The report notes the multiple ways that legislators could structure such a system and attempts to outline the cost and policy effects of the various choices.

However, the report also notes that because such a system would be so different from the healthcare system that currently exists, any firm cost estimates are not possible. There have been multiple legislative proposals introduced recently on this topic including the Choose Medicare Act that would allow Americans to opt-into the existing system as well as the Medicare for America Act that would automatically enroll more individuals into the system and give others a choice between government and private insurance.