Death, taxes . . . and increases in total healthcare spending in the U.S.
It topped $1 trillion for the first time in 1996, and spending has been projected to increase at an accelerating rate to $2.13 trillion by 2007.
In 1987, total national healthcare expenditures stood at a little over $500 billion. Perhaps more than any other statistic, the national healthcare spending figure drives healthcare policy. It dictates the urgency-or lack of urgency-by lawmakers and others to reform the country's healthcare system.
Perhaps more revealing than any other statistic, it shows that despite all the calls for reform and all the incremental reforms that have been made over the past few decades, not much really has changed fundamentally. The status quo rules the day.
The information in this chapter on healthcare economics proves the case. Consider the following:
* Per-capita healthcare spending in the U.S. was $4,090 in 1997, the latest year for which figures are available. That was nearly 75% more than the closest industrialized nation, Germany, which spent $2,339.
* Still, there has been some moderation in the growth of the percentage of the nation's gross domestic product eaten up by healthcare expenditures. While it accelerated from just over 8% in 1978 to 13.4% in 1992, it has changed little since that year. It stood at 13.5% in 1997, according to the latest available figures.
* Also little changed in recent years is medical inflation, as measured by the U.S. Labor Department's Consumer Price Index. During the past 20 years, medical inflation typically has exceeded the CPI, or the general rate of inflation. Last year, for example, the CPI was 1.6% while medical inflation was more than double at 3.4%. In 1988, retail prices for medical care jumped 6.9%, while the CPI was 4.4%.
* Another result indicating that the status quo reigns supreme is the number of uninsured Americans. It keeps growing. In fact, the number has risen by 40% since 1987. It stood at 43.4 million in 1997, according to the latest available statistics from the government.
* Where do the uninsured live? More than one-third live in three states: California, Texas and New York. Some 15.1 million people in those three states had no health insurance in 1997.
* And patients with private insurance continue to do their share helping providers cover their costs of treating the uninsured. According to U.S. Labor Department's Producer Price Index, hospital inpatient revenues from private-pay patients rose 2.1% last year. Even Medicare did its share. Hospitals' inpatient Medicare revenues inched up 0.4% in 1998.