Medicare beneficiaries can choose to receive benefits under Part A (Hospital Insurance) and Part B (Medical Insurance) in the traditional Medicare program or through one of the private insurers participating in the Medicare Advantage program. In the United States, the traditional Medicare program is considered an example of an existing single-payer system for elderly and disabled people, but analysts disagree about whether the entire Medicare program is a single-payer system because private insurers play a significant role in delivering Medicare benefits outside the traditional Medicare program. Private insurance, if allowed, generally plays a relatively small role and supplements the coverage provided under the public plan.The receipts and expenditures associated with the plan appear in the government’s budget and.The eligible population is required to contribute toward financing the system.The government entity (or government-contracted entity) operating the public health plan is responsible for most operational functions of the plan, such as defining the eligible population, specifying the covered services, collecting the resources needed for the plan, and paying providers for covered services.Single-Payer Health Care SystemsĪlthough single-payer systems can have a variety of different features and have been defined in many ways, health care systems are typically considered single-payer systems if they have these four key features: This report uses the term “universal coverage” to characterize systems in which virtually all people in an eligible population have health insurance. For example, some people (such as noncitizens who are not lawfully present in the United States) might not be eligible for coverage under a single-payer system and thus might be uninsured.
Although a single-payer system could substantially reduce the number of people who lack insurance, the change in the number of people who are uninsured would depend on the system’s design. This report does not address all of the issues that the complex task of designing, implementing, and transitioning to a single-payer system would entail, nor does it analyze the budgetary effects of any specific bill or proposal.Ībout 29 million people under age 65 were uninsured in an average month in 2018, according to estimates by CBO and the staff of the Joint Committee on Taxation. In this report, CBO describes the primary features of single-payer systems, as well as some of the key considerations for designing such a system in the United States.Įstablishing a single-payer system would be a major undertaking that would involve substantial changes in the sources and extent of coverage, provider payment rates, and financing methods of health care in the United States. Some Members of Congress have proposed establishing a single-payer health care system to achieve universal health insurance coverage. Congressional interest in substantially increasing the number of people who have health insurance has grown in recent years.
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