The magnitude of public expenditures in any
health care system is important because it indicates
the amount of attention governments are likely to
pay to the system and thus the influence they bring
to bear on its configuration. Rhetoric notwithstanding,
the government’s role in the financing and regulation
of health care has grown inexorably under
both Republicans and Democrats ever since the enactment
of Medicare and Medicaid in 1965. As the
health economist Victor Fuchs puts it, “No matter
how committed the country is in general to the idea
of free markets and capitalism, government plays a
substantial role in health care.