Health care 20 years from now.

Fall 2007

Highlights of a forum convened by David M. Walker US Comptroller General

As Comptroller General of the US, I am afforded a mixed blessing. On the one hand, I am burdened with TMI (too much information) regarding the future of this country's federal fiscal condition and outlook. I live each day with the knowledge and certainty that unless we fix our health care system--in both the public and private sectors--rising health care costs will have severe, adverse consequences for the federal budget as well as the US economy in the not too distant future. On the other hand, my position and long tenure at GAO allow me to bring the message to the public early and often.

So far this year, I've appeared on a number of major radio and television programs, including NPR's Diane Rehm Show, CBS's 60 Minutes and Comedy Central's Colbert Report. Also, since 2005, I have traveled the country with the nonpartisan Fiscal Wake-up Tour--a broad coalition of individuals and organizations led by the Concord Coalition and involving the Brookings Institution, Heritage Foundation and other organizations--to discuss the nation's fiscal challenges in a series of town hall-style forums. Increasingly, and disturbingly, my fiscal message has become a health care spending message. In fact, health care costs represent the number one fiscal challenge for federal and state governments and a major challenge to the competitiveness of US businesses.

I've used another format for shining a light on the challenge posed by rising health care costs on the nation as a whole--2 forums on health care held at GAO, the most recent of which occurred on May 17 2007. Our discussions this year confirmed that little in the health care system has changed since Jan 2004, when GAO held its first health care forum. Our longer-range federal fiscal outlook, owing significantly to federal health care entitlement spending, remains grim; Medicare and Medicaid spending threaten to consume an untenable share of the national economy in the coming decades. Health care spending systemwide continues to grow at an unsustainable pace, eroding the ability of employers to provide coverage to their workers and undercutting our competitive advantage.

Finally, despite spending far more of our economy on health care than other nations, the US has above average infant mortality, below average life expectancy, and the largest percentage of uninsured individuals. In short, our health care system is badly broken.

Nevertheless, I was encouraged to hear participants focus in a constructive manner on a range of possible initiatives for health care reform. Participants examined health care cost, access, and quality challenges in detail.