For anyone that has taken even a basic macroeconomics course or been introduced to the idea of Keynesian economics, they understand that deficit spending is often beneficial and that the macroeconomy doesn't work as a simple arithmetic equation. For example, most mainstream economists agree that concerns over the debt are overblown. In addition, the debt is mainly used as a political tool that for some reason only becomes an issue when social programs are proposed, rather than when insane tax cuts and austerity measures are passed. Secondly, the graphs you posted leave out many critical facts. For example, under Pete's/Biden's/Warren's healthcare plan, which is by in large a continuation of the status quo, we would not realize any of the gains in efficiency (and therefore savings) that single-payer offers. A recent study published in Lancet indicates we could save up to $450 billion annually if we shift over to single-payer. That's $4.5 trillion over 10 years (actually more, if you factor in inflation and the growing rate of health care expenditure). We're not even factoring in the added man-hours of labor that a healthier population would produce over time. 1. Just based on what we currently spend on healthcare (about $3.4 trillion total as a country, both private and government) costs are projected over the next 10 years to be about $45-50 trillion (an estimate provided by CMS) 2. If you add Pete's plan (This plan raises $1.4 trillion over 10 years ($140 billion/year) and adds it on top of the $1.1 trillion dollars per year that the govt currently spends on healthcare), without any of the cost efficiencies realized from single-payer, total costs would be about $46-51 trillion. Now remember, you still have some cost-sharing so things like deductibles/copayments are not going away. Pharmaceuticals will also still be fairly expensive. 3. A single-payer plan, according to the Lancet study, would cost in total about 3.03 trillion for this fiscal year, which you can extrapolate out to about $40-45 trillion over the next decade (using CMS' growth rate). No co-pays, deductibles, nothing. Everyone covered, no questions asked. 4. Single-payer is more efficient, has more comprehensive coverage, and doesn't continue the status quo of 1000s of different health insurance plans that require so many billions of dollars to administer. 5. But wait a minute, how can Sanders' M4All "cost more" but also save money? Because when you raise taxes to pay for single-payer, you shift all of the current private health expenditure (about $2 trillion per year) into the public sector. THIS IS NOT NEW EXPENDITURE. IT WOULD HAVE ALREADY BEEN PAID BY EITHER YOU OR YOUR EMPLOYER. So everyone in the system saves money in the net, but the costs are simply on the government's balance sheet now. 6. If you were a bad-faith actor, you would argue that Sanders' healthcare plan would introduce $20 trillion in "new" expenditures over 10 years, when in fact all of that money (and more) is going to be spent anyways under the status quo and in reality is just going to be shifted to the government via taxes. Anyways, if we want to have an honest discussion about all of Sanders' proposal it has to be better than a few overly simplistic bar graphs and some 3rd-grade arithmetic. I'm gonna stop here since the post is already too long.
Going to quote this again, since I wasn't clear before. Pete's plan will cost an additional $1.5 trillion and Sanders will cost an additional $34 trillion, at least according to the Urban Institute
The Urban Institute's study said that a single payer system would contribute an additional $34 trillion in spending over the next 10 years. It's not $34 trillion total, it's $34 trillion in incremental spending
From the urban institute, on the difference between federal spending and national health expenditure, which is literally titled: "Don’t Confuse Changes in Federal Health Spending with National Health Spending" https://www.urban.org/urban-wire/do...eral-health-spending-national-health-spending "In our most recent report, we estimate that a broad single-payer reform (referred to as Reform 8: Enhanced Single Payer in the report) would increase federal government spending by $34 trillion over the 2020–29 period, $34 trillion beyond what the federal government already spends on health care. However, this reform would shift almost all of the spending currently done by households, employers, and state governments over to the federal government. All people, regardless of whether they have insurance coverage today, would be covered by the new federal program." So the government would have to increase it's yearly expenditure by about $3.4 trillion, which added to current expenditure puts total health expenditure at $4.5 trillion, which is $45 trillion total over 10 years. Matching my earlier post.
Just going by your comment, you literally did not read a word of my initial post. I didn't use the figure $34 trillion anywhere. You should be embarrassed. EDIT: I even bolded the only crucial part of that post. C'mon man, be better.
