"Wages and health costs rise together," he says. High unemployment has held down wages, which will increase if the recovery strengthens.
Two other pressures suggest higher spending.
First, the main provisions of the Affordable Care Act ("Obamacare") are scheduled to take effect in 2014. The CMS actuaries project that 22 million people will become insured and that total health spending will rise to 18.2 percent of GDP.
The insured use more health services than the uninsured.
Second, an aging and sicker population automatically boosts spending.
In 2009, per capita health spending for those 65 and over was $9,744 compared to $2,739 for adults 25 to 44, reports the Kaiser Family Foundation.
As the elderly's ranks swell, Medicare spending as a share of GDP will rise from 3.7 percent now to 5.1 percent by 2035 even if "excess" medical inflation vanishes, projects Harvard economist Michael Chernew in Health Affairs.
To stabilize total health spending as a share of GDP requires savings to offset these increases. The pressures to cut reimbursement (that's already occurred for Medicare) and eliminate unnecessary or futile care - aka "waste" - won't abate.
One new approach has been "consumer-directed health plans": catastrophic insurance plans with high deductibles of $1,000 or more often coupled with "health savings accounts" to cover ordinary expenses.
From 2005 to 2012, the number of Americans covered by these plans jumped from 1 million to 13.5 million, reports America's Health Insurance Plans, a trade group. A Rand study found that families using these plans cut health care spending by 21 percent.
"When employees see more of their own costs, they spend their money more wisely," says Grace-Marie Turner of the Galen Institute, which advocates these accounts.
For all its tumult, the health care system hasn't changed that much.
Most Americans still consider health care a "right" that should not be compromised when people need it. Fee-for-service - which reimburses doctors and hospitals more for doing more - remains the dominant form of payment.
These have been engines of runaway health spending.
From 1993 to 2000, spending stabilized at 13.8 percent of GDP under the restraint of "managed care." But a public backlash weakened this discipline.
Whether the present slowdown suffers the same fate may depend on whether Americans are willing to modify long-standing attitudes and practices about how medical care is delivered.