NRV / PI), where NRV = GVA + NMV - BPL - NET and PI = P_prod + R_sys. The framework distinguishes productive profit, required to elicit investment, innovation, coordination and capacity, from systemic rent, defined as profit-equivalent surplus not matched by corresponding system-level value. The paper applies the two-category NMV specification (Popova-Clark, 2026) capturing both enabling non-market activity (NMV-A: informal caregiving and trust) and government direct welfare provision (NMV-B: public health surveillance, biomedical research, emergency preparedness, and regulatory governance within the healthcare sector boundary). The contemporary central-case MPEI for US healthcare is approximately 4.7 (sensitivity range 2.25–9.01), reflecting NRV of approximately \$3.0 trillion against profit impost of $381 billion at participation-floor coefficient Φ ≈ 0.60. The welfare-optimum benchmark MPEI* — defined as NRV / P_prod^max, where P_prod^max = PI_obs - R_sys^floor and Φ = 1 — is approximately 11.12, indicating that the contemporary US healthcare system operates at approximately 41.9 per cent of its conservative welfare-optimum. The trajectory analysis shows MPEI rising from approximately 10.4 in 1965 to a peak of approximately 15.5 in 1975 — following Medicare and Medicaid expansion and the post-1965 NIH and CDC growth phase — and declining across the subsequent five decades to the contemporary level. The paper develops the substantive policy implications including the framework paper's predator-steward analysis of US pharmaceutical IP regimes (Popova-Clark, 2026, §6.6). Keywords: Macroeconomic Profit Efficiency Index; healthcare; systemic rent; productive profit; US health policy; financialisation; retained value; political economy.