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Policy Perspectives
February 18, 1998

The Changing US Health Care Agenda

Author Affiliations

From the Eisenhower Center for the Conservation of Human Resources, Columbia University, New York, NY.

JAMA. 1998;279(7):501-504. doi:10.1001/jama.279.7.501

WHEN MEDICARE AND MEDICAID were enacted in 1965, informed opinion in Washington, DC, and elsewhere anticipated successive national legislation that would result in universal health insurance coverage within 1 or at the most 2 decades. The federal actuaries estimated that total outlays for Medicare in 1990 would come to $10 billion, a far cry from $180 billion, the staggering total reached in 1996.1 And nobody foresaw the explosive rise of national health care expenditures from $41 billion in 1965 to $1 trillion in 1996, with an expected further doubling to over $2 trillion in 2007 or shortly thereafter.2