Regulations make the provision of healthcare and health insurance more complex, so seem like the most probable culprit. The decline in the share of healthcare

Regulations make the provision of healthcare and health insurance more complex, so seem like the most probable culprit. The decline in the share of healthcare spending constituted by out-of-pocket spending, due to growing insurance-mandated budgeting, could very well have played a role in the growth of healthcare costs, and I believe it did. But two points: 1. Those mandates are regulations, so this development doesn't contradict the thesis. 2. Out-of-pocket spending declined from 44 percent of total spending, in 1965, to about 10 percent today. That can't explain a 32X increase in the number of hospital administrators. It is probably one component, among the many that are responsible for the growth in the number of hospital administrators.