Healthcare spending in the United States surpassed $2 trillion for 2007. The ominous prediction is that if allowed to proceed unchecked, spending will balloon to more than $4 trillion by 2016 or almost 20% of the gross domestic product. Put in an international perspective, we spend more than twice what Germany, France, Canada or Australia do and yet most of our health outcomes are far inferior to theirs. New York state's bill for healthcare, extrapolated from the national numbers, would have been approximately $140 billion in 2007 and could inflate to over $280 billion by 2016.