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PROLOGUEHealth Spending In 2006Health care spending is a bread-and-butter topic of any policy conversation involving U.S. health care, forming one leg in the familiar triad of cost, quality, and access. Anyone who needs evidence of this need look no further than Health Affairs’ archive, which indicates that about 60 percent of the papers published since 1981 have mentioned spending on health or health care at least once. Our coverage over the years has involved many different aspects of the debate, including descriptive work and projections but also exploring subtler aspects of problems surrounding spending and its broader implications, often with surprising results. This work recently caught the attention of the Congressional Budget Office, which cited several Health Affairs spending papers in its report, "The Long-Term Outlook for Health Care Spending" (November 2007). These spending papers are perennially among the journal’s most-read and most-cited papers: In 2006 the annual projections and historical estimates appeared as the second and third most frequently downloaded articles from the Health Affairs archive, and ten of the twenty-five most-downloaded articles that year dealt with some facet of health spending. The releases of such papers are highly anticipated media events, as regular coverage in the nation’s major daily newspapers attests. The importance of health care spending also extends well beyond the realm of the policy wonk, figuring prominently in the consciousness of the American people—a fact reflected in the campaign rhetoric of those running for their parties’ respective presidential nominations in 2008. Every year the Office of the Actuary at the Centers for Medicare and Medicaid Services (CMS) produces estimates of our national health spending, and Health Affairs has published these estimates since 1988. This year’s analysis, by Aaron Catlin and colleagues, is the first to measure the full effects of a major policy change—the introduction of Medicare Part D—on the level of spending and the rearrangement among sponsors, sources, and uses of funds (the last such opportunity, on a larger scale, occurred when Medicare and Medicaid were introduced in the 1960s). Some large-scale effects were predictable; however, the data show complex, sometimes surprising, relations. The trend in this century has been decelerating growth in all three measures of cost: total, per capita, and relative to income. Will the slowdown continue, or are we due for renewed acceleration? In a Perspective that looks at historical trends and the likely lagged effects between income and health spending, Paul Ginsburg of the Center for Studying Health System Change urges us to leave the champagne in the refrigerator for now. It’s a sign of how intractable health spending growth looks, that anyone could contemplate celebrating reduced speed, never mind an actual stabilization or reduction of the one-sixth of income that health care consumes.
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