KEY DESIGN COMPONENTS AND CONSIDERATIONS FOR ESTABLISHING A SINGLE-PAYER HEALTH CARE SYSTEM

By: Congressional Budget Office
Authors: Jared Maeda and Xiaotong Niu (primary authors)
Published: May 2019
Financed by: U.S. Congress
Legislation analyzed: None. Lays out decisions lawmakers will have to make in designing a Single-Payer Healthcare System.


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Author's Summary

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.