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House committee debates single-payer health care design


 

REPORTING FROM A HOUSE BUDGET COMMITTEE HEARING

House Budget Committee Chairman John Yarmuth (D-Ky.) opened a May 22 hearing on the prospect of moving to some kind of single-payer health care system with a bold prediction.

“I strongly believe it’s not a matter of if we will have universal coverage, but when,” Rep. Yarmuth said, adding that the “trick is closing the information gap on what single-payer health care truly is, so that we can close the health coverage gap for millions of American families.”

The hearing was held to review a Congressional Budget Office report ordered by Chairman Yarmuth, which examines the key design elements to be considered in establishing a single-payer system.

Mark Hadley, deputy director of the Congressional Budget Office, highlighted two key points with regard to establishing a single-payer system.

“First, moving to a single-payer system would be a major undertaking,” he said. “It would involve significant changes for all participants – individuals, providers, insurers, employers, and manufacturers of drugs and medical devices. Because health care spending currently accounts for about one-sixth of the nation’s economic activity, those changes could significantly affect the overall U.S. economy. And the transition toward a single-payer system could be complicated, challenging, and potentially disruptive.”

Mr. Hadley continued: “Second, to establish a single-payer system, lawmakers would need to make many decisions and would face complex trade-offs.”

And because of the multitude of trade-offs related to the design of a single-payer system, questions related to coverage, cost, and access to health care services were generally met with vague answers.

For example, would a single-payer system create access issues because of the potential increased burden on providers by providing health care coverage to all?

“Whether the supply of providers would be adequate to meet the greater demand would depend on various components of the system,” Mr. Hadley said. “If the supply of services was not sufficient to meet the demand for care, patients might face increased wait times and reduced access to care. The government, however, could implement policies to encourage the provision of services, and in the longer run, providers might deliver care more efficiently.”

Republican lawmakers on the panel focused on a detail lacking in the report: a cost estimate for implementing a single-payer system.

“What’s noticeably missing from the report is a cost estimate for specific proposals,” said Rep. Steve Womack (R-Ark.), the committee’s ranking member. “My friends across the aisle didn’t ask for one. I think I know why. While the score would be useful, we already know how much a one-size-fits-all health care system would cost the American people. Independent analyses from economists across the ideological spectrum, including George Mason University, the Urban Institute, [and] the American Action Forum have projected single-payer type proposals, such as Medicare-for-all, to cost at least $32 trillion.”

Rep. Womack also said that the report “has been especially helpful in showing that these ideas will never work in America.”

He noted that the report warns that a single-payer system could end up “reducing payment rates for providers. That is payments for doctors, hospitals, and so on. The report explains there will not only be a reduction in the quality of care, there would be a reduction in the supply of care, hampering access to the treatments and services people need.”

The report does caution that using cost-containment measures, such as global budgets and utilization management, “could adversely affect access to and quality of care by causing providers to supply less care to patients covered by the public plan. Less spending on medical services could also alter manufacturers’ incentive to develop new technologies or providers’ incentive to invest in capital, which could affect patients’ choices over the long term.”

Additionally, the report notes that the structure of a single-payer system could result in lower reimbursement for health care services. “Proposals like Medicare-for-all will chase a lot of doctors out of health care,” Rep. Womack said.

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