The Unwell
A scroll-driven history of your U.S. health insurance premium. One small fictional town, six real decades (1960–2026). Health spending climbs from $146 to $15,474 per person per year, and from 5% to 18% of GDP. Every figure is real (CMS, KFF, CDC); the town is not. This feature is interactive and needs JavaScript — the narrative is summarized below.
1960 · House Calls
Health care is 5% of GDP — one dollar in twenty — and about $146 per person. Most bills are paid out of pocket, and most are payable.
1965–1970 · Medicare & Medicaid
Coverage for everyone 65+ and for low-income families. By 1970 the national bill is $74.1B ($353 a person). Coverage is a real win — and it teaches hospitals what guaranteed money looks like.
1980s · The Price Is Wrong
The bill grows because every unit of care costs more, not because people get more care. U.S. prices break away from every peer country and never reconverge.
1990s–2000 · Paperwork City
Spending hits $1.4 trillion (13.3% of GDP). Billing codes, networks, prior authorizations: counting providers' billing, total administration reaches roughly a quarter of all spending.
2000s · The Town Gets Sicker
Adult obesity: 15% (late 1970s) → 42% (2020). Six in ten adults live with a chronic disease, and chronic conditions drive about 75% of all health spending.
2010–2014 · The Affordable Care Act
Coverage expands and the uninsured rate falls toward record lows — but individual-market premiums roughly double ($233→$476/mo, 2013–2017), most ACA co-ops fail, and many counties drop to a single exchange insurer. Subsidies move who pays; they don't set prices.
2015–2019 · Merge & Acquire
1,000+ hospital mergers since 2010; most markets are now highly concentrated. Private-insurance per-enrollee spending rises ~80% (2008–2023) — far faster than Medicare or Medicaid — because private plans pay the highest prices.
2020s · Premium Crunch
The average employer family premium reaches $26,993 in 2025 — about a new Corolla hybrid, every year — with deductibles up 43% in a decade.
The Ledger · 2024
$5.3 trillion. Hospitals $1.63T, physicians & clinics $1.11T, prescription drugs $467B. The big levers are prices, chronic disease, an aging population, and administration.
2026 · Game Over?
18% of GDP; CMS projects 20.3% by 2033. Enhanced ACA subsidies expired this year and the sticker price is back. There is no reset button — but the levers, at least, finally have labels.
Sources
CMS National Health Expenditure Accounts (2024) · KFF Employer Health Benefits Survey (2025) · Peterson-KFF Health System Tracker · CDC / NCHS · JAMA / MEPS · HHS ASPE.