The Congressional Budget Office on Wednesday released an analysis that warned a fully government-financed healthcare system could result in “increased wait times and reduced access to care” if there weren’t enough providers to meet the increase in patient demand.
The analysis, published by Congress’ nonpartisan agency, hedged throughout that much of the success of the system — which has been championed by Vermont Sen. Bernie Sanders and backed by other Democratic candidates for president — would depend on the details of a plan and how quickly lawmakers act when problems emerge.
It did not contain an assessment about how much such a plan, known as “single payer,” would cost the government, although it did predict government spending on healthcare “would increase substantially,” while also potentially lowering administrative costs and eliminating other costs by doing away with the profits of private health insurers.
“The transition toward a single-payer system could be complicated, challenging, and potentially disruptive,” the analysis said.
A price tag wasn’t expected, but Republicans and centrist Democrats have warned that moving all healthcare coverage under the control of the federal government would lead to massive tax increases. They have also warned of less access to care, something that CBO analysts said could happen if the federal government did not work to increase the number of providers. With more people getting coverage, analysts expect a demand in healthcare services will also follow.
The CBO didn’t describe specific legislation but instead laid out the different considerations lawmakers should keep in mind as they move toward more government involvement in the healthcare system. Because of this, the analysts included several caveats throughout the report but said it was possible not only that more people would receive medical coverage, but also that they would get better coverage than they have now.
The analysis acknowledges that people would not have a choice of health insurance plan or of the healthcare benefits that are covered.
“Unlike a system with competing private insurers, the public plan might not be as quick to meet patients’ needs, such as covering new treatments,” the report said.
Analysts explored a series of questions, including how the government would administer the plan, what benefits would be covered, whether private health insurance would play a role, and who would own hospitals. They wrote that a system devoid of profits could create incentives for policymakers to invest in improving people’s health.
The CBO admitted that making predictions about what would happen was difficult because other examples have only been tried on a smaller scale. The analysts recommended that members of Congress carefully watch how different parts of the healthcare system react and that they be prepared to intervene when problems come up.
The bill to have a fully government-financed healthcare system is the Medicare for All Act introduced in the House by Reps. Pramila Jayapal, D-Wash., and Debbie Dingell, D-Mich. It would roll everyone living in the U.S. into a government plan that would be known as Medicare but would be far more expansive than the current Medicare program. It proposes to have the government pay for all medical services without individual patients making payments at the doctor’s office, hospital, or the pharmacy.
The proposal, which has a Senate version introduced by Sanders, would undo nearly all private health insurance, leaving room only for the industry to cover cosmetic surgery. The CBO didn’t address the Medicare for All Act specifically, but it pointed out in its report that other countries with a larger government involvement in healthcare still allow private health insurers to remain in business.
Analysts also pointed out that a slow transition might be key to minimizing the disruption. The House bill would change the healthcare system in two years, but the Senate bill would do so in four years.
The report predicts that everyone in the U.S. would be covered depending on whether lawmakers allow people who are living in the country illegally — an estimated 11 million people — would also be covered by the plan. The House bill leaves the decision of eligibility up to the secretary of the Department of Health and Human Services, which means that coverage would change depending on an administration’s ideology.
