Testimony on the Key Design Components and Considerations for Establishing a Single-Payer Health Care System

Some Members of Congress have proposed establishing a single-payer health care system in the United States. Many more people would probably have health insurance as a result—but the government would take much more control over the health care system. The effects of such a system on its participants and total health care spending could vary greatly depending on the details of the system’s structure and operation.

Earlier this month, CBO released a report on single-payer health care systems. That report describes the primary features of single-payer health care systems and discusses some of the considerations for establishing such a system in the United States. It represents CBO's first step in a broader effort to support the Congress as it considers the issue and to build the agency's capacity to estimate the costs of specific proposals.

CBO conveyed two main points in its testimony:

• First, moving to a single-payer system would be a major undertaking. 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.
• Second, to establish a single-payer system, lawmakers would need to make many decisions and would face complex trade-offs.