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Congressional Budget Office report on single payer: A good start

Jack Bernard, a retired SVP with a large national healthcare firm, has worked extensively with hospitals across the nation regarding cost containment and insurance. He was also the first Director of Health Planning for Georgia.

One of the more productive off-shoots of the Presidential Primary is that healthcare issues are being widely discussed on the national level. This is because 36 percent of Americans believe it to be their top issue and 26 percent as their second highest concern (Real Clear Media poll, 5-19). That ranks healthcare even higher than the economy. Among Democrats, even more are clear about the change they desire with an astounding 82 percent favoring Medicare for All, single payer.
However, one of the bigger healthcare issues is the continuing confusion about how to define single payer. Having been heavily involved with this specific topic for over 10 years, I find this to be true, even among sophisticated single-payer advocates.
The nonpartisan, impartial Congressional Budget Office (CBO) is one of the most respected government agencies. In May, the CBO issued a report on a single-payer approach to healthcare (www.cbo.gov/system/files/2019-05/55150-singlepayer.pdf) requested by the chair of the House Budget Committee. I have advocated in various columns for many years for an objective, non-partisan evaluation of this sort to be done on the Federal level.
Their report analyzes cost/financing, administration, benefits provided, and eligibility. As the document clearly indicates, there is no commonly accepted one-size-fits-all universal coverage plan used in other developed nations, or advocated for here in the USA.
However, this CBO report may do more to confuse the situation than clarify it. For example, one factor the CBO reviewed was who employs those providing care (government or private employment) and if hospitals are owned by the government or private sources. Frankly, a system like the British National Health Service (BNHS), which employs its physicians and owns its hospitals, isn’t being seriously suggested by any US single-payer advocates. That’s not single payer; the BNHS is in effect a “single provider.”
Along these lines,I recently heard former candidate Rep. Seth Moulton on CNN mistakenly refer to expansion of VA as “single payer.” The VA historically has been a truly socialized system, similar to the BNHS, employing its physicians and using hospitals it owns, although that is currently changing with attempts (that have been ongoing since the Carter administration) to partially privatize VA. 
So, what is single payer as conceptualized for the USA? Every single payer advocate (including myself) is clearly visualizing expansion of our existing Medicare program, but with various important key modifications. Of course, that’s the internal philosophical battleground for those of us who have been around the issue for a while.
Where there are differences between our approaches, they relate to: How quickly should Medicare for All be implemented/phased in? Should the program cover non-citizens? Should all physical and mental health services be covered? Should long-term care, dental, vision and hearing be covered? Should there be co-pays? How quickly should Medicare Advantage be phased out? Should private insurance play any role at all? And, the bottom-line financial question as to how should we move current private expenditures by citizens and corporations into the public sector to completely or largely defray the cost of adding 30 million uninsured under the new system?
On this last issue, a key report to review is: Economic Analysis of Medicare for Allby: Robert Pollin, et al (11-30-18). As this document (analyzing the 2017 Medicare for All Act) illustrates, the USA is spending a lot now on healthcare financing via private insurance companies. Simply moving from private to public financing (Medicare) will automatically save us 9 percent in excess corporate marketing, overhead and another 10 percent on drugs and other areas. 
Isn’t it time that we stop paying insurance, drug, and hospital system executives seven and eight figure salaries? Isn’t it time that the other wealthy nations pay their share for drug research helping their citizens?
In my opinion, the best source for further information about Medicare for All is Physicians for a National Health Program (PNHP), whose web site is: http://pnhp.org. This respected and well-established provider-driven organization has state chapters throughout the nation available to explain why single payer is needed and how it can be financed.
It will be interesting to see how the healthcare positions of each of the Democratic Presidential candidates evolve over the next year. Hopefully, when the dust settles, the party will have a comprehensive, financially-feasible plan to roll out. Frankly, just having a plan of any sort would differentiate them from the current administration.

Jack Bernard, a retired SVP with a large national healthcare firm, has worked extensively with hospitals across the nation regarding cost containment and insurance. He was also the first Director of Health Planning for Georgia.