During the legislative debate over the passage of President Obama's healthcare law, supporters of the program were sensitive to any suggestion that it represented a government takeover of the healthcare system.
Back in 2010, PolitiFact branded the charge that Obamacare was a "government takeover" as its "lie of the year."
But as time has gone on, it's become clear that the critics of Obamacare were correct about the government's role under the program – a reality that was reinforced by new federal data.
To be clear, it's fair to acknowledge that Obamacare didn't instantly turn the United States into Britain, where government runs the hospitals, pays the doctors, and provides nearly all the healthcare services. But it did put the healthcare system on the path to single-payer.
In 2014, according to new data from the Centers for Medicare and Medicaid Services published in the journal Health Affairs, "[h]ealth care spending sponsored by the federal government is projected to have risen by 10.1 percent." This was the year that Obamacare added millions of beneficiaries to Medicaid and forked over billions in subsidies for individuals to purchase insurance on government-run exchanges.
Looking at the broader trend is more revealing. In 2007, when Obama launched his presidential campaign and outlined a plan to overhaul the nation's healthcare system, private spending accounted for 60 percent of total U.S. health expenditures, compared with 40 percent coming from government-sponsored spending. By 2024, after a decade of Obamacare's coverage expansion, the government share is projected to reach 47 percent, while the private share is expected to shrink to 53 percent. In that year, CMS predicts government at all levels will spend over $2.5 trillion.
These numbers, however, understate the extent of government's role in healthcare. CMS figures count premiums and payroll taxes that individuals and businesses pay toward the government-run Medicare system as private expenditures. Money spent on premiums toward the purchase of insurance on Obamacare's government-run exchanges are also categorized as private.
Beyond the direct spending, Obamacare's regulations exert more control over the healthcare system. For instance, even "private" insurance must be designed based on dictates of the federal government, which also limits how much profit insurers can earn on policies after paying out medical claims.
All of these expansions of government control were added on top of a system in which the federal government was already a dominant player, including by imposing a tax code that discriminates against individuals purchasing insurance on their own in favor of those who obtain insurance through their employers.
Back in 2003, Obama declared himself "a proponent of a single-payer universal health care program." By the time he ran for president, he shifted to saying that single-payer was the ideal system if he were starting one "from scratch" but he acknowledged that to get anything accomplished, Democrats had to work within the existing system.
Though it wasn't fashionable to admit it during the debate over Obamacare, once the law passed, it became more acceptable to describe the program as a developing single-payer system.
As none other than the liberal economist Paul Krugman put it in the New York Times: "The Affordable Care Act, aka Obamacare, is a policy Rube Goldberg device — instead of doing the simple, obvious thing, which would just be to insure everyone, it basically relies on a combination of regulations and subsidies to rope, coddle, and nudge us into a rough approximation of a single-payer system."
Under Obamacare, the government may not have immediately taken over the healthcare system. But it is process of taking over the healthcare system.