Changing U.S. Health Finance Involves, Um, Words: CBO

Budget analysts at the Congressional Budget Office (CBO) have implied, in a new report on Medicare for All proposals and other single-payer health care system proposals, that they can’t assume would-be health policymakers in Washington know much about how the U.S. health finance system works now, or how the health finance system works in other countries.

(Related: 5 Possible Weird Effects of the Texas Anti-Health Law Ruling)

The CBO is an arm of Congress that helps members of Congress understanding programs and proposals that could affect federal spending, or federal revenue.

The House Rules Committee held a hearing Tuesday on H.R. 1384, a bill introduced by Rep. Pramila Jayapal, D-Wash., that would eliminate all private health insurance, dental insurance, vision insurance and long-term care insurance. The bill calls for the U.S. Health and Human Services secretary to ensure that “no cost-sharing, including deductibles, coinsurance, copayments, or similar charges, is imposed on an individual for any benefits provided under this Act.”

CBO analysts have released a new document with the title, “Key Design Components and Considerations for Establishing a Single-Payer Health Care System.”

The document does not include any systematic analyses of how much various proposals for expanding the role of the government in health finance might affect government spending, government revenue or U.S. health system performance.

Instead, the analysts have focused on trying to help readers understand the various components of the U.S. health care finance system, how other systems work, and how U.S. systems and non-U.S. systems seek to balance the demand for high-quality care with the need to hold down costs.

‘C’ Is for Fun With Cost-Sharing

The authors include, for example, a table comparing the universal coverage systems in Australia, Canada, Denmark, England, Sweden Taiwan.

The table shows that all of the health care systems other the Canadian system require patients to pay part of the costs for prescription drugs, dental care and vision care, and that the Canadian and English systems have no caps on patients’ out-of-pocket spending.

Enrollment Is Something Health Care Systems Do

The CBO primer authors have included a section on the fact that single-payer health care systems still need to have ways to enroll people in coverage and verify eligibility for coverage.

“A single-payer system would need a way to verify eligibility and enroll participants in the system,” according to the primer. “Verifying eligibility would be easier than it currently is for public programs, such as with Medicaid’s income verification, because the single-payer system would have fewer eligibility exclusions. A verification and enrollment system could build on the current Medicare Part A enrollment system. People could also be automatically enrolled when they were issued Social Security numbers, newborns could be enrolled in hospitals at birth, and other eligible individuals could be enrolled when they sought medical care.”