Although health care spending began to decelerate sometime after 2002, there has been remarkably slow growth over the past four years.

During the session "What's Causing the Slowdown in Healthcare Spending?" moderator Joseph Antos, American Enterprise Institute, and panelists David Cutler, Harvard University; Robert Reischauer, Urban Institute; and Eugene Steuerle, Urban Institute, debated the causes of the slowdown as well as whether or not it's here to stay.

There was a general consensus among panelists that this slowdown began roughly a decade ago, but really gained traction over the last four years. The lack of growth came about from a number of factors such as the economy, cost-sharing, state and federal policy changes, a downturn in the introduction of new interventions, and a shift in health care coverage. However, beyond this, Reischauer concluded, there isn't much agreement, neither on which combination of factors contributed most to the current state of health care spending nor on whether or not the slowdown will persist.

According to Reischauer, there are two primary schools of thought: 1) the skeptics who believe the spending slowdown is temporary and resulted largely from a combination of the country's economic travails and other "one time factors," not likely to repeat themselves and 2) those who believe that this time things are truly different, that the curve truly is bent, and that future spending growth will likely be fairly moderate.

Antos expressed that there is no simple, two-dimensional relationship between economic growth and health care spending. Like the other panelists, he noted that the reason for slower growth and its potential to last are unclear. These uncertainties make the future hard to predict: "what it means for access to care, quality of care, or what it means for health care innovations."

More evidence is needed to get at the heart of what's going on; it's too early to tell whether the slowdown is cyclical or structural. Furthermore, one of the biggest considerations in health spending currently is that of the Affordable Care Act (ACA). Antos said that though "one can't plausibly say the ACA has much to do with what we've seen in the might have something to do with what we see in the future."

The growth in per capita medical spending has been much slower than anyone previously guessed and there are many elements at play - exogenous occurrences and fluctuations on the demand and supply sides. And yet, the United States continues to grapple with its spending. "Our national debt is the biggest security threat our country faces," said Cutler.

Ultimately, the panelists concluded that there is no question that growth has been slowing both in the public and private sectors. There are, however, many lingering questions surrounding health care spending's future trajectory. According to Cutler, it is the responsibility of employers and of the federal government to enact the right kinds of policies:

We sometimes think of ourselves as geophysicists, trying to predict what's going on, but we can actually define what happens with the policies we choose...Through our actions we control the incentives facing providers. We now need to deliver on those or we'll be back to where we were.