After Obamacare

Phil Longman wrote in the Washington Monthly about how monopolization among hospitals is to blame for our skyrocketing health costs.

With Obamacare’s troubles continuing, the economy still underperforming, and yet another battle over the long-term federal debt looming, here’s a thought experiment that reveals much about how we got here.

Imagine if, starting during the early years of George W. Bush’s presidency, the government had imposed a new payroll tax that by now was extracting almost one out of every five dollars earned by middle- and working-class Americans. Does it seem reasonable to suppose that the loss of that much discretionary income would have caused a lot of people to take on a lot of debt? Doesn’t it seem plausible that a new regressive tax of that magnitude would have pushed a whole lot of people out of the middle class—maybe even to the point of having caused a Great Recession?

Well, guess what. Almost all of us are now burdened by something akin to such a payroll tax, and the wonder is that so few people realize how big it is or who is responsible for imposing it on us. According to the Milliman Medical Index, which is a standard measure of health care costs, a typical family of four has seen the amount it pays for health care, including premiums and out-of-pocket costs, rise from about 18 percent of its income in 2002 to 35 percent today.