January 9, 2020 | Updates

CBO Confirms One-Size-Fits-All System Could ‘Negatively Impact The Quality Of Care For Patients’

WASHINGTON – A recent letter from the nonpartisan Congressional Budget Office (CBO) reiterated the unaffordable costs and negative consequences American families would face under a new government-controlled health insurance system.  Key findings from the CBO include: 

  • “If coverage was nearly universal, cost sharing was very limited, and the payment rates were reduced compared with current law, the demand for medical care would probably exceed the supply of care – with increased wait times for appointments or elective surgeries, greater wait times at doctors’ offices and other medical facilities, or the need to travel greater distances to receive medical care.  Some demand for care might be unmet … Without sufficient investment over the long term, wait times could lengthen as providers’ costs rise with other costs in the economy and the population grows.”
  • “The transfer of ownership from private to public might be disruptive to the daily operation of hospitals … Such disruption might negatively impact the quality of care for patients.”
  • “If all hospitals were paid 100 percent of Medicare fee-for-service rates, some would close unprofitable departments or close entirely, and fewer new hospitals would be built in the future, reducing access to care.”
  • “Less spending on medical services could also alter manufacturers’ incentive to develop new technologies or providers’ incentive to invest in capital, which could affect patients’ choices over the longer term.”
  • “A potential treatment that a doctor deems reasonable might not be covered by a single-payer system.”
  • “Under a single-payer system that eliminated private insurance entirely … patients would not have a choice of insurer or benefits, and those standardized benefits might not meet the needs of some people.  For example, certain specialty drugs or expensive new treatments, such as gene therapy, might not be covered under a single-payer system.”
  • “If a single-payer system had little or no cost sharing, the demand for physicians’ services would tend to rise.  If payment rates were reduced, on average, the supply of care from physicians would tend to fall.  Both of those factors would contribute to a shortage of physicians in the United States.”
  • “… [I]f there was little or no cost sharing and payment rates were substantially lower than what providers would receive under current law, CBO expects that average wait times would increase.”

In an earlier report, the CBO warns that a one-size-fits-all new government health insurance system, would “put pressure on the available supply of care … if the number of providers was not sufficient to meet demand, patients might face increased wait times and reduced access to care.”  

Meanwhile, studies show and experts note that so-called “moderate” alternatives to Medicare for All – like the public option and Medicare buy-in – would ultimately lead to the same consequences. 

  • Eric Levitz of New York Magazine writes that in reality these new systems “would not allow all Americans to ‘keep their private insurance if they prefer it’” and “would guarantee massive disruptions to private coverage.”
  • As The New York Times reported recently, the public option “could be plenty disruptive” and “tilt in the same direction” as Medicare for All.  This is backed up by the findings of a study, conducted by FTI Consulting for the Partnership for America’s Health Care Future, which reveals the public option could eliminate consumer choice for millions of Americans and “eventually cause the elimination of all private plans in the individual market.” 
  • A study released by KNG Health Consulting, LLC for the Partnership reveals that “Medicare for America,” another proposed new government-controlled health insurance system, could force one-third of American workers off of their current employer-provided health care coverage, also known as employer-sponsored insurance (ESI).  And The Wall Street Journal reports that new government-controlled health insurance systems like the public option, Medicare buy-in and ‘Medicare for all who want it,’ represent “stepping stones to single payer.”
  • An additional study, conducted earlier this year by Navigant for the Partnership, finds that the public option could put more than 1,000 rural U.S. hospitals in 46 states “at high risk of closure.”  These hospitals serve more than 60 million Americans, and as Kaiser Health News and NPR report, hospital closures can have “profound social, emotional and medical consequences,” while RevCycleIntelligence also reports, “[p]atient access to care suffers when a rural hospital closes its doors for good, and consequently, patient outcomes can deteriorate.”



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