Health-related expenditures in the United States have represented an increasing share of the national output since World War II, driven primarily by rapidly advancing frontiers of knowledge and exploding demand generated by expansion of third-part payment mechanisms and governmental tax incentives. In the decades ahead, the demands of an aging population will add a new dimension to the forces already driving total expenditures upward. The demographics of the 1990's and beyond pose a challenge to our society which must be faced today.