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CBO report on single payer design

May 1, 2019

Topics: Quote of the Day

Congress of the United States, Congressional Budget Office, May 2019

At a Glance

Some Members of Congress have proposed establishing a single-payer health care system in the United States to ensure that virtually everyone has health insurance. In a typical single-payer system, people enroll in a health plan operated by the government, and the receipts and expenditures associated with the plan appear in the government’s budget.

This report describes the primary features of single-payer systems, and it discusses some of the design considerations and choices that policymakers will face as they develop proposals for establishing such a system in the United States. The report does not address all of the issues involved in designing, implementing, and transitioning to a single-payer system, nor does it analyze the budgetary effects of any specific proposal.

Some of the key design considerations for policymakers interested in establishing a single-payer system include 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 health care costs?
  • How would the system be financed?

For each question, this report discusses various options and provides a qualitative assessment of the trade-offs they present.


Full Report (PDF – 34 pages): Key Design Components and Considerations for Establishing a Single-Payer Health Care System:


By Don McCanne, M.D.

This is the CBO report requested by Congress describing various features that should be considered in designing a single payer health care system. Single payer advocates already involved in health policy work can easily answer each of the questions above, but reading the report will still be useful. The reason is that when any potential single payer legislation has advanced to the point of committee markup, these features will likely be intensively debated.

It is imperative that we establish well in advance why there should be no compromise in a well designed model of single payer such as that advanced by Physicians for a National Health Program. It would be terrible if we finally enacted single payer only to have it be designed as a bureaucratic boondoggle. So read the report so you can prepare your defense of single payer nirvana.

Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.

About the Commentator, Don McCanne

Don McCanne is a retired family practitioner who dedicated the 2nd phase of his career to speaking and writing extensively on single payer and related issues. He served as Physicians for a National Health Program president in 2002 and 2003, then as Senior Health Policy Fellow. For two decades, Don wrote "Quote of the Day", a daily health policy update which inspired HJM.

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