If single payer were really a bargain, supporters like Rep. John Yarmuth would be upfront about its cost

House Budget Committee Chairman John Yarmuth (D-Ky.) wants the Congressional Budget Office to design a single-payer health care system for the United States — but without saying how much it would cost. 

In a letter to CBO, Yarmuth (D-Ky.)  requested a “qualitative” assessment but wasn’t particularly interested in what single payer would cost, oddly declining an estimate of the impact on federal spending.  Not an auspicious beginning for such a costly endeavor, especially coming from the chairman of the Budget Committee.

{mosads}These things usually work the opposite way — Congress first designs a program and then CBO estimates the cost.  That’s a major part of what the CBO is meant to do, and if we want to have a serious debate on single payer health care Americans deserve to know what it’s going to cost.

If Chairman Yarmuth doesn’t want to know the cost of single payer — actually, it’s you he doesn’t want to know — then Senate Budget Committee Chairman Mike Enzi (R-Wyo.) could provide a valuable public service by asking CBO to provide that key piece of information.

After all, there is a nearly $22 trillion debt already hanging over our economy, with Social Security and Medicare on a path to insolvency in 2034 and 2026, respectively. Any policy that would increase federal spending should be given a full – and transparent – vetting.  Price matters.

Of course, it’s understandable that single-payer supporters would be reluctant for CBO to score a single-payer system — the number would cause sticker shock and likely sink the effort before supporters could even make their case. The Mercatus Center estimated the 10-year cost of Sen. Bernie Sanders’ (I-Vt.) single-payer plan, the Medicare for All (MFA) Act — at around $33 trillion.  Using that same timeframe and similar assumptions, the Urban Institute put it at $36 trillion.  Both are low-ball estimates.

How much would taxes have to increase to fund such a scheme?  According to Mercatus, “doubling all federal individual and corporate income tax collections would fall short of fully funding the plan.”  So, we know that no matter what design CBO comes up with, the price tag and the tax hikes will both be huge. 

Not to worry, say single-payer supporters, the higher taxes would be a bargain because no longer would Americans have to pay for health care premiums, deductibles, fees and other medical costs.  And by eliminating the overhead and profits of private insurance companies, we could actually insure more people for less money.

Doing more with less sounds good. Really good. But as the old saying goes, if it sounds too good to be true, it probably is.   

First, the Mercatus and Urban Institute estimates assume Medicare’s reimbursement rates would be imposed on all or part of entire health care system. Mercatus says that would mean providers getting 40 percent less than they are paid now by private insurance companies. Does anyone believe health care providers would stand for a 40 percent haircut? 

Second, Vermont and California — hardly what you’d call fiscally responsible states — both abandoned single payer plans after they realized the costs and the taxes required to cover those costs were unrealistic. When states like Vermont and California balk at such plans over cost and tax considerations, you know it’s expensive.  

So how do we make health care more affordable? We can start by eliminating certificate-of-need requirements, expanding access to telehealth and working with medical certification boards to make it easier for foreign-trained doctors already in the United States to start practicing more quickly. 

On the insurance front, we can provide Americans with more options that better fit their needs. The Trump administration has already taken steps to achieve this by: expanding flexible, short-term insurance plans; allowing more employers to offer coverage through association health plans; and allowing states to reform their insurance markets while protecting those with pre-existing conditions.

If single payer were such a good idea and such a bargain, proponents would be upfront about its costs. Instead, congressional leaders are apparently committed to keeping up the fiction for as long as they can that single payer health care is somehow “free.” 

Chairman Yarmuth and other single-payer supporters should ask for the actual cost of their idea and let the American people decide if they think they can afford it.

David Barnes is a policy manager at Americans for Prosperity.