CBO: What single payer could look like

A single-payer health system could mean a variety of changes for the healthcare system, depending on its design. One thing is clear, according to the Congressional Budget Office: All participants would face substantial uncertainty.

CBO released its analysis of what a single-payer system could look like, given current proposals. Here are three key takeaways from the May 1 report, which can be viewed in its entirety here.

1. Uncertainty: CBO said uncertainty surrounding single-payer models could be fueled by how healthcare providers and payers respond to changes in the system, as well as political and budgetary processes.

"The transition toward a single-payer system could be complicated, challenging, and potentially disruptive," CBO said. "Policymakers would need to consider how quickly people with private insurance would switch their coverage to the new public plan, what would happen to workers in the health insurance industry if private insurance was banned entirely or its role was limited, and how quickly provider payment rates under the single-payer system would be phased in from current levels."

2. Coverage: A big question surrounding single-payer policies is if noncitizens who are in the country illegally — about 11 million people — would be eligible for health insurance under a universal plan.

"Under the current system, CBO estimates, an average of 29 million people per month — 11 percent of U.S. residents under age 65 — were uninsured in 2018. Most (or perhaps all) of those people would be covered by the public plan under a single-payer system, depending on who was eligible," according to CBO.

3. Costs: Likely the biggest concern and roadblock for a single-payer system is how much government spending on healthcare could climb under a universal health insurance plan.

"Shifting such a large amount of expenditures from private to public sources would significantly increase government spending and require substantial additional government resources. The amount of those additional resources would depend on the system's design and on the choice of whether or not to increase budget deficits," CBO said. Some estimates have pegged that spending at between $28 trillion and $32 trillion during the course of a decade. The U.S. currently spends about $3.5 trillion on healthcare.

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