Single payer, or no single payer?

As candidates and policymakers debate health care’s future amid soaring insurance costs, a new study from the University of California San Francisco examined 22 single-payer plan proposals in the past 30 years. It found that a public-run system would save money over time.

Single-payer opponents argue it would increase both costs and inefficiency: Indeed, the UCSF study’s suggested the details would ultimately determine the savings. Yet the data found that single-payer “would save money over time, likely even during the first year of operation.”

James G. Kahn, a UCSF professor and a study’s researcher, said that “even though they start with different single designs and modeling assumptions, the vast majority of these studies all come to the same conclusion.

Kahn added: “This suggests that fears that a single-payer system would increase costs are likely misplaced.”

Advocates, including several 2020 Democratic presidential candidates, support the idea of expanding on the Affordable Care Act, Medicare Advantage and Medicaid — sidelining or altogether removing the vast network of private companies who have a massive stake in health care delivery, and who are taking the blame for surging costs.

Meanwhile, opponents say this approach would be bad for the industry, and for taxpayers.

“You are letting government compete in the same place as the market they regulate, that just does not seem to be fair competition,” Seema Verma, Administrator of the Centers for Medicare and Medicaid, which is part of the U.S. Department of Health and Human Services, told Yahoo Finance at JPMorgan’s health conference last week.

The UCSF study dovetailed with a Congressional Budget Office report published in May, that said the viability of a single-payer system would be contingent on its scope and structure.

“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,” the CBO’s analysts wrote.

“Total national health care spending under a single-payer system might be higher or lower than under the current system depending on the key features of the new system, such as the services covered, the provider payment rates, and patient cost-sharing requirements,” it added.

Where the private sector plays a role

Ahead of the Iowa caucus, leading Democrats have floated proposals to overhaul the country’s health system. While not all of them fully back Medicare for All, most candidates have embraced a government-centric solution to the problem.