Exhibit 1. National Health Expenditures per Capita,

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1 Exhibit 1. National Health Expenditures per Capita, Average spending on health per capita ($US PPP) $7,500 $7,000 $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 United States Canada France Germany Netherlands United Kingdom Data: OECD Health Data 2009 (June 2009).

2 Percent 25 Exhibit 2. National Health Expenditures as a Percentage of Gross Domestic Product, Projected Data: Centers for Medicare and Medicaid Services, The Lewin Group.

3 Percent Exhibit 3. Average Family Premium as a Percentage of Median Family Income, Projected Data: Commonwealth Fund calculations based on Kaiser/HRET, ; 2008 MEPS-IC; U.S. Census Bureau, Current Population Survey; Congressional Budget Office.

4 Millions uninsured Exhibit 4. Total Number of Uninsured, Note: Figures for are U.S. residents without hospital insurance. Data: National Health Interview Survey, Current Population Survey, The Lewin Group.

5 Exhibit 5. National Health Expenditures (NHE) Under Alternative Scenarios, U.S. Constant 2010 Dollars, NHE in billions $3,000 $2,500 Current NHE (Constant 2010 $) Clinton (1.5% slowdown) Carter (1.5% slowdown) 5.2% annual $2,624 $2,000 Nixon (1.5% slowdown) 4.8% annual $2,110 $1,500 $1,702 $1,583 $1, % annual $500 $ % annual $ Data: The Centers for Medicare and Medicaid Services; Bureau of Labor Statistics, Office of Management and Budget, Congressional Budget Office.

6 Exhibit 6. National Health Expenditures (NHE) Under Alternative Scenarios, U.S. Constant 2010 Dollars, NHE in billions $3,000 $2,500 $2,000 Current NHE (Constant 2010 $) Clinton (1.0% slowdown) Carter (1.0% slowdown) Nixon (1.0% slowdown) 5.2% annual 4.9% annual $2,624 $2,270 $1,967 $1,875 $1,500 $1,000 $500 $ % annual 4.6% annual $ Data: The Centers for Medicare and Medicaid Services; Bureau of Labor Statistics, Office of Management and Budget, Congressional Budget Office.

7 20% 18% 16% 14% 12% 10% 8% 6% Exhibit 7. National Health Expenditures (NHE) Under Alternative Scenarios, Percentage of Gross Domestic Product, NHE (% GDP) 5.2% NHE (% GDP) Clinton (1.5% slowdown) Carter (1.5% slowdown) Nixon (1.5% slowdown) OECD Median 17.7% 14.2% 11.5% 10.7% 9.0% 4% 2% 0% 3.8% Data: The Centers for Medicare and Medicaid Services; Bureau of Labor Statistics, Office of Management and Budget, Congressional Budget Office.

8 Exhibit 8. National Health Expenditures (NHE) Under Alternative Scenarios, Percentage of Gross Domestic Product, NHE (% GDP) 20% 18% 16% 14% 12% 10% 8% NHE (% GDP) Clinton (1.0% slowdown) Carter (1.0% slowdown) Nixon (1.0% slowdown) OECD Median 17.7% 15.3% 13.3% 12.7% 9.0% 6% 4% 2% 0% 5.2% 3.8% Data: The Centers for Medicare and Medicaid Services; Bureau of Labor Statistics, Office of Management and Budget, Congressional Budget Office.

9 Exhibit 9. Federal Health Expenditures (FHE) Under Alternative Scenarios, Percentage of Gross Domestic Product, FHE (% GDP) 7% 6% 5% Current FHE/GDP Clinton (1.5% slowdown) Carter (1.5% slowdown) Nixon (1.5% slowdown) 6.2% 5.0% 4% 3% 4.0% 3.7% 2% 1% 0.6% 0% Data: The Centers for Medicare and Medicaid Services; Bureau of Labor Statistics, Office of Management and Budget, Congressional Budget Office.

10 Exhibit 10. Federal Health Expenditures (FHE) Under Alternative Scenarios, Percentage of Gross Domestic Product, FHE (%GDP) 7% 6% 5% 4% Current FHE/GDP Clinton (1.0% slowdown) Carter (1.0% slowdown) Nixon (1.0% slowdown) 6.2% 5.3% 4.6% 4.4% 3% 2% 1% 0.6% 0% Data: The Centers for Medicare and Medicaid Services; Bureau of Labor Statistics, Office of Management and Budget, Congressional Budget Office.

11 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 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 Adopt medical homes, ACOs, and bundled payments on large scale if pilot programs prove successful; Center for Payment Innovation Modify market-basket updates to account for productivity improvements Increase Medicare payments for PCPs by 5%; bring Medicaid PCPs up to Medicare level Develop a national prevention and wellness strategy; establish a Prevention and Wellness Trust Fund; remove cost-sharing for proven preventive services; grants to support employer wellness programs Establish Center for Comparative Effectiveness Research within AHRQ Establish the Center for Quality Improvement to identify, develop, evaluate, disseminate, and implement best practices; develop national priorities for performance improvement and quality measures Senate 11/18/09 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 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 10% bonus payments for 5 years; half of the costs offset by across-the-board reduction in all other services Provide annual wellness visit and/or health risk assessment for Medicare beneficiaries; strengthen state and employer wellness programs; remove cost-sharing for proven preventive services Create Patient-Centered Outcomes Research Institute 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).

12 Exhibit 12. Total National Health Expenditures (NHE), , Current Projection and Alternative Scenarios NHE in trillions $5 $5 $4 $4 $3 Modified current projection* Current projection Senate 6.6% annual 6.0% annual 6.4% annual $4.8 $4.7 $4.5 $3 $2 $2 $1 $1 $2.5 Total 10-Year NHE Savings Compared with Modified Current Projection $1.090 Trillion $ * 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).

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