The Rising Cost of Health Care by Year and Its Causes

See for Yourself If Obamacare Increased Health Care Costs

emergency room professionals
Health costs are rising thanks to a reliance on emergency room care. Sam Edwards/Getty Images

In 2015, U.S. health care costs were $3.2 trillion. That makes health care one of the largest U.S. industries, equaling 17.8 percent of gross domestic product. Compare that to 1960, when health care cost $27.2 billion, just 5 percent of GDP.

That translates to $9,990 a year per person in health care costs. That was just $146 per person in 1960. Health care costs rose faster than the annual income. That means health care consumed 4 percent of earnings in 1960 compared to 6 percent in 2013.

(Source: "Health Insurance: Premiums and Increases," National Conference of State Legislatures, November 5, 2016.)

The underlying causes of this massive increase were a combination of government policy and lifestyle changes. The United States relies on company-sponsored private health insurance. The Federal government created Medicare, Medicaid, and other programs to help those who were without insurance. These programs spurred demand for health care services, allowing providers to raise prices. Many other programs designed to reform health care and cut costs increased them instead.

Second, was an increase in chronic illnesses, like diabetes and heart disease. They are responsible for 85 percent of health care costs. Almost half of all Americans has at least one of them. They are expensive and difficult to treat. (Source: "7 Reasons for Rising Health Care Costs," Zane Benefits, May 9, 2014.)

Government Policy

Between 1960 and 1965, health care spending increased by 8 percent a year. That's because health insurance expanded. As it covered more people, the demand for health care services rose. By 1965, households paid out of pocket for 44 percent all medical expenses. Health insurance paid for 24 percent.

 

From 1966 to 1973, health care spending rose 11.9 percent a year. Medicare and Medicaid covered more people, allowing them to use more health care services. Seniors were able to move into expensive nursing home facilities. As demand increased, so did prices. Health care providers put more money into research. That created more innovative, but expensive, technologies. 

Medicare helped create an overreliance on hospital care. Emergency room treatment is very expensive, making up one-third of all health care costs in America. By 2011, there were 136 million emergency room visits. That's because an astonishing one out of five adults uses the emergency room each year. (Source: "Fact Sheet," National Center for Health Statistics, July 2014. “Fact Sheet,” National Center for Health Statistics, February 2014.)

In 1971, President Nixon implemented wage-price controls to stop relatively mild inflation. At first, artificially low health care prices created higher demand. In 1973, Nixon authorized Health Maintenance Organizations to cut costs. These pre-paid plans restricted users to a particular medical group. It provided millions of dollars in start-up funding for HMOs. It required employers to offer them when available.

 (Source: “Nixon’s HMOs Hold Lessons for Obama’s ACOs,” Kaiser Health News, October 21, 2011.)

But Nixon dropped the gold standard that same year. As the dollar's value plummeted, it unleashed double-digit inflation. Health care costs grew at the same rate.

From 1974 to 1982, health care prices rose 14.1 percent a year for three reasons. First, they rebounded after wage-price controls expired in 1974. Second, Congress enacted the Employee Retirement Income Security Act of 1974 (ERISA). It exempted corporations from state regulations and taxes if they self-insured. Companies took advantage of these lower-cost and flexible plans. Third, home health care took off, growing 32.5 percent a year.

Between 1983 and 1992, health care costs rose 9.9 percent annually. Congress expanded Medicaid to include illegal immigrants, children (through CHIP),  and pregnant women.

Prescription drug costs rose 12.1 percent a year. Home health care prices increased 18.3 percent annually.

Between 1993 and 2010, costs grew 6.4 percent a year. In the early 1990s, health insurance companies tried to control costs by again spreading the use of HMOs. Congress then tried to control costs with the Balanced Budget Act in 1997. But that forced many health care providers out of business. So Congress relented on payment restrictions in the Balanced Budget Refinement Act in 1999 and the Benefits Improvement and Protection Act of 2000.

