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Eli Ginzberg, PhD

JAMA. 1998;279:501-504.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

INTRODUCTION

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

A few other reminders: 2 years before the passage of Medicare, Congress initiated a program of financial support to expand the output of medical schools, an effort that it pursued aggressively until 1976 when the "physician shortage" was declared to have ended.³ Yet, 2 decades after the official demise . . . [Full Text of this Article]

GOALS IN FLUX

DOLLARS

INFRASTRUCTURE

THE UNKNOWABLE FUTURE

From the Eisenhower Center for the Conservation of Human Resources, Columbia University, New York, NY.

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