Over the last five years, the proportion of employers providing health benefits has dropped from 70 to 60 percent, while during the last six years premiums have gone up 75 percent. A recent poll indicates that nearly a quarter of families earning over $75,000 - all at least solidly middle class - have trouble paying for health insurance. Other surveys report that 65 percent of Americans want univeral health insurance, even if it means more taxes - and that nearly half of American doctors agree with them. Then why don't we have universal health insurance? What on earth is the problem?

Those who decry universal health insurance as a grossly impractical potential boondoggle that would massively overburden American tax payers are wrong. We are already footing 51 percent of the nation's health care bill through our taxes alone - which support Medicare, Medicaid, veterans' programs, public hospitals, school programs and, last but not least, private medical insurance for government employees. Private insurers - your employer and mine, if we are among the lucky ones - pay just 30 percent of the $2 trillion total. Ultimately they pay even less, as private insurers deduct from their own tax bill everything they pay to insure their employees as just another cost of doing business. Nor are employees required to declare health benefits as income, although a portion of their paychecks is deducted by their employers to cover them. A recent study estimates that, of the $443 billion spent by private insurers on health care costs in 2004, the government lost $108.5 billion in tax revenues and $66.4 billion in payroll taxes for Social Security and Medicare. To make up for this lost revenue, Uncle Sam raises taxes on the rest of us - including those of us who don't receive health benefits from our employers. These additional taxes, plus substantial out of pocket costs paid even by those who are insured, raise the total proportion of health care costs met by the average American tax payer from 51 to 74 percent.

Shouldering the remaining 26 percent of the health care burden has little appeal - until one realizes that health care costs are artificially high to begin with. There are potent forces that drive the cost of health care much higher than it might otherwise be. Because health care is an industry, not a service, and is run entirely for profit, equipment and drugs are wildly overpriced and doctors are encouraged to perform unnecessary and expensive tests. It doesn't have to be like this. According to Maggie Mahar, author of Money-Driven Medicine: The Real Reason Health Care Costs So Much, "in virtually every other developed country in the world, the government takes responsibility for trying to check health care inflation. This is why patients in other countries pay so much less for both drugs and medical devices. In nationalized systems, governments are the health care industry's biggest customer, and they use their clout to negotiate lower prices." In our current system, private insurers are as little and ineffectual as the rest of us compared to the vast and avaricious power of the health care industry. Here is a situation where an army of Davids cannot help us. We need a Goliath of our own to face those philistines who dare to overcharge us for our own well-being. As Mahar says, "In the end it is inconceivable that Americans will be willing to continue supporting a health care system that is funded largely by the public but is run largely by lobbyists".

"What Would Lenin Do?" from American Prospect