1
Exhibit 1. International Comparison of Spending on Health,
1980–2010
Average spending on health
per capita ($US PPP)
Total health expenditures as
percent of GDP
18
$8,000
US
$7,000
16
SWIZ
NETH
$6,000
14
CAN
12
GER
FR
10
AUS
UK
8
JPN
US
NETH
FR
GER
CAN
SWIZ
UK
JPN
AUS
Notes: PPP = purchasing power parity; GDP = gross domestic product.
Source: Commonwealth Fund, based on OECD Health Data 2012.
2004
2002
2000
1998
1996
1994
1992
1990
1988
1986
1984
1982
2010
2008
2006
2004
2002
2000
1998
1996
1994
1992
1990
0
1988
$0
1986
2
1984
$1,000
1982
4
1980
$2,000
1980
6
2010
$3,000
2008
$4,000
2006
$5,000
Exhibit 2. Projected U.S. National Health Expenditures (NHE) by Source,
2013–2023
NHE in $ billions
6000
$5.5 trillion
Federal
government
5000
$4.0 trillion
32%
State and local
government
4000
$2.9 trillion
31%
28%
18%
3000
2000
18%
24%
18%
25%
1000
26%
26%
28%
26%
2013
2018
2023
17.9%
18.7%
20.5%
0
% GDP:
Note: GDP = gross domestic product.
Source: Estimates by Actuarial Research Corporation for The Commonwealth Fund.
Private employers
(including "other
private revenue")
Households
Exhibit 3. Medicare Spending per Enrollee Projected to Increase More
Slowly Than Private Insurance Spending per Enrollee and GDP per Capita
Annual rate of growth (percent)
8.0
GDP per capita
7.0
6.0
Medicare spending per enrollee
Employer-sponsored insurance spending per enrollee
5.0
3.7
4.0
3.0
4.6
4.5
3.8
2.9
2.7
2.0
1.0
0.0
2008–2011
2011–2021 (projected)
Note: GDP = gross domestic product.
Source: CMS Office of the Actuary, National Health Expenditure Projections, 2011–2021, updated June 2012.
Exhibit 4. Rising Health Spending Crowds Out Other Priorities
Massachusetts State Budget, FY 2001 vs. FY 2011
State spending ($ billions)
FY2001
FY2011
$16
$14
$12
+$5.1 B
(+59%)
-$4.0 B
(-20%)
$10
-15%
$8
$6
-13%
$4
-23%
$2
-38%
-33%
Public
health
Mental
health
-11%
-50%
$0
Health care coverage
(state employees/GIC;
Medicaid/health reform)
Note: GIC = Group Insurance Commission.
Source: Massachusetts Budget and Policy Center Budget Browser.
Education
Infra- Human
struc- services
ture/
housing
Local
aid
Public
safety
Exhibit 5. Premiums Rising Faster Than Inflation and Wages
Cumulative changes in insurance
premiums and workers’ earnings,
1999–2012
Projected average family premium as
a percentage of median family income,
2013–2021
Percent
Percent
200
Health insurance premiums
175
180%
Workers' contribution to premiums
150
Workers' earnings
125
Overall inflation
35
30
172%
25
22 23
20
100
15 12 13
75
50
25
47%
10
38%
5
15
17
18 18 18 18
19
24
26
25 26
27
28 29
30
31
20
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
0
0
Projected
Sources: (left) Kaiser Family Foundation/Health Research and Educational Trust, Employer Health Benefits Annual Surveys, 1999–
2012; (right) author’s estimates based on CPS ASEC 2001–12, Kaiser/HRET 2001–12, CMS OACT 2012–21.
Exhibit 6. Cumulative Impact of Comprehensive Strategy on
Health Spending, 2013–2023: Medicare, Federal, and NHE
Net impact in $ billions
Medicare
Federal
NHE
Provider payment reforms
–$587
$788
–$1,333
Provide and support highvalue choices by consumers
–$70
–$71
–$189
Make markets work better
–$104
–$177
–$481
Cumulative impact
–$761
–$1,036
–$2,004
Note: NHE = national health expenditures. Components may not add to total because of rounding.
Source: Estimates by Actuarial Research Corporation for The Commonwealth Fund.
Exhibit 7. Cumulative Impact of Comprehensive Strategy
on Health Spending, 2013–2023, by Payer
Net impact in billions
Federal
Total NHE government
2013–2023
–$2,004
–$1,036
State
and local
government
Private
employers
Households
–$242
–$189
–$537
Note: NHE = national health expenditures. Components may not add to total because of rounding.
Source: Estimates by Actuarial Research Corporation for The Commonwealth Fund.
Exhibit 8. Projected National Health Expenditures (NHE), 2013–2023:
Potential Impact of Synergistic Strategy
NHE in $ trillions
$6.0
Current baseline NHE projection
$5.5
Projected NHE net of policy impacts
$5.0
$5.1
$4.0
$2.9
$3.0
$2.0
$1.0
NHE as percentage of GDP—
Current projection: 18% in 2013→21% in 2023
Under unified strategy: 18% in 2013→19% in 2023
Cumulative NHE savings under synergistic strategy: $2.0 trillion
$0.0
2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023
Note: GDP = gross domestic product.
Source: Estimates by Actuarial Research Corporation for The Commonwealth Fund. Current baseline projection assumes that
the cuts to Medicare physician fees under the sustainable growth rate (SGR) formula are repealed and basic physician fees are
instead increased by 1% in 2013 and held constant from 2014 through 2023.