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“Although single-payer systems can have a variety of different features and have been defined in many ways, health care systems are typically considered single-payer systems if they have these four key features:
• “The government entity (or government-contracted entity) operating the public health plan is responsible for most operational functions of the plan, such as defining the eligible population, specifying the covered services, collecting the resources needed for the plan, and paying providers for covered services;
• “The eligible population is required to contribute toward financing the system;
• “The receipts and expenditures associated with the plan appear in the government’s budget; and
• “Private insurance, if allowed, generally plays a relatively small role and supplements the coverage provided under the public plan.”

Source: Congressional Budget Office, Key Design Components and Considerations for Establishing a Single-Payer Health Care System. May 2019.

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“Government spending and total national spending on health care would be lower if provider payment rates under a single-payer system were set at Medicare FFS rates rather than at a higher level, such as average commercial rates. Setting payment rates equal to Medicare FFS rates under a single-payer system would reduce the average payment rates most providers receive—often substantially. Such a reduction in provider payment rates would probably reduce the amount of care supplied and could also reduce the quality of care. Studies have found that increases in provider payment rates lead to a greater supply of medical care, whereas decreases in payment rates lead to a lower supply.⁷³ But because those studies are based only on changes in Medicare’s payment rates for a given set of services within the context of a multipayer system, the results may be less relevant to a single-payer system, and providers’ responses to changes in payment rates are difficult to predict under such a system. Under a multipayer system with different payment rates, providers might be able to offset their loss of income from one payer by adjusting their rates for other payers, as well as by adjusting their patient mix toward payers with higher payment rates, but such opportunities would be eliminated or limited under a single-payer system.”

Source: Congressional Budget Office, Key Design Components and Considerations for Establishing a Single-Payer Health Care System. May 2019.

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“In addition to the short-term effects discussed above, changes in provider payment rates under the single-payer system could have longer-term effects on the supply of providers. If the average provider payment rate under a single-payer system was significantly lower than it currently is, fewer people might decide to enter the medical profession in the future. The number of hospitals and other health care facilities might also decline as a result of closures, and there might be less investment in new and existing facilities. That decline could lead to a shortage of providers, longer wait times, and changes in the quality of care, especially if patient demand increased substantially because many previously uninsured people received coverage and if previously insured people received more generous benefits. How providers would respond to such changes in demand for their services is uncertain. To encourage the supply of providers in the longer term, the government could more heavily subsidize the cost of graduate medical education to encourage people to continue to enter medical professions.”

Source: Congressional Budget Office, Key Design Components and Considerations for Establishing a Single-Payer Health Care System. May 2019.

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“Public spending would increase substantially relative to current spending if everyone received LTSS benefits. Under the current system, many people receive Medicaid benefits for such services but use their own funds to pay for LTSS before they qualify for Medicaid; state Medicaid programs currently pay about half of the cost of such services. Private insurance accounts for a small portion of LTSS spending.20 Under a single-payer system, government payments could replace payments by individuals and private insurance. Further, if the single-payer system eliminated the Medicaid program, federal spending on LTSS would increase considerably unless the system required states to continue their current funding or unless state (or local) governments covered LTSS benefits entirely.

“Currently, much of LTSS is unpaid (or informal) care provided by family members and friends. If a single-payer system covered LTSS with little or no cost sharing, a substantial share of unpaid care might shift to paid care. That effect could be particularly large if the single-payer plan covered home- and community-based services.”

Source: Congressional Budget Office, Key Design Components and Considerations for Establishing a Single-Payer Health Care System. May 2019.

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Selected Resources On Single Payer / “Medicare For All”
A. P. Galvani PhD, et al., The Lancet, 2020: Improving the prognosis of health care in the USA

Cai et al, PLOS Medicine, 2020: Projected costs of single-payer healthcare financing in the United States: A systematic review of economic analyses

Congressional Budget Office, 2019: Key Design Components and Considerations for Establishing a Single-Payer Health Care System

Political Economy Research Institute, 2018: Economic Analysis of Medicare for All

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World Health Systems Facts is a project of the Real Reporting Foundation. We provide reliable statistics and other data from authoritative sources regarding health systems and policies in the US and sixteen other nations.

Page last updated April 7, 2025 by Doug McVay, Editor.