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March 5, 2008

Who Really Pays for Health Care?The Myth of “Shared Responsibility”

Author Affiliations

Author Affiliations: Department of Bioethics, Clinical Center, National Institutes of Health, Bethesda, Maryland (Dr Emanuel); Department of Economics, Stanford University, Stanford, California (Dr Fuchs).

JAMA. 2008;299(9):1057-1059. doi:10.1001/jama.299.9.1057

When asked who pays for health care in the United States, the usual answer is “employers, government, and individuals.” Most Americans believe that employers pay the bulk of workers' premiums and that governments pay for Medicare, Medicaid, the State Children's Health Insurance Program (SCHIP), and other programs.

However, this is incorrect. Employers do not bear the cost of employment-based insurance; workers and households pay for health insurance through lower wages and higher prices. Moreover, government has no source of funds other than taxes or borrowing to pay for health care.

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