http://blog.academyhealth.org/were-closer-to-a-publicly-funded-health-care-system-than-you-think/

Every time health care reform comes up for debate, I see people arguing about whether a publicly or privately funded system would be better. The Affordable Care Act, in an attempt to forestall this debate, decided to split the baby, and give half of its newly insured beneficiaries public insurance (Medicaid) and half private insurance (insurance exchanges). But this isn’t really true. Yes, the half of people getting expanded Medicaid are getting public insurance, but the vast majority of people getting private insurance are also getting public funds (subsidies) in order to purchase their private insurance.

In other words, even though we expanded private insurance, we’re doing it with taxpayer dollars. Overall, the reduction in the uninsured was due to mostly public spending, with relatively little private spending overall. This isn’t rare in the US health care system. A recently released policy brief from the UCLA Center for Health Policy Research, “Public Funds Account for Over 70 Percent of Health Care Spending in California“, explains this quite well.

If you just look at a simple analysis of Medicaid, Medicaid, and CHIP, you might find that about 45% (or less than half) of total US health care spending is public. But that ignores a ton of health care spending that is also paid for with public funds outside those programs. In an effort to document the different, researchers looked at health care spending in California. They included four major public funding categories:

1. Payments for public health insurance programs (like Medicare and Medicaid)
2. Government payments for health insurance coverage for public employees (like me at Indiana University, for instance)
3. Tax subsidies for employer-sponsored insurance and those purchasing exchange plans who earn less than 400% of the poverty line
4. County health care expenditures