• The Congressional Budget Office (CBO) issued a report assessing the policy considerations associated with a single-payer healthcare system. The report looks at various components of a single payer system such as beneficiary premiums and cost sharing, the role of non-government payers, the role of technology, payments to providers and administrative costs.
• Both supporters and opponents of single-payer healthcare will find provisions of the report they can point to that supports their position.
• Several House Committees are holding hearings on legislation that would create a single-payer system. Even if the House of Representatives passes a single-payer bill, it is highly unlikely that the Republican-controlled Senate or Republican President will advance the bill.

The Congressional Budget Office (CBO), a non-partisan agency of Congress that provides Congress with budgetary and economic analysis of legislation and policy proposals, published a report highlighting the “Key Components and Considerations for Establishing a Single-Payer Health Care System.”

“Single-payer” healthcare can take many different forms. A completely nationalized healthcare system in the style of Canada or the United Kingdom is one iteration while a national health insurance program such as “Medicare-for-All” is another. Many of the twenty-plus candidates seeking the Democratic nomination for President in 2020 have expressed support for some form of Medicare-for-All or single-payer healthcare. Similarly, several proposals for such systems have recently been introduced in Congress.

House Budget Committee Chairman John Yarmuth (D-KY-03) asked CBO to provide a report examining “the important policy considerations associated with single-payer health systems and their potential impact on the federal budget, national health care spending, and access to care.”

Unlike most CBO reports, the CBO is not providing a cost estimate for single payer healthcare. Cost considerations aside, the report emphasizes how creating a single-payer system “would be a major undertaking that would involve substantial changes in the sources and extent of coverage, provider payment rates and financing methods of healthcare in the United States.”

The CBO mainly considers a national health insurance plan as the single-payer health care system for purposes of this report.

The report looks at various components of a single payer system such as beneficiary premiums and cost sharing, the role of non-government payers, the role of technology, payments to providers and administrative costs. The report also explores how Congress can most effectively move towards a single-payer system by making the transition gradually instead of immediate and in full.

Regardless of what exact form the new system takes, the CBO believes it can achieve greater administrative efficiencies and can incentivize shifting of resources towards preventive care. Universal coverage is also considered an “opportunity” to be gained by a single-payer system.

However, a single-payer system would likely lead to significantly higher government spending which would likely require tax increases to finance the system. Patients could also face longer wait times and delayed access to new treatments due to high demand for medical services and insufficient “supply” of healthcare providers. Patients might also be subject to step therapy policies which requires providers to try less expensive treatments before receiving authorization for a more expensive treatment.

Both supporters and opponents of single-payer healthcare will find provisions of the report they can point to that supports their position.

The CBO’s report is timely considering Medicare for All is receiving more attention on Capitol Hill. On April 30th, The House Rules Committee held a hearing to discuss Medicare-for-All legislation introduced by Rep. Pramila Jayapal (D-WA) that would institute a single-payer iteration of Medicare-for-All. Under Rep. Jayapal’s bill, Medicare would cover essentially everything for everyone with no premiums or cost-sharing. Private insurance would not be able to cover anything that Medicare covers. The House Ways and Means Committee and the House Budget Committee also intend to hold hearings on this topic.

As always, ADVOCATE will keep you up to date on this and all issues impacting radiology as they become available.

Best regards,

Kirk Reinitz, CPA 

President