Reinhardt U E
Woodrow Wilson School, Princeton University, NJ.
Physician Exec. 1995 Jan;21(1):10-2.
Almost since the federal government took its giant step into health care delivery and financing in 1965 with Medicare and Medicaid, the emphasis in Washington has been on reducing the costs of health care. Almost all federal health law subsequent to those two programs has been aimed at cost control, even when the titles of the bills promised a more noble purpose. The most notable exception is the law establishing end-stage renal disease coverage, but it has become a prime exacerbator of rising costs. Not even the designers of the federal programs envisioned how quickly health care costs would rise and how substantial the increases would be. The federal tab in 1993 was $280.6 billion. In 1960, it was $3 billion and in 1970 it was $17.8 billion. And overall health care costs have followed a similar curve, growing from 5.3 percent of the U.S. GDP in 1960 and 7.4 percent in 1970 to 13.8 percent in 1993. The end is not in sight. Economists are predicting growth to 18 percent of GDP by the next century. Uwe E. Reinhardt, PhD, James Madison Professor of Political Economics in the Woodrow Wilson School at Princeton University, does not believe that the "bite" will become that large, but he does expect increases to continue into the near future. In the interview recorded in this article, Professor Reinhardt assesses both the current and his predicted financial scenario for the health care field.
自1965年联邦政府通过医疗保险和医疗补助计划在医疗服务提供和融资方面迈出巨大步伐以来，华盛顿一直将重点放在降低医疗成本上。在这两个计划之后的几乎所有联邦医疗法律都旨在控制成本，即使法案的标题承诺了更崇高的目标。最显著的例外是确立终末期肾病保险范围的法律，但它已成为成本上升的主要加剧因素。就连联邦计划的设计者也没有预见到医疗成本会如此迅速地上涨以及涨幅会如此之大。1993年联邦支出为2806亿美元。1960年为30亿美元，1970年为178亿美元。总体医疗成本也呈现出类似的曲线，从1960年占美国国内生产总值的5.3%、1970年的7.4%增长到1993年的13.8%。看不到尽头。经济学家预测到下个世纪这一比例将增长到国内生产总值的18%。普林斯顿大学伍德罗·威尔逊学院政治经济学詹姆斯·麦迪逊教授乌韦·E·莱因哈特博士认为这一“占比”不会变得那么大，但他预计在不久的将来成本仍会继续上升。在本文记录的采访中，莱因哈特教授评估了医疗领域当前以及他所预测的财务状况。
