Getting government involved in any area of human life is an effective way to guarantee you spend gobs of money without improving the situation or making people especially happy.
asserted
people → get → situation
That's clearly true of health care, a field in which government has increasingly intruded for years even as dissatisfaction becomes the norm and costs go through the roof.
asserted
costs → intrude → roof
A recent report finds that health care now consumes almost one of every three dollars the federal government spends, with more to come.
asserted
government → find → more
You are reading The Rattler from J.D. Tuccille and Reason.
asserted
You → read → Tuccille
Federal Health Spending Is Twice the Size of the Defense Budget
"The largest and fastest-growing category of federal spending is major healthcare programs, including Medicare, Medicaid, Affordable Care Act (ACA) subsidies, and the Children's Health Insurance Program (CHIP)," William McBride and Guy Cardwell wrote last week for the Tax Foundation.
asserted
McBride → grow → Foundation
"As this report shows, total federal healthcare spending, including smaller programs scattered across various agencies, is now nearly one-third of the federal budget."
asserted
spending → show → budget
"In total, the fiscal cost of federal tax expenditures and spending for health care, as of 2025, is nearly $2.7 trillion, or 8.9 percent of GDP," they add.
asserted
they → add → GDP
At 31 percent of the budget, the combined cost of federal health programs was "more than twice the size of the defense budget" last year.
asserted
cost → combine → budget
"Federal healthcare spending has grown at a staggering rate over the last several decades, mainly through expansions of Medicare and Medicaid beginning in the 1960s that increased benefits and eligibility for those programs, but also due to an aging population, increased income and ability to pay for health care, and rising healthcare costs."
asserted
that → grow → care
Federal Spending Produced a Health Care 'Crisis' and Poor Outcomes
asserted
Spending → produce → Crisis
Despite such vast amounts of tax (and borrowed) dollars flowing into healthcare, a Gallup poll published last December finds "a record-high 23% now saying the U.S. healthcare system is 'in a state of crisis' and another 47% saying the system has 'major problems.'"
asserted
system → borrow → problems
The biggest problem respondents cited was cost, which you'd think all that spending would address, but which federal policy may be making worse.
uncertain
policy → cite → which
Writing last year in The Wall Street Journal, Cato Institute health expert Michael F. Cannon warned that "Medicare and Medicaid impose rules that reduce healthcare quality.
asserted
that → write → quality
They increase prices for private-sector medical care and health insurance.
asserted
They → increase → care
They require taxes that reduce incomes, financial security and potentially economic growth.
asserted
that → require → incomes
They have subsidy phaseouts that discourage upward mobility."
asserted
that → have → mobility
Cannon added that there's little evidence the supposed increased access to care produced by federal subsidies really improve anybody's health.
asserted
access → add → health
A 2010 University of Virginia study of surgical patients who had, variously, Medicare, Medicaid, private insurance, or were uninsured, found that "after controlling for age, gender, income, geographic region, operation, and 30 comorbid conditions," private insurance resulted in the lowest mortality, followed by Medicare, then the uninsured, with Medicaid producing the highest mortality.
asserted
Medicaid → have → mortality
Plus, "Medicaid is further associated with higher postoperative in-hospital complications as well as the greatest adjusted length of stay and total costs despite risk factors or the specific major operation."
asserted
Medicaid → associate → factors
In 2013, the much discussed "Oregon Experiment" concluded that "Medicaid coverage generated no significant improvements in measured physical health outcomes in the first 2 years."
asserted
coverage → discuss → years
Coverage did increase demand for health care services and "raise rates of diabetes detection and management, lower rates of depression."
asserted
Coverage → increase → depression
It also reduced financial strain on patients—by shifting it to taxpayers.
asserted
It → reduce → taxpayers
Medicaid has been expanded in recent years, which extends coverage to more people and increases government spending.
asserted
which → expand → spending
It's not clear that it does much good, though.
asserted
it → do → good
For its part, Medicare is not only wildly expensive and consuming a growing share of federal spending; it's also projected to become insolvent in less than a decade.
asserted
it → consume → decade
Federal Policies Harm Private Coverage and Boost Costs
Federal policies don't just screw up government programs, they also damage what's left of nominally private medicine.
asserted
what → harm → medicine
In April, Cato's Cannon and Elizabeth J. Fowler pointed out that the federal government's insistence on taxing wages but leaving employer-provided health benefits untaxed encourages businesses to pay employees in health coverage rather than money.
asserted
insistence → point → money
"Economists across the political spectrum have noted that making employer coverage tax-free encourages more comprehensive plans than many workers might otherwise choose, which reduces price sensitivity.
uncertain
which → note → sensitivity
That means higher prices, higher premiums and more health care spending overall," they wrote.
asserted
they → mean → prices
Indeed, the Congressional Budget Office noted in 2023 that "most Americans' health insurance is subsidized by the federal government, either through a program, such as Medicare or Medicaid, or through tax provisions.
asserted
insurance → note → provisions
As we know, you get more of anything you subsidize.
asserted
you → know → anything
Pushing people via the tax code to more comprehensive health plans doesn't directly drive federal spending.
asserted
Pushing → push → spending
But it helps increase the costs that have Americans so upset.
asserted
Americans → help → costs
And those rising costs increase federal health spending.
asserted
costs → rise → spending
As a result, the federal government's role in health care has metastasized.
asserted
role → metastasize → care
"In 1962, prior to the advent of Medicare and Medicaid, the federal government spent $2.3 billion for health programs, representing about 2.1 percent of the budget and about 0.4 percent of GDP," emphasize McBride and Cardwell of the Tax Foundation.
asserted
McBride → spend → Foundation
"Back then, healthcare spending from all sources, including state and local governments as well as private spending, was 5.4 percent of GDP, and the federal government's share of that spending was 7.2 percent.
asserted
share → include → spending
Since that time, overall healthcare spending has grown to 18.4 percent of GDP, as of 2025, and the federal share has grown to 39.3 percent.
asserted
share → grow → percent
"
As the federal role in health care has increased, so has the cost of that health care.
asserted
cost → increase → care
Rising costs then fuel greater demand for federal subsidies to offset the financial burden on patients.
asserted
costs → rise → patients
…and 4 more, not listed.
The Aporia
