The United States spends more on health care than any other country in the world. Spending in 1998 averaged $4,094 per person, compared to $2,689 in 1990, $1,052 in 1980, $341 in 1970, and $141 in 1960. The only countries that approached the United States in per capita spending were Switzerland ($2,412), Germany ($2,222), Luxembourg ($2,206), and Canada ($2,002). In the United States, spending on health care exceeded $1.1 trillion in 1998, up from $699.4 billion in 1990, $247.3 in 1980, $73.2 in 1970, and $26.9 billion in 1960.

Yet millions of Americans still do not have adequate access to health care because they lack insurance coverage. An estimated 44.2 million people had no health insurance in 1998. Access is a greater problem in the United States because most other industrialized countries have national health insurance systems that cover medical expenses. Since the 1960s, the United States Congress established and expanded programs to improve access to care. Medicare, the major program, covered about 38 million people over age 65 and people with disabilities in 1997. Another was Medicaid, a federal-state program that covers low-income people. During the 1990s, Congress considered and rejected proposals to establish a national health insurance system or extend government health care benefits to more people. The high costs of such a program were among the reasons for rejection.