“As “Medicare for All” increasingly becomes a battle cry for Democrats on Capitol Hill and those running for president, the nonpartisan Congressional Budget Office weighed in Wednesday on how difficult it could be to move to a single government health care system.
“The transition toward a single-payer system could be complicated, challenging and potentially disruptive,” budget analysts wrote.
The report was issued a day after a House committee held a hearing on a bill supported by more than 100 House Democrats that would move the nation to a single, government insurer in two years.
CBO said establishing a single-payer system would be a major undertaking that would involve substantial changes in how people get health care, what care they get, how much providers are paid and who pays the bills.
The report also said:
- A single-payer system could substantially reduce the number of uninsured, which currently averages about 29 million people a month. But if undocumented immigrants are not allowed to participate, about 11 million U.S. residents could end up without coverage. (About half of undocumented immigrants have coverage now.)
- The changes could significantly affect the U.S. economy. The magnitude of the effect on the nation and individuals is hard to predict because the evidence CBO would rely on to make those predictions comes from much smaller changes to the health care system.
- Whether the nation – and individuals – would end up spending more or less on health care would depend on key features such as how much health care providers would be paid, what services would be covered and whether patients would be required to share some of the costs.
- Benefits of a single-payer system could include lower administrative costs and more incentives to improve people’s health. But patients may also have longer wait times or reduced access to care if there aren’t enough physicians to meet increased demand. Patients may also have less choice than they have now.
- Expanding access to health insurance through a multi-payer system instead of a single-payer model could be less disruptive and give patients greater choice. But the nation would probably spend more on health care than it would under a single-payer system.
Most Democrats running for president have voiced support for some version of a Medicare for all system – such as allowing some people without insurance to purchase coverage through Medicare.
But not all go as far as Vermont Sen. Bernie Sanders, who made it a centerpiece of his 2016 presidential campaign.
Still, support for a single government plan has grown enough among the party base that House Speaker Nancy Pelosi – who does not back such an approach – allowed the House Rules Committee Tuesday to hold a hearing on a proposal similar to Sanders’.
The CBO report was requested by Rep. John Yarmuth, the Kentucky Democrat who heads the House Budget Committee. Yarmuth said he wanted to hear from experts how policy choices would affect costs and care before the Budget Committee holds its own review.
Yarmuth said Wednesday that it’s “no longer a matter of if we will have a single-payer health care system in our country, but when.”
Many Republicans are eager for Democrats to advance a proposal, hoping to gain a political advantage in the next election by portraying it as a radical government takeover of the health care system.
“We heard all about the majority’s highest priority this Congress, which is – in my view –putting everyone on a one-size-fits-all government-run health plan that will double everyone’s taxes, eliminate choice and put Medicare at risk,” Oklahoma Rep. Tom Cole, the top Republican on the House Rules Committee, said Tuesday.
Polling by the nonpartisan Kaiser Family Foundation shows broad support for incremental approaches to nationalizing health care, including letting some people buy into Medicare or Medicaid. But public opinion can shift dramatically depending on how the idea is framed.
A slight majority – 56% – surveyed by Kaiser in January backed the idea of all Americans getting insurance from a single government plan. Support shot up to 71%, and opposition fell to 27%, when respondents were told Medicare for all could “guarantee health insurance as a right for all Americans.”
Levels of support and opposition flipped when respondents were asked their views if the proposal would “lead to delays in people getting some medical tests and treatments.”
Larry Levitt, senior vice president of the Kaiser Family Foundation, said the CBO report didn’t answer the most important questions of how much a single-payer system would cost or save consumers, the health system, and the federal government.
“Probably the most important message from the CBO report is that the details of how a Medicare-for-all proposal is designed will matter a lot for how much it costs,” he tweeted. “Who is eligible? How much cost-sharing do patients have, if any? How much do providers get paid? Which taxes go up?”