National Health Expenditure Projections, 2024-33: Despite Insurance Coverage Declines, Health To Grow as Share of GDP, Health Affairs, June 25, 2025, by Sean P. Keehan, et al, Centers for Medicare and Medicaid Services (CMS)
Each year for the full 2024–33 projection period, national health care expenditure growth (averaging 5.8 percent) is expected to outpace that for the gross domestic product (GDP; averaging 4.3 percent) and to result in a health share of GDP that reaches 20.3 percent by 2033 (up from 17.6 percent in 2023).
From the Conclusion
Although the projections presented here reflect current law, future legislative and regulatory health policy changes could have a significant impact on the projections of health insurance coverage, health spending trends, and related cost-sharing requirements, and they thus could ultimately affect the health share of GDP by 2033.
Healthcare Reclaims Top Spot Among U.S. Domestic Worries, GALLUP, March 31, 2026, by Lydia Saad
Healthcare has reclaimed its position as Americans’ foremost domestic concern, returning to the top tier after several years when economic matters commanded more attention. While the percentage highly worried about the availability and affordability of healthcare hasn’t increased over the past year, ongoing public concerns about healthcare costs, including personal challenges in affording care, make this a perennial concern.
Income Inequality Is Surging in the U.S., New Oxfam Report Shows, Forbes, Jan. 8, 2026, by Josie Cox
The richest 1% of households in the United States have accumulated almost 1,000 times more wealth than the poorest 20% over the last three and a half decades, and economic inequality is getting worse at a rapid pace, new research shows.
The analysis, published by Oxfam, found that between 1989 and 2022, a household in the top 0.1% gained an average of $39.5 million in wealth, while a top 1% household gained $8.35 million. By contrast, a bottom 20%-household gained less than $8,500 during the same period.
Over the past year alone, Oxfam noted, the wealth of the 10 richest U.S. billionaires soared by $698 billion. That means that the top 0.1%’s share of total wealth is now at a record high of 12.6%.
“The data confirms what people across our nation already know instinctively: the new American oligarchy is here,” said Abby Maxman, president and CEO of Oxfam America. “Billionaires and mega-corporations are booming while working families struggle to afford housing, healthcare, and groceries.”
Comment:
By Don McCanne, M.D.
Recently, HJM’s editor Jim Kahn asked readers for their input. Readers responded thoughtfully about current problems, views on political context, and a profusion of strategic and tactical ideas.
One suggestion by two readers was that the system should be funded by premiums, not taxes. This is understandable in that most people are generally anathema to taxes, and have been amenable to paying health insurance premiums when they were less expensive and especially if employers paid a significant portion.
Let’s take a close look at whether taxes or premiums should pay for our health care.
A critical consideration is that health care consumes one-fifth of our GDP, and far more than one-fifth of income for the economically less well-off. Assuming that we want to cover everyone’s essential medical care, we need to include them in the risk pool. If each person or family were asked to pay an equal fraction of health care costs as a premium, all low- and most middle-income individuals would be unable to comply, or would do so only by compromising other of life’s necessities – housing, food, or education.
With the recent surge in economic inequality, those at the top would be much more capable of paying, painlessly, into a common pool for health care. Obviously, this would require progressive funding, based on the ability to pay, to subsidize or entirely cover expenses for lower-income individuals and families. Making premiums progressive would be anathema to the idea of premiums, as well as quite complex, adding to our already excessive administrative expenses. On the other hand, we are already accustomed to progressive taxes. We could easily expand these taxes, beginning with zero taxes for the impoverished, expanding to much higher taxes for those who can readily afford them. That applies not only to income but also to wealth taxes — which are naturally attuned to progressive funding. Billionaires might not like the higher taxes, but they could certainly afford them.
The recent Gallup survey shows that health care is now Americans’ foremost domestic concern. We can fix this problem. Even if we dislike taxes, a progressive tax approach would cause us much less concern than widely unaffordable insurance premiums. Making health care accessible and affordable for all is certainly a situation that we could get used to, taxes be damned. It’s the norm in rich nations, so we know how it works.
To my health care justice friends: Please keep reflecting on how we should pay for health care. And elect candidates for Congress and president based on the policy positions you support. And forthrightly communicate to candidates what you believe those positions should be!
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