Exhibit 1. National Health Expenditures per Capita, 1980–2007
Average spending on health per capita ($US PPP)
$7,500
$7,000
United States
Canada
France
Germany
Netherlands
United Kingdom
$6,500
$6,000
$5,500
$5,000
$4,500
$4,000
$3,500
$3,000
$2,500
$2,000
$1,500
$1,000
$500
$0
1980
1984
1988
1992
1996
2000
2004
THE
COMMONWEALTH
FUND
Data: OECD Health Data 2009 (June 2009).
Exhibit 2. National Health Expenditures as a Percentage of
Gross Domestic Product, 1960–2020
Percent
25
21.3
20
18.9
17.7
15.9
15
13.7
13.8
12.3
10.4
10
7.2
5.2
8.1
9.1
5.9
5
0
1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 2020
Projected
THE
COMMONWEALTH
FUND
Data: Centers for Medicare and Medicaid Services, The Lewin Group.
Exhibit 3. Average Family Premium as a Percentage of
Median Family Income, 1999–2020
Percent
25
20
16
17
22 22
21
20 21
20
19 19 19
18 18 18 18 18
23
24
14
15
11
12
13
10
5
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
0
Projected
Data: Commonwealth Fund calculations based on Kaiser/HRET, 1999-2008; 2008 MEPS-IC;
U.S. Census Bureau, Current Population Survey; Congressional Budget Office.
THE
COMMONWEALTH
FUND
Exhibit 4. Total Number of Uninsured, 1963–2010
Millions uninsured
60
53.4
49.6
50
44.8
40.6
40
36.9
37.9
38.4
34.7
30.0
31.0
1980
1987
30
20
10
0
1963
1968
1974
1990
1995
Note: Figures for 1963-1974 are U.S. residents without hospital insurance.
Data: National Health Interview Survey, Current Population Survey, The Lewin Group.
2000
2005
2010
THE
COMMONWEALTH
FUND
Exhibit 5. National Health Expenditures (NHE) Under Alternative
Scenarios, U.S. Constant 2010 Dollars, 1960–2010
NHE in billions
$3,000
Current NHE (Constant 2010 $)
5.2% annual
growth
Clinton (1.5% slowdown)
$2,500
Carter (1.5% slowdown)
Nixon (1.5% slowdown)
4.8% annual
growth
$2,000
$2,110
$1,702
$1,583
$1,500
4.3% annual
growth
$1,000
$500
$2,624
4.2% annual
growth
$204
$0
1960
1965
1970
1975
1980
1985
1990
Data: The Centers for Medicare and Medicaid Services; Bureau of Labor Statistics,
Office of Management and Budget, Congressional Budget Office.
1995
2000
2005
2010
THE
COMMONWEALTH
FUND
Exhibit 6. National Health Expenditures (NHE) Under Alternative
Scenarios, U.S. Constant 2010 Dollars, 1960–2010
NHE in billions
$3,000
Current NHE (Constant 2010 $)
5.2% annual
growth
Clinton (1.0% slowdown)
$2,500
Carter (1.0% slowdown)
$2,270
4.9% annual
growth
Nixon (1.0% slowdown)
$2,000
$2,624
$1,967
$1,875
$1,500
4.6% annual
growth
$1,000
4.5% annual
growth
$500
$204
$0
1960
1965
1970
1975
1980
1985
1990
Data: The Centers for Medicare and Medicaid Services; Bureau of Labor Statistics,
Office of Management and Budget, Congressional Budget Office.
1995
2000
2005
2010
THE
COMMONWEALTH
FUND
Exhibit 7. National Health Expenditures (NHE) Under Alternative
Scenarios, Percentage of Gross Domestic Product, 1960–2010
NHE (% GDP)
20%
NHE (% GDP)
Clinton (1.5% slowdown)
Carter (1.5% slowdown)
Nixon (1.5% slowdown)
OECD Median
18%
16%
14%
17.7%
14.2%
12%
11.5%
10.7%
9.0%
10%
8%
6%
5.2%
4%
3.8%
2%
0%
1960
1965
1970
1975
1980
1985
1990
Data: The Centers for Medicare and Medicaid Services; Bureau of Labor Statistics,
Office of Management and Budget, Congressional Budget Office.
1995
2000
2005
2010
THE
COMMONWEALTH
FUND
Exhibit 8. National Health Expenditures (NHE) Under Alternative
Scenarios, Percentage of Gross Domestic Product, 1960–2010
NHE (% GDP)
20%
NHE (% GDP)
Clinton (1.0% slowdown)
Carter (1.0% slowdown)
Nixon (1.0% slowdown)
OECD Median
18%
16%
14%
17.7%
15.3%
13.3%
12.7%
12%
10%
9.0%
8%
6%
5.2%
4%
3.8%
2%
0%
1960
1965
1970
1975
1980
1985
1990
Data: The Centers for Medicare and Medicaid Services; Bureau of Labor Statistics,
Office of Management and Budget, Congressional Budget Office.
