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in 2009 there is no bigger issue

From CBO documents describing the cost and assumptions behind the $1T dollar Fed expense over 10 years.     No certain way to know the real total cost.  CBO usually undershoots on cost estimates on social programs. 

Estimated costs to households:  pdf file     (Note the incompleteness of the analysis.)

The federal government’s financing of health care will total more than $1 trillion in 2009, all told. Federal outlays for Medicare and Medicaid are about $700 billion; tax preferences for health care (especially the exclusion of premiums for employment-based health insurance from income and payroll taxes) amount to more than $250 billion; and the federal government also pays for veterans’ health care, public health initiatives, and other health programs. Already, those direct and indirect payments for health care account for nearly 60 percent of total health expenditures for the nation.

Many experts think that transformational changes in health care financing and delivery could reduce the federal budgetary commitment to health by more than the 10 percent increase that would result from a large-scale expansion of insurance coverage. Achieving substantial and lasting savings, however, would require fundamental changes in the organization and delivery of health care. 

Examples of efficient care certainly exist today, with many individual health care providers and groups of providers offering both high quality and relatively low cost.

Yet applying the methods of those efficient providers throughout the health care system cannot be accomplished through fiat or good intentions. Instead, the government controls two powerful policy levers for encouraging changes in medical practice.

 

From the other pdf on response to questions on costs to users:

Although the proposals generally are not specific enough for CBO to estimate their budgetary impact, several are similar to approaches that the agency has previously analyzed. They include the following:

� Reducing Medicare payments to hospitals with high readmission rates, which CBO has estimated could save between $5 billion and $10 billion over 10 years;1

� Capping the amounts of noneconomic and punitive damages that can be awarded in malpractice claims, which the agency has said could result in net federal savings of around $5 billion over the next decade;2

� Establishing a pathway for regulatory approval of so-called follow-on biologics, which, according to CBO’s estimate, could yield federal savings of approximately $10 billion over that same span;3

� Extending prescription drug coverage to the entire population, which would probably increase the deficit significantly; and

� Expanding the use of home and community-based services in Medicaid, which would generally increase federal spending—depending on the details, from about $8 billion to almost $90 billion over 10 years, according to CBO’s estimates.4

In summary, the industry documents describe a number of initiatives that may affect the quality and the cost of health care but sometimes would not involve the federal government at all.

Only a subset of the initiatives could result in savings (or costs) that would be relevant for CBO’s cost estimates for legislative proposals, but more specific legislative details would be required in order to prepare such estimates.