WASHINGTON -- Conservative opponents of the Affordable Care Act tried to warn us that it was a government takeover of the health care system.
And while this may come as a surprise to all the privately employed doctors, hospital employees and insurance companies executives across the land, the takeover has apparently already happened, if you believe the Washington Examiner. But you shouldn't believe the Washington Examiner, because it doesn't understand how numbers work.
"Turns out Obamacare is a government takeover," reads the headline of an item published Friday by Philip Klein, the newspaper's managing editor. Big, if true. Except it isn't. Let's review Klein's "argument" first, though.
Using new data released this week by the independent Office of the Actuary at the Centers for Medicare and Medicaid Services, Klein points out that the government's share of national health care spending will be higher in the future than it was in the past. Ergo, Obamacare is a government takeover of health care, no matter what those liberals at PolitiFact said when they decreed that exact claim the 2010 Lie of the Year. Klein writes:
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.
Case closed! There's even a pair of fetching pie charts to drive home this unassailable point.
Except it's easy to assail. In 2009 -- more than a year before the Affordable Care Act passed in Congress and nearly five years before spending on the law's coverage expansion began to kick in -- those same actuaries predicted more rapid future growth in the government's share of the health care spending pie even though there was no Obamacare!
On Feb. 24, 2009, I wrote a story in The Hill headlined: "Gov’t nearing 50 percent of health spending total." From the article:
The government will shell out for more than half of the nation’s healthcare spending by the final year of President Obama’s second term in office, according to federal auditors. ... The combined share of government healthcare spending will cross the historic 50 percent threshold in 2016 and, in 2018, reach 51.3 percent of the $4.35 trillion in projected healthcare spending. That same year, healthcare spending will make up 20.3 percent of the gross domestic product (GDP) of the United States.
That's right: In 2009, the Medicare and Medicaid actuaries predicted the government would own half of the nation's health care bill by 2016. Now, they're forecasting that the government share of health care spending will still be less than half nine years from now. In other words, the government is currently spending a smaller chunk of national health expenditures than these experts thought it would, even though millions more people now have health insurance.
That's quite a government takeover!
(Klein assures his readers he's aware Obamacare isn't a government takeover, right before he declares that, in fact, the government has taken over health care: "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." Okay, got it.)
The fun thing about slogans like "government takeover of health care" is that they can be used qualitatively to mean whatever you want them to mean. So new federal regulations on health insurers that require them to, say, cover anyone regardless of pre-existing conditions can be described as a "takeover" without being demonstrably, factually incorrect. Using language like this is a good way to avoid ever being proved wrong about things like, for instance, predicting the Affordable Care Act would result in a government takeover of health care.
But where you can be proved demonstrably, factually incorrect is when you attempt to use a phrase like "government takeover of health care" in a quantitative manner. Klein is correct that 47 is larger than 40. But it's also smaller than than the 50 percent the actuaries predicted for a world without Obamacare. Which is kind of a shame, because somebody at the Examiner put a lot of effort into making those charts.
Update: Philip Klein published a follow-up to his original post that introduces a new element which, he argues, bolsters his case that the government has indeed taken over. Specifically, Klein accurately notes that the Medicare and Medicaid actuaries altered how they tabulate government versus private spending in 2011 in a way that counts more spending as private and less as government.
In that way, HuffPost's comparison of the actuaries' 2015 projections with their 2009 forecast was imperfect, since the government share would show up as a bit larger in this year's report had the auditors not changed how they categorize who spent what.
The fact remains, however, that the government's share of national health care spending was already projected to increase relative to the private-sector share based on the costs of Medicare, Medicaid and a plethora of other federal, state and local government health care programs that predated the passage of the Affordable Care Act, no matter how the actuaries counted it. Then as now and for the foreseeable future, the lion's share of the projected spending is for benefits and populations defined by laws that were on the books prior to the ACA's even being written, such as the enrollment of millions of Baby Boomers into Medicare.
And, of course, under both previous and current calculation methods, about half of all health care spending still comes and will continue to come from private entities, including patients, and flow to private physicians, hospitals and insurance companies.
So if, as the Examiner originally argued, the government's gradually increasing its share of America's health care tab is sufficient evidence that the government has taken over the health care system, it would have been just as true in a world where the Affordable Care Act never existed. One may as well claim a government takeover of health care already took place, a half-century ago, when Medicare and Medicaid were created (and Barack Obama was three years old).