We may not have government-run health care, but according to new data analyzing the distribution of health care spending and subsidies in 2002, we certainly have a hefty amount of government-funded health care. About 56.1% of all health spending comes in the form of public outlays. Of this, about 28 percent is tax subsidies (like the employer health deduction) and 72% is Medicare, Medicaid, and assorted other programs. And while most of this spending is on the old and the ill, somewhat less than you'd think is on the poor. In fact, "the public sector finances nearly half of all health care spending for families with incomes over four times the poverty line." In other words, our health care system isn't nearly so free of government as some like to suggest. But in a uniquely American twist, we've managed to offload an incredible amount of spending onto government but done so in a way that ensures the government can't use its size or regulatory power to cut spending growth or produce a manageable, moral health system: So Medicare Part D can't bargain for better drug prices; Republicans have systematically killed attempts to produce good cost-effectiveness research that could be used to cut waste; insurers operate in a confusing-but-counterproductive regulatory structure which spurs them to compete on risk-shifting rather than better care delivery; the government pays billions in tax subsidies so paper companies, toy retailers, and assorted employers to act as middlemen in the health care system, etc. Other countries, of course, don't have these problems. They realized early on that if you were going to guarantee health care to your segments of your society and accept the government intrusion that entails, you may as well do it right, and leverage the benefits of government involvement to restrain spending and rationalize your delivery system. And it worked: Our per capita spending is double that of any other industrialized country, even as they cover all of their citizens (we don't) and boast outcomes that are comparable, and frequently better, than ours. Sadly, we've decided to go with the worst-of-all-worlds compromise: Demand lots of government involvement, but stubbornly insist on doing it wrong.
