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Delivering Public Health Insurance through Private Plan Choice in the United States

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  • Jonathan Gruber

Abstract

The United States has seen a sea change in the way that publicly financed health insurance coverage is provided to low-income, elderly, and disabled enrollees. When programs such as Medicare and Medicaid were introduced in the 1960s, the government directly reimbursed medical providers for the care that they provided, through a classic "single payer system." Since the mid-1980s, however, there has been an evolution towards a model where the government subsidizes enrollees who choose among privately provided insurance options. In the United States, privatized delivery of public health insurance appears to be here to stay, with debates now focused on how much to expand its reach. Yet such privatized delivery raises a variety of thorny issues. Will choice among private insurance options lead to adverse selection and market failures in privatized insurance markets? Can individuals choose appropriately over a wide range of expensive and confusing plan options? Will a privatized approach deliver the promised increases in delivery efficiency claimed by advocates? What policy mechanisms have been used, or might be used, to address these issues? A growing literature in health economics has begun to make headway on these questions. In this essay, I discuss that literature and the lessons for both economics more generally and health care policymakers more specifically.

Suggested Citation

  • Jonathan Gruber, 2017. "Delivering Public Health Insurance through Private Plan Choice in the United States," Journal of Economic Perspectives, American Economic Association, vol. 31(4), pages 3-22, Fall.
  • Handle: RePEc:aea:jecper:v:31:y:2017:i:4:p:3-22
    Note: DOI: 10.1257/jep.31.4.3
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    References listed on IDEAS

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    Cited by:

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    2. Simón Ramírez Amaya & Adolfo J. Quiroz & Álvaro José Riascos Villegas, 2019. "Regression by clustering using metropolis-hastings," Documentos de Trabajo Quantil 018180, Quantil.
    3. Keaton S. Miller & Amil Petrin & Robert Town & Michael Chernew, 2019. "Optimal Managed Competition Subsidies," NBER Working Papers 25616, National Bureau of Economic Research, Inc.
    4. Geruso, Michael & Layton, Timothy J. & McCormack, Grace & Shepard, Mark, 2019. "The Two Margin Problem in Insurance Markets," Working Paper Series rwp19-035, Harvard University, John F. Kennedy School of Government.
    5. Michael Geruso & Timothy J. Layton & Jacob Wallace, 2020. "Are All Managed Care Plans Created Equal? Evidence from Random Plan Assignment in Medicaid," NBER Working Papers 27762, National Bureau of Economic Research, Inc.
    6. Anthony Scott, 2018. "Pump Up the Volume: Making Health and Wellbeing the Centre Stage of Economic Growth," Australian Economic Review, The University of Melbourne, Melbourne Institute of Applied Economic and Social Research, vol. 51(2), pages 247-252, June.

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    More about this item

    JEL classification:

    • G22 - Financial Economics - - Financial Institutions and Services - - - Insurance; Insurance Companies; Actuarial Studies
    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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