The Slippery Slope to Socialized Medicine

Daniel Gross makes the point that completely apart from Barack Obama’s proposals, the private sector health insurance system is inexorably unraveling:

The latest report from the Census Bureau on income, poverty, and health insurance is full of interesting data. (For example, median household family income in 2008, at $50,303, was below where it was in 1998. Heckuva job, Bushie, Greenie, and the whole economic team!) Perhaps the most surprising census data are the significant evidence that, even absent a reform bill, the United States is slowly nationalizing health care. In 2008, enrollment in Medicare and Medicaid rose from a combined 81 million to a combined 85.6 million. Add in military health care, and some 87.4 million Americans in 2008 got health insurance directly from a government source—about 29 percent of the total. Meanwhile, health insurance became less tethered to work. The percentage of people covered by employment-based health insurance fell from 59.3 percent in 2007 to 58.5 percent 2008, and the percentage of those working full-time and part-time who lacked health insurance rose in 2008. The ranks of those getting insurance from employers include a substantial number of public employees—teachers, state workers, etc. (In August, government accounted for about 17 percent of payroll jobs.) Add those folks to the people receiving coverage from Medicare, Medicaid, and the military, and, as Jon Bon Jovi once put it, “we’re half way there.” Most of the Americans who have insurance may already be getting it through the government, one way or another.

See also this CBPP chart:

Obama’s proposals have been structured to try to avoid accelerating these trends. But if his framework were put in place, it would be easy enough to tweak so as to really change things. As written, the public option would be part of a Health Exchange that most people can’t participate in. But if the Exchange works well then there will presumably be pretty to open it up (à la a proposal from Ron Wyden) in which case pretty quickly most people might be getting their insurance in a very different way from how it mostly works today.