A recent Wall Street Journal article predicted that health care costs will reach 20 percent of gross domestic product (GDP), and it included a series of charts showing how and why costs have risen. Alas, the newspaper, like the health policy field, failed to note an important date coinciding with the latest dire predictions: We are now in the fiftieth year of the official US health care crisis.
Health care costs had been an on-and-off concern for decades when, on July 10, 1969, President Richard Nixon proclaimed, “We face a massive crisis in this area.” Without prompt administrative and legislative action, he added at a special press briefing, “we will have a breakdown in our medical care system.”
This was not only the first time a president declared a health care “crisis,” it also marked the first attempt at sweeping health care reform far more comprehensive than previous insurance expansion proposals. Leaders of what was then the Department of Health, Education, and Welfare (HEW) added in the press conference that what the administration planned was nothing less than “drastic measures” to cut costs and improve quality via “revolutionary change in the medical care system.”
That is what every single administration since then has promised, in one form or another, as national health expenditures have grown from 6.9 percent of GDP in 1970 to 17.9 percent in 2016, according to the Centers for Medicare and Medicaid Services (CMS). The cautions about impending calamity can almost appear to be cut and paste. So, for instance, the Obama administration warned in year 41 of the crisis (2009): “Soaring health care costs make our current course unsustainable.” In year 50 (2018), the Trump administration used nearly the same language, declaring, “The system we have is unsustainable, and it cannot continue.”