Exhibit 1. National Health Expenditures per Capita, 1980 2007 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 1980 1984 1988 1992 1996 2000 2004 Data: OECD Health Data 2009 (June 2009).
Percent 25 Exhibit 2. National Health Expenditures as a Percentage of Gross Domestic Product, 1960 2020 21.3 20 17.7 18.9 15.9 15 12.3 13.7 13.8 10 5 5.2 5.9 7.2 8.1 9.1 10.4 0 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 2020 Projected Data: Centers for Medicare and Medicaid Services, The Lewin Group.
Percent 25 20 15 10 11 Exhibit 3. Average Family Premium as a Percentage of Median Family Income, 1999 2020 12 13 14 16 17 18 18 18 18 19 19 19 20 20 21 18 21 22 22 23 24 5 0 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 Projected Data: Commonwealth Fund calculations based on Kaiser/HRET, 1999-2008; 2008 MEPS-IC; U.S. Census Bureau, Current Population Survey; Congressional Budget Office.
Millions uninsured Exhibit 4. Total Number of Uninsured, 1963 2010 60 50 40 30 53.4 36.9 37.9 30.0 31.0 34.7 40.6 38.4 44.8 49.6 20 10 0 1963 1968 1974 1980 1987 1990 1995 2000 2005 2010 Note: Figures for 1963-1974 are U.S. residents without hospital insurance. Data: National Health Interview Survey, Current Population Survey, The Lewin Group.
Exhibit 5. National Health Expenditures (NHE) Under Alternative Scenarios, U.S. Constant 2010 Dollars, 1960 2010 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 $1,000 4.3% annual $500 $204 4.2% annual $0 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 Data: The Centers for Medicare and Medicaid Services; Bureau of Labor Statistics, Office of Management and Budget, Congressional Budget Office.
Exhibit 6. National Health Expenditures (NHE) Under Alternative Scenarios, U.S. Constant 2010 Dollars, 1960 2010 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 $204 4.5% annual 4.6% annual $0 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 Data: The Centers for Medicare and Medicaid Services; Bureau of Labor Statistics, Office of Management and Budget, Congressional Budget Office.
20% 18% 16% 14% 12% 10% 8% 6% Exhibit 7. National Health Expenditures (NHE) Under Alternative Scenarios, Percentage of Gross Domestic Product, 1960 2010 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% 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 Data: The Centers for Medicare and Medicaid Services; Bureau of Labor Statistics, Office of Management and Budget, Congressional Budget Office.
Exhibit 8. National Health Expenditures (NHE) Under Alternative Scenarios, Percentage of Gross Domestic Product, 1960 2010 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% 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 Data: The Centers for Medicare and Medicaid Services; Bureau of Labor Statistics, Office of Management and Budget, Congressional Budget Office.
Exhibit 9. Federal Health Expenditures (FHE) Under Alternative Scenarios, Percentage of Gross Domestic Product, 1960 2010 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% 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 Data: The Centers for Medicare and Medicaid Services; Bureau of Labor Statistics, Office of Management and Budget, Congressional Budget Office.
Exhibit 10. Federal Health Expenditures (FHE) Under Alternative Scenarios, Percentage of Gross Domestic Product, 1960 2010 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% 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 Data: The Centers for Medicare and Medicaid Services; Bureau of Labor Statistics, Office of Management and Budget, Congressional Budget Office.
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).
Exhibit 12. Total National Health Expenditures (NHE), 2009 2019, 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 $0 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 * 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).