Thread by @sangerkatz

New gem for the CBO cover design file. cbo.gov/system/files/2…

This paragraph is so important. And it's why it is hard for CBO--and other scorers--to provide precise estimates of exactly what "Medicare for all" will cost. cbo.gov/system/files/2…

Reminder: There are a handful of existing scores for single-payer plans floating around. Looking at all of them, with their range of outcomes, and different considerations of key variables, may be helpful. nytimes.com/interactive/20…

(I did not realize so many undocumented immigrants
had health insurance.)

The next time a politician says "every other industrialized nation in the world..." remember this table.

A good test case for this proposition is a drug like Sovaldi. nytimes.com/2014/08/03/ups…

Republicans often say that a single-payer plan will mean waits for care. That's definitely possible, not but a given. A lot depends on the particulars of design. Not every single payer system has waits.

I am sad but not surprised that CBO is not considering these questions now. Would be necessary to calculate a dynamic score.

Helpful summary of the current administrative cost breakdown for different kinds of insurance now.

This kind of process question--how would the single payer decide what new medical technologies to cover--is largely unspecified in the Sanders and Jayapal bills.

Unavoidable truth here about long-term care: Covering it will be expensive, because so much of it now goes unpaid. Both the Sanders and Jayapal bills would pay for more long-term care than Medicare covers currently.

The report highlights that policymakers need to think about whether they will allow any private insurance. They will also need to decide whether to allow private doctors.

There's a fun two-page insert in the report on multipayer systems--a good reminder that single-payer is not the dominant choice for providing universal coverage in Europe. More on that here: nytimes.com/interactive/20…

We tend to talk about what percentage of Medicare "rates" "Medicare for all" might pay. But there are also completely different options. The Jayapal bill wants to pay hospitals with global budgets. nytimes.com/2019/02/26/ups…

CBO continues to raise its eyebrow at the potential for Medicare negotiations to substantially lower drug prices, even in a Medicare-for-all world. Effective negotiation means the ability to say no to drugs that some people will wish to take. nytimes.com/2016/02/02/ups…

President Trump will enjoy this paragraph.

Reminder that it's totally possible (maybe likely) that a government run system will do many of the things that annoy patients about private insurance.

This is the paragraph the Budget Committee was looking for: CBO would score single-payer as government expenditure--meaning it would have a big score. (This is not surprising, but it's important. Obamacare didn't have this feature.)

If you were hoping this CBO report would contain a lot of numbers, you are going to be disappointed.

But it makes a lot of sense that they left the numbers out for now. As the report highlights, the cost of single payer health care depends tremendously on various policy design considerations, some of which remain hazy.

If you want to read a report that walks through many of the same questions, with some illustrative numbers attached to key choices, this @jodiliu dissertation is a very helpful read. rand.org/pubs/rgs_disse… h/t @MarkVinPaul

And, if you want to get a sense of the possible costs for the Sanders plan, at least, we've summarized a range of estimates here: nytimes.com/interactive/20…

Here’s my article on today’s CBO report on single-payer health care. It was specific enough to be helpful. But vague enough to be easily deployed by enthusiasts and detractors alike. nytimes.com/2019/05/01/ups…