After 1998, people rebelled and demanded more choice in providers. As demand increased again, so did prices. This time, pharmaceutical companies invented new types of prescription drugs. They advertised directly to consumers, creating additional demand. (Source: "History of Health Spending in the United States, 1960-2013," Centers for Medicare and Medicaid Services, November 19, 2015.)

In 2003, the Medicare Modernization Act added Medicare Part D to cover prescription drug coverage. It also changed the name of Medicare Part C to the Medicare Advantage program. The number of people using those plans tripled to 17.6 million by 2016. Those costs rose faster than the cost of Medicare itself. 

The nation’s reliance on corporate private health insurance left many people without a primary care physician. By 2009, half of the people (46.3 percent) who used a hospital said they went because they had no other place to go for health care. These uninsured patients cost hospitals a staggering $10 billion a year. The hospitals passed this cost along to Medicaid. (Source: “Emergency Room Use Among Adults Aged 18–64: Early Release of Estimates From the National Health Interview Survey, January-June 2011,” Centers for Disease Control and Prevention, May 2012. “The Emergency Medical Treatment and Active Labor Act (EMTALA): What It Is and What It Means for Physicians,” National Institute of Health, October 2001.)

Chronic Diseases

The second cause of rising health care costs is an epidemic of preventable health crises. The four leading causes of death are heart disease, cancer, Chronic Obstructive Pulmonary Disorder and stroke. Chronic diseases cause all of them. That means they can either be prevented or treated cheaply if caught in time. Risk factors for heart disease and strokes are poor nutrition and obesity, while smoking is a risk factor for lung cancer (the most common type) and COPD. Obesity is also a risk factor for the other common forms of cancer. (Source: “Under Health Law, Colonoscopies Are Free,” Kaiser Health News, April 25, 2011. “Smoking and COPD,” Centers for Disease Control and Prevention)

These diseases cost an extra $7,900 each, five times more than a healthy person. The average cost of treating diabetes, for example, is $26,971 per family. They diseases are difficult to manage. Patients get tired of taking the various medications. Those who cut back find themselves in the emergency room with heart attacks, strokes, and other complications. (Source: “The Impact of Chronic Diseases on Health Care,” For a Healthier America, 2014. “U.S. Health Care Spending: Who Pays?” California Health Care Foundation, July 2014.)

How the ACA Slowed the Rise of Health Care Costs

By 2009, rising health care costs consumed the federal budget. Medicare and Medicaid cost $676 billion. That’s 10.4 percent of the total budget. Payroll taxes only cover half of Medicare and none of Medicaid. This so-called mandatory spending also included federal and veterans' pensions, welfare, and interest on the debt. It consumed 60 percent of the federal budget. Even worse, retiring Baby Boomers would more than double Medicare and Medicaid costs by 2020. As health care costs increase faster than the economy, Medicare taxes and the trust fund would cover less and less. By 2030, the trust fund would be bankrupt, and taxes would pay for less than half (48 percent) of costs.

Federal health care costs were eating up funding for discretionary budget items, such as defense, education, or the Justice Department. See today's Mandatory Budget

That's one reason why Congress agreed to Obamacare. It required insurance companies to provide preventive care for free. That treated chronic conditions before they required expensive hospital emergency room treatments. It also reduced payments to Medicare Advantage insurers.

Since 2010, when the Affordable Care Act was signed, health care costs rose 4.3 percent a year. It achieved its goal of lowering the growth rate of health care spending. 

In 2010, the government forecast that Medicare costs would rise 20 percent in just five years. That’s from $12,376 per beneficiary in 2014 to $14,913 by 2019. Instead, analysts were shocked to find out that spending had dropped by $1,000 a person, to $11,328 by 2014. That’s for four specific reasons:

  1. The ACA reduced payments to Medicare Advantage providers. That’s because their costs for administering Parts A and B were rising much faster than the government’s costs. They couldn't justify their higher prices. Instead, it appeared as though they were overcharging the government. 
  2. Medicare began rolling out accountable care organizations, bundled payments, and value-based payments. Spending on hospital care has stayed the same since 2011. Part of the reason is that hospital readmissions dropped by 150,000 a year in 2012 and 2013. That’s one of the areas that hospitals get penalized if they exceed standards. That increased efficiency and quality of patient care. 
  3. High-income earners paid more in Medicare payroll taxes and Part B and D premiums. That means the Medicare Part B premium charged to everyone else can probably remain at its current rate of $104.90 per month. For more, see Obamacare Taxes.
  4. In 2013, sequestration lowered Medicare payments by 2 percent to providers and plans.

