Medicare for All’s Price Tag? Even the CBO Can’t Say.

(Bloomberg Opinion) -- The Congressional Budget Office — a nonpartisan group that analyzes the cost of legislation for Congress — released a much-anticipated report Wednesday that analyzes the potential design and implementation of a single-payer health-care system along the lines of “Medicare for All.”  Many on both sides of the health-care debate were hoping the report would include numbers with which to assail or support the plan; instead, they were disappointed. 

The report doesn’t estimate the cost of any specific proposal or come to a conclusion about the rather foundational issue of whether a single-payer system would save the U.S. money. That’s because the only correct answer to that question is, it depends.

The CBO leads off with a visual aid that explains why that is, and it also explains why the report is light on numbers for the usually highly analytic organization:

Here’s the rub: The cost impact of any single-payer proposal — be it the one touted by U.S. Senator Bernie Sanders as part of his platform as a presidential candidate or those pushed by House Democrats led by Pramila Jayapal — depends on where it lands on a long list of complicated policy decisions, any one of which could swing government spending by billions of dollars and dramatically change how millions of Americans get health care. Every one of those decisions interacts with all of the others and affects everyone who participates in the health-care system.

My suggestion is to pull out that CBO chart the next time a Republican politician cites a terrifying multi-trillion figure for the cost of single-payer health care or cites socialist dystopia as the inevitable outcome. The same goes for when a Democrat makes the transition sound easy or refers to a specific plan as the only option. 

Think of it as an antidote for a politicized and reductive health-care discussion. 

The fact is, we already make all of the above decisions and spend those trillions of dollars on health care — but in a fragmented, wildly inefficient, and often deeply unjust way. There are plenty of paths to a system where we spend less and get better outcomes; we know that because other rich industrialized countries have found them. 

A transition to something entirely different would be phenomenally difficult over a decade, let alone the two to four years Sanders and House Democrats have called for, and there are valid intermediate options between our current system and Medicare for All.  

Health care is full of complexity and trade-offs. The CBO didn’t crown a winner or loser Wednesday, but its report will hopefully encourage people debating it to sweat the details.

To contact the editor responsible for this story: Beth Williams at bewilliams@bloomberg.net

This column does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners.

Max Nisen is a Bloomberg Opinion columnist covering biotech, pharma and health care. He previously wrote about management and corporate strategy for Quartz and Business Insider.

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