The Inexorable March of Big Government Health Care

According to data released yesterday by the federal government , due to the Affordable Care Act, 6 million more Americans now have insurance through Medicaid. That's a victory for the law and for the Obama administration, and it's also a victory for our national soul, despite the fact that we still have some distance to go before we reach the goal of universal coverage. I want to elaborate on something I discussed this morning at the Washington Post with regard to these and other numbers: The conservative nightmare of a nation of moochers suckling at government's teat for health insurance has, to a substantial degree, come true.

As you might expect, I have a chart. But first, let's go over a few numbers. With these six million new members, enrollment in Medicaid and CHIP (the Children's Health Insurance Program) is now at 64 million. Add in the 52 million seniors on Medicare and the 9 million veterans in the Veterans Health Administration, and 125 million Americans, or 39 percent of the total population, get their health insurance from the government.

I had a little trouble finding historical enrollment data for veterans, but here's how Medicare and Medicaid have grown over the last three decades (data come from here, here, and here):

In 1985, 21 percent of the American population was enrolled in one of these two programs. By 2000 it was 26 percent, after the Great Recession (which made a lot of people newly eligible for Medicaid) it jumped to 33 percent, and according to projections, by 2020 it'll be 43 percent.

If you harbor the hope that one day we might be able to assemble a single-payer health insurance system, that number makes it seem not so out of reach. Not that going to there from where we are now would by any means be easy, but you could envision some kind of reform that combines Medicare and Medicaid into a single program. Throw in the possibility for people and businesses to buy into that program (a public option, if you will), and it could expand even further.

A chart like that one no doubt fills many conservatives with despair, even if most American still get their health insurance through private companies. As the Republicans' repeated failed attempts to privatize Medicare show, it's almost impossible to get people to go along with a change in their health coverage if they're pleased with what they have. That's why one of progressives' primary health care tasks in coming years should be to make sure Medicaid works as well as it possibly can. Imagine if it was as beloved among its recipients as Medicare is now. Republicans would find their efforts to devolve and slash and undermine it equally fruitless. They might even give up trying.


The ACA will never drive down healthcare costs, but a fiercely free market approach could:

The US health care industry is totally and completely opposed to the idea of "free market medicine". The American Medical Association was organized back in 1846 as a means to raise the income of doctors through the creation of a legal monopoly that would allow them to charge considerably more for their services than what was possible under free market conditions. In a free market, there are no prescription laws, medical drugs are available to any adult to purchase with the need for a doctor's prescription. Also, the provision of medical services is not limited to those with MD after their names. Nor is the government involved in regulation of hospitals to the degree it is today. Instead there are multiple "tiers" of providers of medical services (doctors, hospitals, etc). This is "free market medicine". Needless to say, no one involved in the health care industry favors this any more than the United Auto Workers favors "Right to Work". Also, "protectionism" is used to prevent a free trade in health care goods and services. You cannot legally import medical drugs for your own use. The drug companies want Americans to pay far higher prices for the same drug that is sold outside the US for a far lower price. So it has been made illegal for Americans to purchase the same (American made) drug in say Canada which is sold at a lower price than it is here in the US.

All of these things are "why" US health care costs are the world's highest!

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