Need for Reform

This page covers information on U.S. health care expenditures, excessive cost of pharmaceuticals, why employers seek universal health care, and links to documentation that demonstrate the critical need to reform U.S. health care. 

The U.S. national debt is more than $35 trillion and growing by $1.5 to $2.0 trillion per year.  The increasing size of the national debt, inhibits federal funding for Medicare, Medicaid, and Social Security.

Need for reform

Excessive Cost Of U.S. Health Care

  • U.S. National Health Care Expenditures (NHE) for 2023 were $4.66 trillion; $13,413 per person (link.)
  • U.S. NHE expenditures are more than two times the per person average of similar industrialized nations (link).

Breakdown Of 2022 NHE (US. National Health Care Expenditures)

  • Medicare expenditures: $944.3 billion; 21% of NHE.
  • Medicaid expenditures: $805.7 billion; 18% of NHE.
  • Private health insurance: $1.23 trillion; 29% of NHE
  • Out-of-pocket (what patients paid): $471.4 billion; 11% of NHE.
  • Other third-party payers, programs and public health activity expenditures: $564.0 billion; 13% of NHE.
  • NHE Fact Sheet

Waste And Fraud In U.S. Health Care

  • Recent and past studies estimate “waste” of 25% in U.S. NHE (national health care expenditures) (link).
  • For 2023, that waste represents about $1.15 trillion.
  • Medicare fraud is estimated at more than $100 billion annually (link).

Excessive Costs Of Pharmaceuticals

  • US. pharmaceutical prices are 2.78 times greater than in 33 other countries, based on 2022 data (link).
  • US. prices for brand-name drugs are 4.22 times higher than those in other peer nations (even after manufacturer-funded rebates, the prices are still more than triple those in other nations).

Decreasing Quality Of U.S. Health Care​

  • In spite of spending two times more per person than other nations, the U.S. is ranked eleventh in health care quality among similar nations (link).
  • The U.S. ranks last on access to care, administrative efficiency, equity, and care outcomes (link).

The Uninsured, Under-insured, And Medical Debt

127.7 million people – 38.0% of the U.S. population – are uninsured, under-insured, or have medical debt.

  • 27.3 million U.S. persons under the age of 65 are uninsured (link) (8% of U.S. population).
  • 59.4 million of U.S. adults are under-insured (inadequate insurance to cover expenses) (link) (23% of U.S. population).
  • Nearly 23 million U.S. adults owe $220 billion in medical debt (link) (6.7% of U.S. population).

Underfunded Medicare And Medicaid​

  • Medicare is projected to be underfunded by 2036 (link).
  • Without reform, Medicare and Medicaid will be unaffordable for citizens and the nation.
  • Without reform, transition to universal health care will be unaffordable for citizens and the nation.

Rising Costs For Health Care

Medical care prices and overall health spending typically outpace growth in the rest of the economy. Health costs represent a growing share of gross domestic product and many American families have seen the costs of health services and premiums grow faster than their wages (link).

  • In 2024, employer and employee health care costs are projected to rise by 6.5% (link).
  • Health care costs are rising at more than twice the projected 2024 overall U.S. inflation rate (link).
  • The 2024 6.5% increase, represents additional costs of $58.3 billion for employers and $14.9 billion for their employees; though many employees may still be under-insured.

Employers Cannot Afford To Provide Health Care Benefits For Their Employees

In April of 2021, Kaiser Family Foundation (KFF) (link) published a survey of corporate CEOs on “How Corporate Executives View Rising Health Care Cost and the Role of Government”.

The survey results (link) demonstrated a tipping point had been reached; employers seek government assistance to reduce the costs of health care benefits to their employees (employers are seeking universal health care).

  • 87% of employers believe in the next 5 to 10 years the cost of providing health benefits will become unsustainable
  • 86% believe a greater government role in providing coverage (universal health care) and containing costs would be better for their employees
  • 83% stated it would be better for their business.

Employers Have Reached Their Limit​

This [KFF]survey highlights what we’ve understood for some time:

The current [U.S.] health care system is on an unsustainable path.  Our large employer members support competition and prefer market solutions.”

But they have reached their limit; they’re tired of pouring tons of money into a broken health care market that delivers uneven quality at bloated costs.*  

*Comments by the president of PBGH, a cosponsor of the KFF-PBGH survey.  PBGH works to increase health care value for private employers and public purchasers. (link).”

Costs Of A Pandemic​

  • The U.S. federal government’s direct costs, related to the Covid pandemic, were $4.6 trillion (link).
  • The estimated direct and indirect costs were projected at $16 trillion (link).
  • The U.S. and global nations cannot afford the social or economic costs of another pandemic.

Universal Health Care

Public insurance (government funded) and out of pocket costs paid by patients, represent is 53.6% of the total U.S. NHE (national health expenditures).

  • Public insurance represents 43.0% of 2022 NHE; Medicare, Medicaid, CHIP, Veterans Administration and Department of Defense.
  • Out of pocket (what patients pay directly is 10.6% of 2022 NHE.

 

Americans pay substantially more for a health care system that delivers substantially less than the person cost of universal health care programs of peer nations.

The U.S. National Debt And Health Care​

The continuing growth of the U.S. national debt imperils the full funding of Medicare, Medicaid, Social Security, and other important programs.

  • In 45 of the last 50 years, the federal government has spent more than it collected from taxes and other sources (link).
  • The national debt increases when the government borrows money to fund the deficit between revenues (what government collects) and expenses (what government spends) (link).
  • In 2023, the federal government collected $4.4 trillion in taxes and spent $6.1 trillion, resulting in a deficit of $1.7 trillion that had to be funded with new national debt (link).
  • The national debt is currently at $35 trillion and growing daily (link).
  • By 2036, Medicare will be under-funded and the national debt is projected at more than $50 trillion (link).

Social Security

By 2035, Social Security benefits will be reduced by 25%, if Social Security taxes are not raised (link) (link).

Medicare, Medicaid, and Social Security represent $2.75 trillion and 45% of the federal government’s 2023 spending (link). The more we reduce capital waste and fraud and the overall costs of U.S. health care:

  • Medicare and Medicaid will be more secure.
  • The nation can transition to universal health care.
  • The savings achieved in health care can assist in extending the full benefits of Social Security beyond 2036.

Impact Of Decreasing Buyers Of U.S. Debt​

  • As the U.S. national debt increases, the pool of buyers of new U.S. debt decreases and the costs of financing new debt and supporting previous debt, increases.
  • As debt costs become prohibitive, Medicare, Medicaid, and Social Security will experience substantial cuts in access, benefits, and services.

 

An internet search yields a sobering plethora of articles on the national debt’s threat to our fiscal and social stability.

  • A Warning About the Nation’s Fiscal Health, U.S. Government Accountability Office (GAO) (link)
  • The U.S. National Debt Dilemma, Council On Foreign Relations (link)
  • A Million Simulations, One Verdict for US Economy: Debt Danger Ahead; com (link)