The political jockeying over "Medicare for All" continued Wednesday as a House committee hosted a second hearing on single-payer healthcare.
Representatives from the Congressional Budget Office (CBO) attended the House Budget Committee session to discuss the group’s recent report that digs into the many policy choices the legislators would need to make to push such a plan forward.
“Moving to a single-payer system would be a major undertaking—it would involve significant change for all participants,” CBO Deputy Director Mark Hadley told the lawmakers.
But the bulk of the hearing was spent less on debating the feasibility of any single-payer plans and more on trying to coax Hadley into confirming the ideas as either impossible or extremely beneficial.
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Hadley didn’t take the bait, instead emphasizing the implications—the impact on people with preexisting conditions, the costs, the operations—hinge on complex policy decisions that can have ripple effects.
For example, he noted that a single-payer health system that pays physicians a rate that they are extremely unhappy with could lead to fewer people becoming doctors. This could lead to access issues if demand far outweighs supply, he said.
CBO also noted in the report that there are multiple different options available to pay for a national healthcare system: Policymakers could choose to keep some type of cost-sharing or fund it all through payroll taxes.
Each option has drawbacks—and both are unpalatable to patients to some degree—but each could be structured in a progressive manner, he said.
Many Democrats in Congress have signed on to support either single-payer Medicare for All proposals or other plans, such as for a public option modeled on Medicare or a buy-in. Republicans, on the other hand, have hammered their colleagues on the other side of the aisle over their support for a government health system.
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Medicare for All’s first hearing in the House was much the same, with plenty of mudslinging from representatives from both parties. Wednesday’s hearing did underscore some of the divide between Democrats on the issues, as many favor more incremental proposals over a wholesale healthcare system overhaul.
Following the hearing, some provider and payer groups echoed many of the GOP talking points, arguing a single-payer plan would be too costly and could restrict access. Instead, lawmakers should focus on stalled plans to shore up the existing Affordable Care Act exchanges.
In a statement (PDF) submitted to the committee, America’s Health Insurance Plans (AHIP) said a “one-size-fits-all" approach would force people into government insurance they may not want.
“These proposals do nothing to address our top challenge: a growing health care affordability crisis,” AHIP said. “These proposals would mean higher taxes on all Americans, higher total premiums and costs for the hundreds of millions of people enrolled in private coverage, longer wait times, and lower quality of care.”
Other industry groups, such as National Nurses United, have conversely been actively campaigning for single-payer healthcare.