So, what's the fuss? Health care costs too much. Health care costs a lot of money, and the rate of increase in that cost is outpacing increases and workers wages, and the overall economic growth in the United States. If you will indulge me for a few minutes, I would like to talk about why that is a problem. Health insurance premiums and workers' contributions to those premiums have been on a steady incline. However, it is obvious to say, that worker's earnings as well as underlying levels of inflation have not been able to keep up. In fact, although both have also been on a steady incline, look at the gap between the worker's earnings, contributions, and premiums. It is outrageous. Individuals, businesses, and the government are all impacted. How can this be sustained? How is this increase affecting the average individual? As health care costs and premiums increase, an increasing share of a person's income is paying for health insurance. Which means there is less money to spend on other things. Both necessary things like food and clothing, as well as discretionary items like going on vacation. It is also becoming increasingly unaffordable for businesses and the government. For businesses, higher health care expenses mean higher cost to run their business, and the need to charge higher prices for their goods and services. For state and federal governments, when an increasing amount of money is spent on health care, that means that less money is available for other things like education, infrastructure, and discretionary spending. Let's look at data provided by several entities, that compile data and statistics, on spending and economic indicators. All of that data from 1987 to 2016, was accumulated to create this chart, that highlights the continued growth in health care spending relative to underlying economic factors. Let's explain. The blue line represents the annual change in gross domestic product or GDP, which is the total value of goods produced and services provided in the United States, each year. The red line represents the annual increase in national health spending. Note that, I say increase as there were no annual reductions in national health expenditures during this time period. The three bars, highlight various recessions that occurred during this time frame, and the width indicates the duration of those recessions. This allows us to see the sharp reductions in GDP, during and immediately after recessions, yet limited to no change in annual growth of health care expenditures. The most important takeaway from this chart, is that national health expenditures continued to grow albeit at lower rates, at times, in spite of downturns in the economy and deceleration in GDP. Let's look at US spending in context with other countries. The US spends far more per capita, and as a percentage of GDP than any other country. This chart illustrates that, the US spends far more as a percentage of GDP than any other country. In 2016, the US was spending over 17 percent of its GDP, and approximately $9,000 per person on health care with the next closest spending country Switzerland, spending 12 percent of its GDP and approximately $6,700 per person. What does this mean? Well, simply put, it means that health care spending makes up a large portion of spending in the United States, which is continuing to increase year over year, widening the gaps in comparison to other countries. Let's continue to look at these countries, and now more specifically at the health care spending per capita or per person. As you can see, compared to other countries the United States has spent more per person than any other country consistently for the past 16 years, and that difference is growing. When we compare vital statistics across populations, we are not seeing that the US population is healthier, or living longer, with lower life expectancy and higher infant mortality. In spite of the higher health care spending in the United States, the quality or overall health outcomes are not commensurately better. In fact, there seems to be little correlation between the cost and quality of care. Higher health care spending is more related to higher income. This is where the fuss comes in. Individuals, businesses, and government purchasers should care, that they are spending more for a product, specifically health care, but not receiving a better product or outcome. Also, we need to consider the deeply personal nature of health care and the reticence of many to want to challenge the price or cost of their health. Let's take some time, to reflect on these sobering truths. Perhaps, while we reflect, let's think of reasons why discussing these topics is necessary, and where you think the United States will be, in the very near future.