Let’s Be Honest About a Single-Payer System
A shift to single-payer would be incredibly challenging — but that doesn’t mean it’s not worth doing
Today, perhaps more than ever, the health care debate in Washington is characterized by absolutes.
On the left, “Medicare for all” advocates (including a number of Democratic candidates for president) promise that a single-payer system will produce better outcomes, at a lower cost, for more people. Congressional Republicans counter that a single-payer system would spell our health care apocalypse.
In reality, a single-payer system could bring big benefits — everyone, rich and poor, would have access to the same (presumably) reasonably comprehensive health care. But it will also cost a lot of money, and efforts to rein in costs may affect both access and quality.
The truth is that when it comes to designing health care systems, there are very few certainties. Instead, there are just lots of trade-offs and difficult, contentious decisions to be made. This point was driven home by a report published last week by the Congressional Budget Office (CBO). The report laid out the various policy choices politicians would have to make when designing such a system, and noted that the total costs would depend heavily on decisions surrounding…
