With little fanfare, Vermont is preparing to become the first state to implement a single-payer, government-run health-care system. The Vermont plan, if implemented, would abolish private health insurance in the state and replace it with a taxpayer-funded system under which the state government directly pays doctors and hospitals.

Of course the state is having a bit of trouble figuring out how to pay for the programs estimated $2 billion price tag, considering that the entire state governments operating budget is currently just $2.7 billion. Currently under consideration is an increase in the state sales tax from 6.9% to 29%.

At the same time, opponents of ObamaCare have often suggested the massive health-care program is really a stalking horse for such a government-run system. ObamaCares fans have sometimes suggested the same. Senate Majority Leader Harry Reid (D-Nev.) has said that the health-care law is as step in the right direction toward abolishing private health insurance.

But a single-payer system or at least government-run health care may already be a reality in far more ways than most Americans realize.

Already the government directly pays for more than half of every dollar spent on health care in this country. This compares to just 13 cents directly paid by the individual purchasing or consuming the health care. (Virtually all of the remaining 37% is paid for through insurance, much of which is also subsidized, directly or indirectly, by the government).

In fact, consumers in many countries that we associate with socialized medicine, such as France, actually pay more out of pocket for their health care than do Americans.

Medicare is the single biggest government health care program. At a cost of $612 billion this year, the massive insurance program for seniors alone accounts for one-fifth of all US health care spending. Medicaid pays an additional 15%. Altogether, there are at least a dozen government programs to provide or pay for health care.

In 2012, nearly 41% of New Yorkers receive health care through one or another government program, Medicaid in particular. According to the Kaiser Family Foundation, roughly 23% of New Yorkers are on Medicaid. By comparison, just 15% of Connecticut residents and 12% of New Jerseyans are on Medicaid.

Medicare is the second-largest health-care payer in New York, providing coverage for 12% of residents, slightly below the 14% in Connecticut and New Jersey.

But Medicares influence extends well beyond the number of enrollees. Because the program is the 800-pound gorilla in terms of paying for health care, it establishes the standards that private insurers use to set reimbursement rates for doctors and hospitals. Thus, directly or indirectly, the government is already involved in setting health-care prices.

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Dems want health care for all no matter the cost