Analyzing the financial realities of our nation’s public finance and social insurance programs.

Enhancing Perspective. Improving Outcomes.

We believe America's Social Insurance Programs Are Not Financially Sustainable

Our Mission: Provide full, accurate, and easily understood analyses of the financial realities affecting the funding and security of our nation's public finance and social insurance programs. These programs include federal, state, and local retirement, healthcare, and other publically funded social entitlements dependent on long-range planning and advance funding.

What We Hope to Achieve: Ensure that the nation's public finance and social insurance programs are designed and managed with the actuarial discipline and transparency such programs deserve and should require.

What We Do: Seek illumination and understanding of and agreement about, the facts affecting the nation's public finance and social insurance programs and their stakeholders.

Share information with the nation's public finance and social insurance programs’ stakeholders including beneficiaries, current, and future taxpayers, and policymakers.

Advocate for rigorous standards, disciplined program costing, management metrics, and transparency.

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American Healthcare 2022 - Now What?

Are you as an employer, health care provider, insurer, elected official, community leader and/or taxpayer satisfied with the current quality, availability, accessibility, cost and sustainability of health care in your community? If not, we would urge you to be aware of the following information.

It seems increasingly clear that American Health Care will be shaped by another decade of spectacular scientific breakthroughs and new technical accomplishments.

Unfortunately, unless we can significantly improve the health care policy decision-making process, its seems equally clear that the current health care system will continue to be plagued with funding issues that challenge taxpayers and patients and create access problems for rural and low-income populations, both of which adversely affect the nation’s overall health status and the productivity of its workforce.

This disconnect between our scientific and technological capacity to do better for people who need care and our ability to deliver that care equitably in an efficient, effective and affordable manner represents one of the largest human and financial challenges facing the nation, its people and its employers.

As the United States Congress weighs the merits of a $3.5 trillion investment in infrastructure  initiatives that sponsors say would be paid for partially with reductions in health care costs, the need to address this disconnect becomes even more important and urgent. The disconnect evolved over decades of policy debates too narrowly focused (i.e., cost versus coverage) and inadequately informed regarding holistic impact and unintended consequences. It will continue to get worse unless we address the fundamental need for better analytics and recognize the need for on-going, outcome-driven evaluation and correction.


“The offsets for the $3.5 trillion in proposed new spending are in three main buckets: “health care 

  savings, reforming the tax code [and] long-term economic growth.”

  Punchbowl News, July 14, 2021

The Concerned Actuaries Group, a non-partisan 501(c)(3) organization has spent the past two years developing a comparative actuarial assessment model (CA2M) capable of providing the health care policy making process (e.g., policy-makers, consumers and the media) with far greater, more holistic analytical capacity to evaluate the potential impacts of proposed changes to the system.


This past year we recorded a series of discussions about the disconnect, the need for better decision-making and the role of the CA2M model that we believe you and your peers could find useful as you think about how to engage with the inevitable next national debate about delivering and paying for health care in the 21st Century. To access, visit our Healthcare Tab or click on the video link below.

Please take a look at what’s being said, and if you think it worthwhile, share it with as many people as you think might find it helpful.


Thank you.


Mark Litow, FSA, Milliman Principal (Ret.) - Chair, Concerned Actuaries Group

Ronald Colby, FSA, Former CEO, UnitedHealthCare Insurance Company; Founding Partner Insurex,

Robert Collett, FSA, Former CEO, Milliman (Ret.)


The United States spends more on health care than any other country in the world, and a large share of that spending comes from the federal government.

In 2017, the United States spent about $3.5 trillion, or 18 percent of GDP, on health expenditures - more than twice the average among developed countries.

Of that $3.5 trillion, $1.5 trillion, is directly or indirectly financed by the federal government. In other words, the federal government dedicates resources of nearly 8 percent of the economy toward health care. By 2028, we estimate these costs will rise to $2.9 trillion, or 9.7 percent of the economy. Over time, these costs will continue to grow and consume an increasing share of federal resources.

Over the long term, the rising cost of federal health care spending is clearly unsustainable. Without a course correction, the result will be program insolvency, crowding out of important public priorities, and a growing federal debt.

Given how central health care spending is to the federal budget, it is important to understand how that spending is distributed and how it will grow. This paper will provide background on major health care programs in the federal budget. It is the first in a series called the American Health Care initiative, a joint collaboration of the Committee for a Responsible Federal Budget and the Concerned Actuaries of the U.S.


Health care benefit payments are made by a variety of different entities and are financed in different ways. There are, for example, public tax-supported programs including Medicare, Medicaid, the Affordable Care Act and the Children’s Health Insurance Program. There are also employer and individual sponsored premium financed insurance programs And, of course, there are out of pocket costs paid for by individuals and families.


This article, Who Pays, requires a “Spoiler Alert,”which is that the American Health Care business model is simply not working. That conclusion is supported by the three major take aways in the article, including:


• the numbers don’t work in terms of sustainability or sufficiency;


• there are political and financial tensions in the American health care system that work against the system’s need for public awareness, accountability, and capacity to address problems in a timely manner; and,


• the distribution of services, costs, and payments on the one hand and collection of taxes, premiums and fees to fund the payments on the other does not effectively recognize or manage either the differences between insurance coverage and different types of subsidized care or the redistribution of income required to support the subsidized care.


We don't have enough data in order to make informed decisions with regard to coverage, cost and quality. This is where CAUS comes in. We need much better data to make more informed decisions to get us from where we are to where we need to be.

David Walker, Former United States Comptroller General 


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