If you think if Medicare and Medicaid as examples of “single payer” health insurance plan, you are at best partially correct. Government health spending (including federal, state, and local) does accounts for about 46% of total US health care spending. However, a major and largely unremarked change is that government health care spending is being filtered through a system in which those receiving the government health insurance need to make choices between privately-run health insurance plans.
A three-paper symposium in the Fall 2017 issue of the Journal of Economic Perspectives tackles this issue of choice and health insurance coverage. The introductory essay by Jonathan Gruber is called “Delivering Public Health Insurance through Private Plan Choice in the United States.” Then Michael Geruso and Timothy Layton focus on the issue of “Selection in Health Insurance Markets and Its Policy Remedies,” while Keith Marzilli and Justin Sydnor focus on the issue of how difficult it can be for consumers to make wise choices between health insurance plans–especially when the providers of these plans may have incentive to slant those choices in certain directions in “The Questionable Value of Having a Choice of Levels of Health Insurance.” For example, Gruber describes how US government health care spending has moved away from a “single payer” approach over time and writes:
“Currently, almost one-third of Medicare enrollees are in privately provided insurance plans for all of their medical spending, and another 43 percent of Medicare enrollees have standalone private drug plans through the Medicare Part D program. More than three-quarters of Medicaid enrollees are in private health insurance plans. Those receiving the subsidies made available under the Patient Protection and Affordable Care Act of 2010 do so through privately provided insurance plans that are
reimbursed by the government.”
