CBO offers a brief analysis of what a single-payer system might be like in the U.S.

A May 2019 report released by the Congressional Budget Office (CBO) addresses questions surrounding the growing number of Congress members who support a single-payer healthcare system/universal health insurance coverage. In its report, the CBO looks at the main features of single-payer systems and describes how these systems might play out if they were to be adopted in the U.S.

“Establishing 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 health care in the United States,” states the CBO report, noting also that the analysis does not address all of the issues that would need to be considered if the country moved to a single-payer system. “Nor does it analyze the budgetary effects of any specific bill or proposal.”

The agency, in the report’s executive summary, asserts that while Universal healthcare would reduce the number of people who lack insurance measurably, the number of people who would be uninsured would depend on the system’s design (e.g. noncitizens in the U.S. illegally would likely not qualify under a single-payment system).

The report explains that while single-payer systems present many different features and definitions, they are typically considered single-payer systems if they have the following key features:

·   The government entity (or government-contracted entity) operating the public health plan is responsible for most operational functions of the plan, such as defining the eligible population, specifying the covered services, collecting the resources needed for the plan, and paying providers for covered services.

·   The eligible population is required to contribute toward financing the system.

·   The receipts and expenditures associated with the plan appear in the government’s budget. 

·   Private insurance, if allowed, generally plays a relatively small role and supplements the coverage provided under the public plan.

Meanwhile, the report presents many questions that would arise if transitioning to a single-payer system and suggests that policy makers consider the following:

·   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 healthcare costs?

·   How would the system be financed? For each question, this report discusses various option