Certainly lost productivity is a valid cost measure in very small sample sizes (i.e. a defined labor group working at the same task for the same company). But when you start attempting to determine lost productivity using millions of commuters, or millions of consumers of healthcare, it's not valid at all. The bottom line is that everyone has to travel to work. We don't beam into and out of the office. So commutes don't necessarily count as "lost" productivity. Opportunity loss, maybe, but we'll never be able to retrieve it, so why bother?
Same goes with healthcare. Taking time off to care for someone? Well, yeah. That happens. So do frequent doctor visits for chronic ailments. Who cares? The only solution is healthier people, but the paradox is that to make people healthier (in theory), you give them more healthcare (inducing more productivity losses).
So we have "hidden costs" of $363 billion. Tell me what that means in any relevant sense. It's just another method to freak people out.
“The bottom line is that everyone has to travel to work. We don’t beam into and out of the office. So commutes don’t necessarily count as “lost” productivity. Opportunity loss, maybe, but we’ll never be able to retrieve it, so why bother?”
Huh? I’m not sure what distinction you’re drawing between lost productivity and opportunity loss. They’re the same thing. Lost productivity is what’s lost by having to commute. The notion that this is inevitable is quite wrong. Many people work at home, for example, eliminating such costs altogether. Assuming they are as productive at home as at work, this elimination of commuting time is a productivity gain. Or other people convert that commuting time to productive use, e.g., by using their cell phones or laptops on trains as they commute into work etc.
Same with medical care. Even if the cost of laparoscopic surgery is higher than the old-fashioned kind, it may well be worth it precisely because of productivity gains. We used to keep heart attack victims in hospitals for weeks. Now we get them back to work in days etc.
Likewise, the most efficient forms of medical care do NOT require on-going care: vaccinations are generally “one-and-done” for example. That’s why they typically save $3 to $10 per dollar spent on vaccinations. Most other forms of preventive care increase health spending, on net, even though they may do so very cost-effectively (e.g., gaining each added year of life for only $3,000). Conversely, some preventive measure that saves the health system $100 buts adds $200 in productivity losses is surely not “value for the money.” That would be an innovation not pursuing, whereas an innovation that cost the health system $100 more but saved $200 in productively losses assuredly would be. But there would be no way of differentiating these kinds of medical advances and deciding which ones were worthwhile if we simply ignored their impact on productivity costs.