Fuzzy math has dominated much of the health care debate.  How much things cost, over what time frame, how many people are uninsured, how many will be covered, etc etc etc….  The plans advanced by the Democrats thus far all have high costs – approaching $1 trillion dollars.  With the federal deficit hitting $1.4 trillion this year – that’s 10% of US GDP for those paying attention – why the persistent focus by the Obama administration on an expensive “public option” for health insurance?   The answer to this question may lie in some pretty simple electoral math.

Consider how many people currently get health insurance from the federal government.  The two main federal health insurance programs are Medicare and Medicaid.  In 2008, Medicare insured roughly 45 million people, while Medicaid had expanded to cover 50 million additional people.  Ninety-five million, all told, are currently enrolled in these two federal programs.

The uninsured in America number around 46 million.  Of these, about 30 million are US citizens, and are therefore eligible for any of the various “public option” programs that are being floated in Washington.  If all 30 million of these currently uninsured individuals were covered by a new federal program, as the Obama administration wants, then a grand total of some 125 million Americans would have their health insurance provided by the federal government. 

What does having 125 million people dependent on the federal government for health care coverage do to the political landscape?   The total US population right now is about 304 million, of which 230 million people are over the age of 18 and eligible to vote.  If 125 million of these folks were insured by the federal government, then this would be 54% of all eligible voters.  With a public option added to Medicare and Medicaid, more than half of the electorate would be dependent upon the federal government to receive their health care.  In other words, more than half of the electorate would be receiving an income redistribution, in the form of subsidized health insurance.  And it’s a fair bet that these 125 million people would not subsequently vote into office any fiscal conservative who wanted to turn around and cut their health benefits. 

By “locking up” the remaining 30 million uninsured people in a new federal health insurance program, the Democrats go a long way toward ensuring a permanent, left-leaning, redistributive American state.  The prospect of an America that is  “Democratic now, Democratic forever” must be pretty intoxicating, both on Capitol Hill and in the White House.  The dream of a permanent Democratic state is likely a big contributor to the insistence on the part of the Obama administration about retaining the public option.  The people in the White House have done the electoral math, and they like the numbers. 

Dr. Laura Niklason is a physician and professor of Anesthesia and Biomedical Engineering at Yale University.