Health costs are cyclical in nature. Per capita health spending goes up and down. The period from 2006 to 2010 saw modest increases between 6% and 3% – the longest period of moderation on record. This could be the effects of a weak economic recovery or, perhaps, growth in cost-sharing and high-deductible plans. Workers in a plan with a $1,000 deductible or more went from 18% in 2008 to 31% in 2011 and from 35% to 50% in smaller firms. Out-of-pocket spending has not gone up as a share of overall health spending, but it has gone up relative to wages. Could it be possible that the recession in combination with high-deductible health plans have caused people to use less health care?