The purpose of the articles and editorials in the latest American Journal of Public Health special section is to clarify the complexity and significance of the issues involved in moving from the current multiple-payer system of financing health care in the United States to the variety of single- and multiple-payer systems currently advocated by candidates for public office and their allies.
Single payer refers to a health system that is financed by a single entity; in its common usage, that single entity is government. Government is the payer for services, and such payments are financed by taxes, but there is no implication that government employs the providers or actually owns or operates the health system. There still may be intermediaries between the government as payer and the provider, such as exists now with Medicare and health insurance intermediaries. In its “purest” form, in a single-payer system, health care services are paid for only by the government; in the case of Medicare, beneficiaries also contribute to payments through premiums.
Multiple payer refers to a health system that is financed through more than a single entity, one of which may include government. Private health insurance companies participate in multiple-payer systems, with financing through individual premiums paid directly by beneficiaries, employers, and, in some cases, government.
The authors include Dr. Peter Donnelly with the Dalla Lana School of Public, University of Toronto, Dr. Paul Erwin, dean of the University of Alabama at Birmingham School of Public Health, Dr. Daniel Fox with the Milbank Memorial Fund, and Dr. Colleen Grogan, with the School of Social Service Administration, University of Chicago.Friday Letter Submission, Publish on October 11