So, whatever happened with the CBO analysis of Single Payer HR 676?

[seafan]

No one is saying.


Representative Weiner, what can you tell us?



I did some research and found this 1993 report on Single-Payer by the CBO. And, wonder of wonders, a single-payer system ("SP1") that utilizes co-pays appears to trample the others in terms of reducing national health expenditures (NHE). And, according to this report, that doesn't even include cost containment estimates, so the final numbers for Single-Payer cost savings would likely be even stronger.


This report compares four options, described in detail below:


1. Single Payer (with co-payments) SP1

2. Single Payer (without co-payment) SP2

3. All Payer (universal coverage) AP1

4. All Payer (not universal) AP2

CBO STAFF MEMORANDUM

SINGLE-PAYER AND ALL-PAYER HEALTH INSURANCE SYSTEMS USING MEDICARE'S PAYMENT RATES


April 1993
CONGRESSIONAL BUDGET OFFICE
SECOND AND D STREETS, S.W.
WASHINGTON, D. C.

.....

SP1 is like the single-payer plan examined in CBO's earlier
study, with hospital and physician reimbursement based on
Medicare's current payment methods, but with hospital rates
increased 11 percent to cover current average costs per case
fully. Insurance coverage would be universal, and the plan's
benefits would be actuarially equivalent to the average benefits
now paid under Medicare and private insurance. Copayments
would be required of patients, similar to the copayment
requirements now typical in the United States, but balancebilling
(collecting the difference between the provider's charge
and the insurer's payment rate from patients) would be
prohibited.



SP2 is a Canadian-style single-payer system. Coverage would be
universal, and no copayments would be required of patients.
Although physicians would be paid based on Medicare's rates,
hospitals would be funded through global budgets and would
maintain only very limited management information systems.


API is like the all-payer plan examined in CBO's previous
study. As with SP1, all hospitals and physicians would be
reimbursed based on Medicare's payment methods, and
copayments but not balance-billing would be required of
patients. Coverage would be universal-Medicare would cover
people currently uninsured, and there would be no change in
insurer for others.


AP2 is like API except that coverage would not be universal.
Those currently without insurance would remain without
coverage.




The Illustrative estimates presented in this paper are not cost estimates.
The cost estimates that CBO prepares for specific legislative proposals require
much more detail about the characteristics of the proposals, and they show the
impact on the federal budget. The estimates here indicate what national
health expenditures would have been had any of the alternative payment
systems been fully effective throughout 1991. They show only the immediate
effects of each option-savings on insurers' and providers' overhead expenses,
savings from lower average payment rates, and the costs of extending coverage
to the uninsured (for all but AP2). Additional savings might accrue if the new
systems provided for effective cost containment through, for example,
expenditure caps or price and utilization controls. If such features were
included, spending might be significantly lower than for the options shown.


.......


ESTIMATES FOR SINGLE-PAYER AND ALL-PAYER OPTIONS


This section presents estimates for the four options described earlier. Each
option would use Medicare's payment rates for hospital and physician services
(with hospital rates adjusted to cover average costs) and would eliminate
balance-billing on physician services for all patients. Medicare enrollees' bad
debts on hospital copayment liabilities would no longer be covered under
these options. None of the estimates include the effects of cost containment
provisions-such as effective expenditure caps or price and utilization controls--
that might reduce spending if they were part of the new system.

Both single-payer options would achieve universal insurance coverage.

SP1 would retain copayment requirements and case-specific billing for
hospitals. SP2 would eliminate copayment requirements and use global
budgeting for hospital payments. Although private insurers would be
permitted to offer coverage for services excluded from the single-payer plan,
no effects of any additional private health insurance are included in the
estimates.

Both of the all-payer options would retain copayment requirements and
case-specific billing for hospitals. API assumes that universal coverage would
be achieved by extending Medicare to those currently without insurance.
AP2 assumes that those currently without insurance would remain so.



Overall Changes in National Health Expenditures (NHE)

.....

NHE would be lowest under SP1, the singlepayer option that would retain copayment requirements. Spending would be highest under SP2, the single payer with first-dollar coverage, but would be
nearly as high under API, the all-payer option with universal coverage and copayment requirements.



SP1. Under this single-payer option that would retain copayment requirements,
the combined effects of changes in spending for health care services
and for overhead expenses would be to reduce NHE by $14.2 billion or 1.9
percent. Payments to providers, minus expected savings on their overhead
costs, would increase by $10.1 billion. Costs for uncompensated care would
fall from $20.3 billion to $5.6 billion.

SP2. Under this option without copayment requirements, the combined
effects of changes in spending for health care services and for overhead would
be to increase NHE by $37.6 billion, or 5.0 percent. Under this option,
payments to providers would increase by $64.4 billion, and there would be no
uncompensated costs.

API. In this all-payer option with universal insurance coverage, the combined
effects of changes in spending for health care services and for insurance
administration would increase NHE by $23.3 billion. Payments to providers
would increase by $17.1 billion. Costs for uncompensated care would fall by
$14.7 billion, to $5.6 billion.

AP2. Under this option without universal coverage, the combined effects of
changes in spending for health care services and for insurance administration
would reduce NHE by $9.9 billion, or 1.3 percent. Payments to providers
would fall by $12.7 billion. Costs for uncompensated care would increase by
$0.9 billion, primarily the result of an increase for Medicare patients.

I think this report is valuable for the definitions of the payer systems and in the differences among them. Single payer with co-pays appear to outshine the others in lowering national health expenditures. When cost containment is added in, there is no way anything would beat Single Payer in its universal coverage, cost containment and as having the least impact on the national budget.




Yet, in 2009, Single Payer was **OFF THE TABLE** before this dance even started.





It is through this information that we feel the crushing iron grip of Big Health Insurance/Big Pharma that imprisons us, backed up by the bought-off Republicans, Blue Dogs and ConservaDems.


And today, we hear that Harry Reid is deliberately shielding conservative Democratic senators from scrutiny if they bolt over to the Republicans to help filibuster a public option.



This is it, people. Fasten your seat belts.


It's our very lives that are at stake.

[Freddie Stubbs]

1. According to Weiner, it was supposed to happen over the August recess:

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=389&topic_id=6267501&mesg_id=6267501

[Oregone]

2. SP1 would cause self-rationing

I guess its better than nothing, but for a family having a bad month, they may avoid the hospital at all costs. Better than the status quo, by far though

[joeycola]

3. since weiner is now offering an amendment instead of 676, I do

wonder if it is being scored.



http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=389&topic_id=6267501&mesg_id=6267501