In a coloquy on "The Last Word" the other day, one of the participants mentioned that the size of the National Health Care budget is really quite extraordinary, dwarfing the defense budget considerably. I was reminded that in 2004, when Howard Dean made a serious issue of health care, the national budget was about two trillion dollars a year and growing quite exponentially. So, I was prompted to check the dimensions of what the Treasury is potentially funding directly if the administration of medical expenditures is consolidated under its jurisdiction, as the PPACA is proposing to accomplish.
The latest compendium of data seems to be from the year 2011 and was published in pdf format by the Center for Medical Services and I have edited the first of three pages for copying ease. But, before I get to that, let me just mention that the single payer mantra was actually a bit confusing because, in fact, the U.S. Treasury is the single issuer of all dollars and the important issue is really how many middlemen there are between the Treasury and the providers of real goods and services. Which, in the case of Medicare is one and Medicaid, which the states administer additionally, the middlemen are two. Private insurers involve either one or two layers of administration, but the individual consumer's outlay is greater to compensate investors with profit.
Whether the U.S. Treasury or the insurance industry come between patients and their doctors is probably not particularly relevant as long as the services needed are paid. What does seem relevant is that the PPACA, in setting up a separate fund, seems to be in the process of effectively removing Congress from the mix. Congress, it would seem, has efectively privatized itself right out of influence. Which probably accounts for the panic on Capitol Hill.
And, with that thought in mind, let's get to the latest figures.
National Health Expenditures 2011 Highlights
U.S. health care spending reached $2.7 trillion in 2011,or $8,680 per person.
Health spending grew 3.9 percent in 2011, the same rate of growth as in 2009 and 2010.
National health spending and nominal Gross Domestic Product (GDP) grew similarly in 2010 and 2011, and health spending as a share of GDP has remained stable from 2009 through 2011, at 17.9 percent.
Health Spending by Type of Service or Product:
Personal Health Care
•Hospital Care:
Hospital spending increased 4.3 percent to $850.6 billion in 2011 compared to
4.9 -percent growth in 2010. The slower growth in 2011 was influenced by a slow down in price growth and continued low growth in the use of hospital services.
*Medicaid spending on hospital services slowed in 2011, while private health insurance and Medicare hospital spending accelerated.
•Physician and Clinical Services:
Spending on physician and clinical services increased 4.3 percent in 2011 to $541.4 billion, accelerating from 3.1-percent growth in 2010. Although growth in prices slowed, nonprice factors such as use and intensity of services increased faster in 2011.
Spending by private health insurance and Medicare, the two largest payers of physician and clinical services, both accelerated in 2011.
•Other Professional Services:
Spending for other professional services reached $73.2 billion in 2011, increasing
4.9 percent and slightly faster than growth of 4.6 percent in 2010.
Spending in this category includes establishments that provide services such as
physical therapy, optometry, podiatry, and chiropractic medicine.
•Dental Services:
Spending for dental services increased 3.0 percent in 2011 to $108.4billion, increasing slightly faster than in 2010 when growth was 2.7 percent.
Out -of-pocket spending for dental services (which accounts for approximately 40 percent of all dental spending) increased 4.1 percent in 2011 following growth
of 0.7 percent in 2010.
•Other Health, Residential, and Personal Care Services:
Spending for other health, residential, and personal care services grew 4.0 percent in 2011 to $133.1 billion, a deceleration from growth of 4.5 percent in 2010.This category includes expenditures for medical services that are generally
delivered by providers in non-traditional settings such as schools, community centers, the workplace, ambulance providers, and residential mental health and substance abuse facilities.
•Home Health Care:
Spending growth for freestanding home health care agencies slowed in
2011, increasing 4.5 percent to $74.3 billion following growth of 5.8 percent in 2010.
Medicare and Medicaid spending, which account for slightly over 80 percent of total home health care spending, both grew at a slower rate in 2011 than in 2010.
•Nursing Care Facilities and Continuing Care Retirement Communities:
Spending for freestanding nursing care facilities and continuing care retirement
communities increased 4.4 percent in 2011 to $149.3billion, an acceleration from growth of 3.2 percent in 2010. The faster growth in 2011 was primarily due to a one-time sharp increase in Medicare spending for skilled nursing facilities, which increased 16.5 percent in 2011 following 7.2-percent growth in 2010.
•Prescription Drugs:
Retail prescription drug spending grew 2.9 per cent to $263.0 billion in 2011,
following a historically low growth rate of 0.4 percent in 2010.
The acceleration in 2011 was partly due to both faster growth in prescription drug prices, particularly for brand -name and specialty drugs, and increased spending on new brands. However, the relatively low rate of growth in 2011 continued to be influenced by slower growth in the number of prescriptions dispensed, increased use of generics, and continuation of patent expirations for brand-name drugs.
To read more,
consult the pdf.