Based on these new trends, Medicare spending was projected to grow just 5.3 percent a year between 2014 and 2024. (Source: "The Facts on Medicare Spending and Financing," Kaiser Family Foundation, July 28, 2014.)

Health Care Costs by Year

YearNational Health Spending (Billions)Percent GrowthCost Per PersonEvent
1960$27.2NA$146Recession
1961$29.17.1 percent$154Recession ended
1962$31.89.3 percent$166 
1963$34.68.6 percent$178 
1964$38.411 percent$194LBJ started Medicare and Medicaid
1965$41.99 percent$209
1966$46.110.1 percent$228Vietnam War
1967$51.611.9 percent$253 
1968$58.413.3 percent$284 
1969$65.912.9 percent$318 
1970$74.613.1 percent$355Recession
1971$82.711 percent$389Wage-price controls
1972$92.712 percent$431Stagflation
1973$102.811 percent$474Gold standard ended. HMO Act
1974$116.513.4 percent$534ERISA. Wage-price controls ended.
1975$133.314.4 percent$605Inflation at 6.9%
1976$152.714.6 percent$688Inflation at 4.9%
1977$173.913.8 percent$777Inflation at 6.7%
1978$195.312.4 percent$865Inflation at 9.0%
1979$221.513.4 percent$971Inflation at 13.3%
1980$255.315.3 percent$1,108Inflation at 12.5%
1981$296.216 percent$1,273Fed raised rates
1982$334.012.8 percent$1,422Recession ended
1983$367.810.1 percent$1,550Tax hike and defense spending
1984$405.010.1 percent$1,692
1985$442.99.4 percent$1,833 
1986$474.77.2 percent$1,947Tax cut
1987$516.58.8 percent$2,099Black Monday
1988$579.312.2 percent$2,332Fed raised rate
1989$644.811.3 percent$2,571S&L crisis
1990$721.411.9 percent$2,843Recession
1991$788.19.2 percent$3,070Recession
1992$854.18.4 percent$3,287 
1993$916.67.3 percent$3,487HMOs 
1994$967.25.5 percent$3,641 
1995$1,021.65.6 percent$3,806Fed raised rate
1996$1,074.45.2 percent$3,964Welfare reform
1997$1,135.55.7 percent$4,147Balanced Budget Act
1998$1,202.05.8 percent$4,345LTCM crisis
1999$1,278.36.4 percent$4,576BBRA
2000$1,369.77.1 percent$4,857BIPA
2001$1,486.88.5 percent$5,2209/11 attacks
2002$1,629.29.6 percent$5,668War on Terror
2003$1,768.28.5 percent$6,098Medicare Modernization Act
2004$1,896.37.2 percent$6,481 
2005$2,024.26.7 percent$6,855Bankruptcy Act
2006$2,156.56.5 percent$7,233 
2007$2,295.76.5 percent$7,628 
2008$2,399.14.5 percent$7,897Recession slowed spending.
2009$2,494.74.0 percent$8,141 
2010$2,596.44.1 percent$8,404ACA signed.
2011$2,687.93.5 percent$8,638Debt crisis
2012$2,795.44.0 percent$8,915Fiscal cliff
2013$2,877.62.9 percent$9,110ACA taxes
2014$3,029.35.3 percent$9,515Exchanges opened.
2015$3,205.65.8 percent$9,990 

(Source: "National Health Expenditures Summary Including Share of GDP, CY 1960-2015," Centers for Medicare and Medicaid Services. Inflation Rate by Year.)