The U.S. health care system is undergoing rapid change and growth. In 1929, expenditures on health care totaled $3.6 billion, or 3.5% of gross national product (GNP). In 1950, that amount had risen to $12.7 billion, or 4.4% of GNP (Rice, 1990). By 1984, expenditures on health care had exploded to $387 billion, or 10.6% of GNP, and by 1994, expenditures were expected to exceed $1 trillion, an estimated 13% of GNP. Growth was even faster in public health care programs. Between 1970 and 1990, Medicare spending increased at an average rate of 14.3%. Moreover, overall health care spending is expected to continue to grow as a percentage of the GNP. Expenditures are predicted to be $1.5 trillion, or $5,550 per capita, by the year 2000 (15% of GNP) and to reach as high as 26% of GNP by 2020 (Young-Mason, 2000).
No other country currently spends as much on health care. In 1990, the United States spent $2,566 per person on health care, whereas Canada spent $1,770; Germany, $1,456; Japan, $1,171; and the United Kingdom, $972, in constant 1990 dollars. Moreover, in contrast to the rapidly rising costs of health care in the United States, costs for most of these countries has stayed steady during the past decade.
Despite the high cost of health care in the United States, and in contrast to other Western democracies, access to services is not available to every American. Estimates of the number of Americans without either public or private insurance on any given day range from 31 to 37 million, the number without coverage at some time during the year is estimated to be 48 million. African Americans, the unemployed, children under 18 years of age, and the poor are more likely to be uninsured (Malchiodi, 1999).............
