Here's yet another estimate of a single payer system by the CBO, but this time focusing in on how such a switchover would be done and at what cost.
The nonpartisan Congressional Budget Office weighed in: "The transition toward a single-payer system could be complicated, challenging, and potentially disruptive," budget analysts wrote.
Oddly, none of the “problems” pointed out by the CBO are new or unexpected, so any doom and gloomers out there are just showing us how little they know about our complicated health care in the first place. The report also said:
1. A single-payer system could substantially reduce the number of uninsured, which currently averages about 29 million people a month. But if undocumented immigrants are not allowed to participate, about 11 million U.S. residents could end up without coverage. (About half of undocumented immigrants have coverage now.)
2. The changes could significantly affect the U.S. economy. The magnitude of the effect is hard to predict because the evidence CBO would rely on to make those predictions comes from much smaller changes to the health care system.
3. Whether the nation would end up spending more or less on health care would depend on key features such as how much health care providers would be paid and whether patients would be required to share some of the costs.
4. Benefits of a single-payer system could include lower administrative costs and more incentives to improve people’s health. But patients may also have longer wait times or reduced access to care if there aren’t enough physicians to meet increased demand.
5. Expanding access to health insurance through a multi-payer system instead of a single-payer model could be less disruptive and give patients greater choice. But the nation would probably spend more on health care than it would under a single-payer system.
Throughout the analysis, the CBO showed reasons for the current costliness. For instance, the office found that in 2013 the "three major insurers" paid hospital rates that were 89% higher on average than Medicare rates for the same services. The federal government's administrative costs for Medicare were about 1.4% of total Medicare expenditures in 2017. For Medicare Advantage and Part D plans, administered by commercial insurers, those costs rose to 6% of total expenditures. For commercial insurers, those expenditures averaged about 12% of total costs.
The CBO said that the projected administrative savings could be one of the "opportunities" of developing a single payer system ... the system would have more incentive to invest in preventive medicine and improve overall population health if it could eliminate the turnover seen in the employer and individual markets.
Dr. Doris Browne, a retired military medical officer and immediate past president of the National Medical Association argued that a universal coverage option would force widespread adoption of preventive medicine, which has so far baffled the U.S. "If you put prevention into practice, you're not going to have many of these hospitalizations that end up in the ICU. We have not practiced prevention. We have been talking about it for years and years and it has gone by the wayside."
New York City emergency physician Dr. Farzon Nahvi used personal anecdotes from the treatment room to advocate for single payer. In one instance, he said he treated a woman who had overdosed on fish antibiotics she bought from a pet store to manage a fever, as she didn't think she could afford seeing a doctor. The overdose affected her brain, and she fell down a staircase and was rushed to the emergency room. In another story, a patient who had a urinary infection treatable with antibiotics couldn't get her insurer to cover the $300 medicine. She bought cranberry juice instead only to come to the emergency room with sepsis from a subsequent infection — costing thousands of dollars.
"We're paying more for bad outcomes, and that needs to be part of the discussion too," Nahvi said. "There's no way to account for what we're seeing on the ground level."