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A woman gets her blood pressure checked by a registered nurse in Plainfield, Vt., in June 2013.
Associated Press

The national discussion on health care has focused on expanding coverage: How many people are enrolling in insurance under the Affordable Care Act? What is the impact on the number of uninsured? But the conversation will soon shift back to health-care costs because they are rising more sharply again.

Recent reports show that health spending is rising more rapidly after five years of record low increases. Health spending grew by less than 4% per year in 2009, 2010, 2011 and 2012. There had never been even one year where health-care spending grew that slowly since the government started counting it in 1960. The main factor was lingering effects of the slow economy; people put off visits to doctors and hospitals and bought fewer drugs. But changes in health care and health insurance also played a role, including higher deductibles and other cost sharing in private insurance coverage, which also causes people to use less care.

Now utilization is picking back up as the economy improves. The increase in health spending  ticked up past 5% in the last quarter of 2013, and preliminary estimates suggest it continues to accelerate, driven almost entirely by higher health-care use rather than higher health-care prices. Some of the growth so far in 2014, but probably not all, reflects a one-time bump as more people get insured through the ACA and use more health care.

Spending rose by at or near double digits in the late 1980s and early 2000s, and the average over the past 30 years was more than 7%. Are we returning to the norm of around a 7% annual increase, or worse? Or, with more cost consciousness in the system than I have ever seen, will we remain just below it? The stakes here are enormous. Every 1 % rise in the rate of health-spending growth means about $2 trillion more in spending on health over the next 10 years.

We have no national policy on health-care costs and will not have one anytime soon; liberals, conservatives and health care’s big interests could never agree on one. As the discussion turns back to costs, current efforts in the public and private sector, however fragmented and uncoordinated, will need to step up their game.







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