• Total spending on health care in the U.S. would rise from 16% of the GDP in 2007 to 25% of the GDP in 2025, 37% in 2050, and 49% in 2082.
• Federal spending on Medicare and Medicaid would rise from 4% of the GDP in 2007 to 7% of the GDP in 2025, 12% in 2050, and 19% in 2082.

• These projections assume no changes to the federal laws governing Medicare and Medicaid spending.
• For the long term, the projections assume the rise in health care costs would cause employers and employees to alter their behavior - employers are assumed to increase employee contributions, reducing coverage, and increasing out-of-pocket charges. Employees are assumed to either shift to lower-premium plans or to limit their use of health insurance. These assumptions are added into the projections because the use of historic growth rates alone would eventually allow health care spending to exceed GDP.

On either side of the CBO's projections are two alternative: a worst-case scenario and a best-case scenario.
In the worst-case scenario, in which the medical expenditures grow 2.5% or more over the growth of the GDP, medical costs spiral up and out of control, forcing many employers to drop employee coverage, massive cuts in Medicare and Medicaid spending, and public hospital and clinic closures as they go unpaid.

The worst-case scenario would likely have much wider implications than just the health care industry. Employers that could or would not drop employee coverage would face huge costs that could potentially cripple them. Insurance companies could face massive costs as payments rise, resulting in either huge losses or dropped customers. State governments would be strapped with growing Medicaid costs. Personal debt would rise as people turn to credit cards to pay for health care.

In the best-case scenario, in which health care costs increase more slowly than the overall rate of GDP growth, health care costs become manageable, and spending falls as a percentage of incomes and the GDP.

• Canada -The Canadian system is for the most part publicly funded, yet most of the services are provided by private enterprises or private corporations, although most hospitals are public. Most doctors do not receive an annual salary, but receive a fee per visit or service. About 30% of Canadians' health care is paid for by the private sector or individuals. This mostly goes towards services not covered or only partially covered by Medicare such as prescription drugs, dentistry and vision care. Many Canadians have private health insurance, often through their employers, that cover these expenses.

• England - The National Health Service provides the majority of health care in England, including primary care, in-patient care, long-term health care, ophthalmology and dentistry. The National Health Service Act 1946 came into effect on 5 July 1948, and is considered the world's first universal health care system provided by government. With the exception of small subsidized charges for prescriptions, dentistry and ophthalmology (which themselves are free to children, the elderly, the unemployed and those on low incomes), all treatment is free. Private health care has continued parallel to the NHS, paid for largely by private insurance, but it is used by less than 8% of the population, and generally as a top-up to NHS services.

• The Netherlands -The Netherlands has a dual-level system. All primary and curative care (i.e. the family doctor service and hospitals and clinics) is financed from private compulsory insurance. Long term care for the elderly, the dying, the long term mentally ill etc. is covered by social insurance funded from taxation. According to the WHO, the health care system in the Netherlands was 62% government funded and 38% privately funded as of 2004.

• Germany - Germany has the world's oldest universal health care system, with origins dating back to Otto von Bismarck's Health Insurance Act of 1883. As mandatory health insurance, it originally applied only to low-income workers and certain government employees, but has gradually expanded to cover virtually the entire population. Currently 85% of the population is covered by a basic 'Statutory Health Insurance' plan, which provides the standard level of coverage. The remainder opt for private health insurance, which frequently offers additional benefits. According to the World Health Organization, Germany's health care system was 77% government-funded and 23% privately funded as of 2004.

• Finland - In Finland, public medical services at clinics and hospitals are run by the municipalities (local government) and are funded 76% by taxation, 20% by patients through access charges, and 4% by others. Private provision is mainly in the primary care sector. There are very few private hospitals. The main hospitals are either municipally owned (funded from local taxes) or run by the medical teaching universities (funded jointly by the municipalities and the national government). According to a survey published by the European Commission in 2000, Finland's is in the top 4 of EU countries in terms of satisfaction with their hospital care system: 88% of Finnish respondents were satisfied compared with the EU average of 41.3%. Finnish health care expenditures are below the European average. The private medical sector accounts for about 14 percent of total health care spending. Only 8% of doctors choose to work in private practice, and some of these also choose to do some work in the public sector.