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The total national expenditure for health in fiscal 1975 was $118.5 billion, which included $46.6 billion for hospital care, $22.1 billion for physician services, $10.6 billion for drugs, $9 billion for nursing-home care, $7.5 billion for dentists' services, $3.5 billion for Government public health activities and $2.8 billion for medical research. Third-party payments (public and private) for medical care increased from 35% in 1950 to nearly 70% in 1975, thus leaving about 30% of the total to direct payments by the beneficiaries—a significant burden. Hospitals, physicians and drugs consumed almost 70% of the total expenditure. Gross overuse of all three has become a major problem.
The consumer movement focused on the skyrocketing costs of medical care, questioning doctors' fees and incomes, their unavailability and the amounts of unnecessary surgery. Mass media joined the assault, along with those largely liberal politicians trying to generate support for national health insurance as the antidote. The American Medical Association was increasingly viewed as a guild, mostly interested in the welfare of its own members. Nonetheless, virtually every poll of attitudes toward different occupations continues to show that the American physician ranks No. 1 and enjoys immense prestige, exceeding that of Senators and Supreme Court Justices. My doctor is great—it's those doctors!
Where do we stand today, and what are our prospects for health beyond 1976? Gone are the
scourges of smallpox, yellow fever, tuberculosis, measles and infantile diarrhea. Life expectancy has increased from 47.3 years in 1900 to 72.4 years in 1975. Of the roughly 2 million deaths annually in the U.S., 37.8% are due to heart disease, 19.5% to cancer, 10.2% to strokes, 4.3% to lung disease (pneumonia, bronchitis and emphysema), 5.3% to accidents, 1.9% to diabetes, 1.7% to cirrhosis of the liver, 1.4% to suicide and 1.1% to homicide. But death statistics give only part of the picture. For every successful suicide, eight others (or 200,000 people) may have made the attempt. For every person who dies of cirrhosis—commonly related to alcoholism and malnutrition—at least 200 and probably 300 people can be classified as alcoholics (10 million Americans). For every accidental death, hundreds are injured, some permanently disabled. Twenty-four million Americans, 11 million of whom receive no federal food stamps, live below the federally defined poverty level, a level that does not support an adequate diet. Venereal disease has been increasing annually, with nearly 1 million cases of gonorrhea and syphilis reported last year.