In 2023, U.S. federal, state, and local governments spent a combined total of $9.6 trillion, or 35.1% of the U.S. economy as measured by gross domestic product. This figure has risen from around 10% in 1930 and doesn't include the costs of government mandates that shift the expenses of their policies to the private sector. For example, the federal government sets minimum prices for certain products, and it requires most hospitals with emergency rooms to provide an "examination" and "stabilizing treatment" for anyone who comes to such a facility and requests care for an emergency medical condition or childbirth, regardless of their ability to pay and immigration status. Such costs are ultimately borne by paying customers.