A U.S. single-payer system could redistribute doctor and hospital pay, congressional budget officials told a U.S. House of Representatives panel on Wednesday.
But ultimately a House Budget Committee hearing painted only a vague picture of what the hospital world would look like if the entire healthcare system were overhauled.
Some projections from Congressional Budget Office officials were promising for hospitals that struggle now. For example, rural hospitals that treat a high share of uninsured, Medicaid and Medicare patients could get a boost, according to CBO's Jessica Banthin.
Also, doctors don't necessarily need to face a major rate slash, CBO Deputy Director Mark Hadley said. The government could simply lower doctors' pay by the amount saved through fewer administrative costs.
When Rep. Jan Schakowsky (D-Ill.) asked whether Americans under single-payer would lose choices for care, Hadley gave some reassurances. He said that since a single-payer system would combine every network that currently exists, "all providers would participate and be potentially available."
But there were plenty of caveats. For instance, depending on how the government decided to pay doctors, a single-payer system could also cause doctor shortages, Hadley warned.
He also advised lawmakers constantly that functionality of a single-payer system would depend on what the government agrees to physicians and hospitals: these rates would determine the healthcare supply and the government's ability to control costs. And he noted that policymakers would have to consider global budgets and prior authorizations as ways to control spending.
However, lawmakers largely chose not to dive into these details, other than critical Republicans who warned of additional government bureaucracy and decisions to limit care. Ultimately, the testimony presented a grab-bag of issues for the panel members to advocate for their own point of view of a single-payer system.
Budget Committee Chair Rep. John Yarmuth (D-Ky.) based Wednesday's hearing on the recent CBO analysis he commissioned, which posed various issues that lawmakers should consider if they want to design a single-payer system for the country. The report didn't scrutinize any particular single-payer proposal, nor did it estimate costs. Various independent estimates put the cost at about $32 trillion over a decade.
While the U.S. spent $3.5 trillion on healthcare in 2017 and economists say the overall costs could shrink under a single-payer system, the rub for most is that the government would have to shoulder a considerable share of those expenses that are currently borne by the private market.
The other concern is disruption. Hadley told lawmakers in his opening statement that he primarily wanted to help them understand the complications of restructuring healthcare, especially the cost and the intertwining of the economy with the current system.
"It would involve significant changes for all participants—individuals, providers, insurers, employers and manufacturers of drugs and medical devices," Hadley said. "Because healthcare spending currently accounts for about one-sixth of the nation's economic activity, those changes could significantly affect the overall U.S. economy."
When it came to the elephant in the room — employer sponsored insurance — lawmakers' questions signaled how dicey that issue can become.
Yarmuth laid it out in his opening remarks, where he criticized the status quo as wasteful and inefficient.
"There is a consensus among economists that our system of employer-based coverage displaces wages," the chairman said. "Relieving employers from the burden of providing coverage will empower American companies to raise employee wages, expand their businesses and help to grow our nation's economy."
Rep. Ro Khanna (D-Calif.), a staunch advocate for Medicare for All, tried to push Hadley to say single-payer would help workers by increasing their wages.
But Hadley proved evasive, declining to affirm Khanna's question whether a single-payer healthcare system is "one of the biggest things we could do on wage stagnation." Hadley wouldn't absolutely agree that single-payer would raise wages for most Americans, although he acknowledged that it's possible to design a system that would cost some people less and also drive up their salaries.
Wednesday's hearing served as a contrast to last month's testimony in the House Rules Committee where lawmakers discussed specific legislation on Medicare for All by progressive Rep. Pramila Jayapal (D-Wash.). Her bill is also expected to get a hearing in the Budget Committee, where she is a member.