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
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