How the U.S. Spent Its Health Care Dollar: 1929-1980

Prologue: The cost of medical care has become an overriding interest of the health sphere, government, and private payers because medicine has demonstrated a capacity to consume an increasing portion of the gross national product at the expense of other goods and services. Based on the estimates of the Health Care Financing Administration (HCFA) that health care will be a 1. 4 trillion annual enterprise by the year 2000, there is every indication the interest in costs and their moderation will only increase. One dimension of the cost picture that has received less attention is how America spends its medical care dollar. In this essay, authors Marc Berk, Alan Monheit, and Michael Hagan focus on that subject by looking at spending trends over a fifty-year period ending in 1980. Berk joined Project HOPE's Center for Health Affairs in early 1988 as a senior policy analyst after spending nine years at the National Center for Health Services Research and Health Care Technology Assessment (NCHSR), where he was one of the principal designers of the National Medical Care Expenditure Survey. Berk, who took much of his graduate training at Brown University, received a doctorate in sociology from New York University in 1980. He joined the National Opinion Research Center soon afterward to work on the National Medical Care Expenditure Survey, which was underwritten by NCHSR. Berk's research pursuits have included the analysis of the rising costs of medical expenditure surveys and health policy issues relating to access to care (particularly among Hispanics, divorced women, and the elderly), and Medicare and Medicaid. Monheit, who holds a doctorate in economics (from the City University of New York), is a labor economist who has worked at NCHSR for a decade. He is best known in the research community for his work on the relationship between employment and health insurance (see Monheit et al. , “Health Insurance for the Unemployed: Is Federal Legislation Needed? ” Health Affairs, Spring 1984). Hagan, who also is a labor economist, formerly worked at NCHSR as a research analyst.