Switch to Medicare for All Would Be ‘Complicated and Potentially Disruptive’: CBO
Health Care


iStockphoto/The Fiscal Times

Transitioning the United States to a single-payer health care system “could be complicated, challenging, and potentially disruptive,” the Congressional Budget Office said Wednesday in a new report looking at the considerations involved in making such a switch. The transition could be eased by phasing in the biggest changes gradually to minimize their impact, the report says.

CBO did not assess any specific Medicare for All proposal or provide a cost estimate for a potential switch to a single-payer system. It noted that shifting from the current mix of private and public health care spending, which totaled $3.5 trillion in 2017, to a single-payer system “would significantly increase government spending and require substantial additional government resources.” Just how substantial those resources would need to be would depend on the specifics of the system and whether or not policymakers decided to increase annual budget deficits.

“Total national health care spending under a single-payer system might be higher or lower than under the current system depending on the key features of the new system, such as the services covered, the provider payment rates, and patient cost-sharing requirements,” the report says.

Overall, though, the highly anticipated report may be more notable for the host of questions it raises about a potential transition that it describes as “a major undertaking that would involve substantial changes in the sources and extent of coverage, provider payment rates, and financing methods of health care in the United States.”

The key questions CBO laid out for policymakers include:

  • How would the government administer a single-payer health plan?
  • Who would be eligible for the plan, and what benefits would it cover?
  • What cost sharing, if any, would the plan require?
  • What role, if any, would private insurance and other public programs have?
  • Which providers would be allowed to participate, and who would own the hospitals and employ the providers?
  • How would the single-payer system set provider payment rates and purchase prescription drugs?
  • How would the single-payer system contain health care costs?
  • How would the system be financed?

Rep. John Yarmuth (D-KY), who requested the CBO report, said Wednesday he hoped it would help speed the adoption of a single-payer system. “The fact remains that we have made immense progress in the past ten years, yet access to quality and affordable health care is still too often out of reach for families and hardworking Americans across the country,” Yarmuth said in an emailed statement. “We must do more, which is why I believe it is no longer a matter of if we will have a single-payer health care system in our country, but when. I hope this report and upcoming hearings help advance that timeline.”

But Republicans are certain to find ammunition in the report for their criticisms of a single-payer system. Rep. Steve Womack (R-AR), the ranking member of the House Budget Committee said in a statement: “While Democrats avoided asking questions they don’t want the answers to, including how much Medicare-for-All will cost the American people, the report CBO released today illuminates several consequences of Democrats’ one-size-fits-all health care approach, such as higher premiums, out-of-pocket expenses, and taxes.”