The Supreme Court takes up the Affordable Care Act next week, and NPR will be exploring the questions surrounding health care in America beforehand. Many of the publicly debated issues in the act hinge on money. How much is spent on our health? Who spends it? How?
Some know how much we pay for our own medical care, but many aren't aware of how immense an industry health care is in the U.S. Our trips to the doctor employ a lot of people, and our schools play an important role in preparing those people to take care of us.
The workforce numbers don't even count people who work for pharmaceutical or health insurance companies.
All those employees are part of the huge growth in the U.S. health care industry in the last 40 years. If spending keeps climbing as it has, in another 40 years the share of our GDP that goes to health care could be about twice what it is today.
"That either means that we get an awful lot more health care, or we get a lot of health care that's awfully expensive," Anthony Carnevale, a labor economist at Georgetown University, tells NPR's Robert Siegel. "Generally what the research says is it's about 50-50 — we get a lot more health care, and the health care we get a lot more of is more expensive."
The money isn't just from individuals and the private sector. The government is a big player in health care. NPR's Julie Rovner says that while the sector is complex, it's not a predominantly private system.
About 100 million people — a third of the U.S. population — are covered by the major government programs: Medicare, Medicaid and military coverage. Public employees and their dependents who receive health insurance paid for by the government add another big chunk to that amount, bringing the public share of spending to about 45 percent. But government programs don't cover everyone, and about 1 in 6 Americans under 65 is uninsured. Many of those are young adults and children.
For some people, employers fill the gaps in health care that the government doesn't reach. But employer insurance only covers a little over half of U.S. workers, and many Americans are struggling to keep up.
Health care's share of our workforce and our economy keeps on growing, and economists expect it to be about 40 percent of our spending by 2050, up from 18 percent today. Even now, the U.S.'s share is about twice that of other developed nations — most European countries spend about 9 percent of their GDP on medical costs.
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