As shown in Chart 1, the growth in health care is a significant part of that increase. Currently, net exports are about -3.0 percent. By contrast, one can see a stronger relationship between net exports and the federal budget balance, where the correlation coefficient is 0.42. Indeed, the share of federal spending devoted to health care increased from two percent in 1950 to 25 percent in 2024. So my alternative basic macroeconomic view is that the inefficient health care sector has grown too large over time, is being funded by growing federal deficits, these deficits are driving down net exports (and somewhat, goods production), and the deficits are dangerous and harmful.