1995
2000
2005
2010
THE
COMMONWEALTH
FUND
Exhibit 9. Federal Health Expenditures (FHE) Under Alternative
Scenarios, Percentage of Gross Domestic Product, 1960–2010
FHE (% GDP)
7%
Current FHE/GDP
6%
Clinton (1.5% slowdown)
6.2%
5%
Carter (1.5% slowdown)
Nixon (1.5% slowdown)
5.0%
4.0%
3.7%
4%
3%
2%
1%
0.6%
0%
1960
1965
1970
1975
1980
1985
1990
Data: The Centers for Medicare and Medicaid Services; Bureau of Labor Statistics,
Office of Management and Budget, Congressional Budget Office.
1995
2000
2005
2010
THE
COMMONWEALTH
FUND
Exhibit 10. Federal Health Expenditures (FHE) Under Alternative
Scenarios, Percentage of Gross Domestic Product, 1960–2010
FHE (%GDP)
7%
Current FHE/GDP
6%
Clinton (1.0% slowdown)
6.2%
5%
Carter (1.0% slowdown)
Nixon (1.0% slowdown)
5.3%
4.6%
4.4%
4%
3%
2%
1%
0.6%
0%
1960
1965
1970
1975
1980
1985
1990
Data: The Centers for Medicare and Medicaid Services; Bureau of Labor Statistics,
Office of Management and Budget, Congressional Budget Office.
1995
2000
2005
2010
THE
COMMONWEALTH
FUND
Exhibit 11. System Improvement Provisions of
National Health Reform Proposals, 2009
Exchange Standards and Plans
Innovative Payment Pilots: Medical
Homes, Accountable Care
Organizations, Bundled Hospital and
Post-Acute Care
Productivity Improvements
Primary Care
Prevention and Wellness
Comparative Effectiveness
Quality Improvement
House of Representatives
11/05/09
Senate
11/18/09
National or state exchanges; private, public,
or co-op plans offered; essential health
benefits 70%–95% actuarial value, four tiers;
insurers must meet specified medical loss
ratio of 85 percent
State or regional exchanges;
private and co-op plans offered;
public plan with state opt-out;
essential health benefits 60%–90%
actuarial value, four tiers plus
young adults policy; insurers must
report medical loss ratio
Adopt medical homes, ACOs, and
bundled payments on large scale
if pilot programs prove successful;
Center for Payment Innovation
Allow Medicaid beneficiaries to designate
medical home; ACOs to share savings in
Medicare; CMS Innovations Center
Modify market-basket updates to
account for productivity improvements
Modify market-basket updates to account for
productivity improvements
Increase Medicare payments for
PCPs by 5%; bring Medicaid PCPs
up to Medicare level
10% bonus payments for 5 years; half
of the costs offset by across-the-board
reduction in all other services
Develop a national prevention and wellness
Provide annual wellness visit and/or
strategy; establish a Prevention and Wellness
health risk assessment for Medicare
Trust Fund; remove cost-sharing for
beneficiaries; strengthen state and employer
proven preventive services; grants to
wellness programs; remove
support employer wellness programs
cost-sharing for proven preventive services
Establish Center for Comparative
Effectiveness Research within AHRQ
Create Patient-Centered Outcomes
Research Institute
Establish the Center for Quality Improvement
to identify, develop, evaluate, disseminate,
and implement best practices; develop
national priorities for performance
improvement and quality measures
Direct HHS to develop national
quality strategy, public reporting
Source: K. Davis, S. Guterman, S. R. Collins et al., Starting on the Path to a High Performance Health System:
Analysis of Health System Reform Provisions of Reform Bills in the House of Representatives and Senate
(New York: The Commonwealth Fund, Dec. 2009).
THE
COMMONWEALTH
FUND
Exhibit 12. Total National Health Expenditures (NHE), 2009–2019,
Current Projection and Alternative Scenarios
NHE in trillions
$5
6.6% annual
growth
Modified current projection*
$5
$4.8
$4.7
$4.5
Current projection
$4
Senate
6.4% annual
growth
$4
6.0% annual
growth
$3
$3
$2.5
Total 10-Year NHE Savings
Compared with Modified
Current Projection
$2
$2
$1
$1.090 Trillion
$1
$0
2009
2010
2011
2012
2013
2014
2015
2016
2017
* Modified current projection estimates national health spending when corrected to reflect
underutilization of services by previously uninsured.
Source: D. M. Cutler, K. Davis, and K. Stremikis, Why Health Reform Will Bend the Cost Curve
(Washington and New York: Center for American Progress and The Commonwealth Fund, Dec. 2009).
2018
2019
THE
COMMONWEALTH
FUND