You're leaving out the private cost again. Bernie's is 34 trillion TOTAL in addition to the current federal spending. Pete's 1.5 trillion over a decade leaves out the private cost which the majority of cost. What's the total cost of Bernie's M4A for America? and the total cost of Pete's M4A who want it for America? And please, don't say 1.5 trillion vs 34 trillion
Basic econ? Please be more patronizing. From your own article: "public debt reduces capital accumulation and may therefore have welfare costs. However, welfare costs may be smaller than typically assumed...The paper seeks to foster a richer discussion of the costs of debt and fiscal policy and not to argue for more public debt, especially in the current political environment." Even if I grant that concerns about deficit spending are overblown, when you continue to increase the deficit, more of your money goes to paying down interest instead of the programs that can actually help Americans. You know that Lancet study is written by Alison Galvani, who was an unpaid advisor to Bernie's Senate office. It even ends with a call to action! I have doubts about the veracity of this study. Mind if we stick with the Urban Institute or some other reputable study? I'm here to have a discussion. The Urban Institute estimates that a single payer plan adds meaningfully to federal spending, by the tune of at least $34 trillion in 10 years. I do agree with @ThatBoyNick that lower income individuals will benefit because they no longer have to pay copays and premiums. But net-net, we will still be spending more as a nation on healthcare if we move to a single payer system To be clear, I think that a single payer system is the north star for us to target eventually. However, we need to be honest about how expensive it would be (incremental $7 trillion) and how risky it is to run a national campaign with M4A as the landmark legislation (see 2018 midterms).
I wouldn't blame anybody for not knowing with the way the candidates and media talks about the cost of M4A, one really would think M4A is 30 trillion dollars more, when in reality, most studies show M4A saves trillions over a decade. We properly insure 80+ million who are currently un or underinsured, we stop 30-50K+ from dying per year due to lack of access, we stop 500k people going bankrupt... and we save money? It's hard to believe, but that's just how hard our current system has been ****ing us, people should listen when they hear that we spend twice as much the OCED average on healthcare... yet are the only highly developed country to not have universal coverage, our system is broken.
Net-net, we will still be spending more as a nation on healthcare if we move to a single payer system Propoerly insuring 80+ millions, preventing 50k deaths due to lack of access, stopping 500k bankruptcies are all fantastic benefits of a single payer system (They are also the benefits of a comprehensive public option). But the single payer option adds $7 trillion in national spending. It's not somehow going to save the government money. We need to deal with the issues of access and medical bankruptcy. It's just a question of what is the next best step. To me, that is a public option. It's less expensive than single payer and a winning issue politically.
A 14% increase is a bit of a ridiculous quote, the majority of studies show M4A saving trillions per decade, and at worst costing roughly the same.
The $34 trillion figure comes from the Urban Institute study, which I give more credence to than a paper written by a former Sanders aide. I'm at least trying to be civil while pointing out all the things you are getting wrong, you condescending piece of ****
This study takes into account the comprehensive health care plan that Sanders wants to provide (dental, vision), as well as the changes in consumption of medical services once you offer them for free. I'm no expert on health care policy though, so always willing to discuss alternative estimates of the cost/benefit of a single payer system. Just don't think it's as black and white as you're making it seem.
I am not necessarily advocating for increasing the deficit. But reasonable deficit spending (not the shitshow we have now) for the sake of investing in things like health/education/infrastructure/climate-change is fine with me. They're investments, and there will be an ROI somewhere down the line. The Lancet is one of the leading peer-reviewed publications in the world. If we can't trust them then who are we going to trust? The fact that the was an advisor to Sanders' office could just mean that he was a good expert and Sanders made a smart choice, especially considering he did get this article published in a pretty good journal. "Adding $34 trillion to federal spending" basically means nothing to me. We're shifting costs from private to public so it's not a good way to look at it. The Urban Institute concludes that "enhanced single-payer" would cost $8 trillion more over the next 10 years to cover everything for everyone (including the undocumented) and no out of pocket expenses. I need more time to look at why the discrepancy between the cost estimation differs between the Lancet Study and the Urban Institute, these studies often do not agree on the costs. However, most of the studies I have seen are closer to the Lancet study in terms of cost estimation. The politics of this are a separate discussion. I tend to think the Anti-trump wave was coming in 2018, regardless of the politics of many of the individual races. There's also the reality that national races and local race politics are quite different.
Right, but it's wrong to say this: Not sure if you mean something special by the term "incremental spending" but The Urban Institute says enhanced single-payer would cost $8 trillion more over 10 years. That's the fairest way I think we can look at it. Now, without going through that study in its entirety I'm not going to immediately make it my gospel. Most of the studies I have read see a net savings from switching to single-payer, it could be that they project bigger gains in efficiency or project a greater reduction in physician/worker pay. Either way, need to time to look through it. Good discussion, a little feisty but that's how I like it. Good Night.
The only thing i'm certain of with studies on how much single payer will cost is that the chance of any of them being right is broken clock territory (though "where we get the revenue" being overstated, and "how much it will cost" being understated should be a law of government budget analysis)
The parties have gotten very good at running off elections of imaginary rorschach candidate against presidential candidates, as the candidate themselves doesn't have his voters but the other party can draw the anti them vote. This strategy seems to be really awful for the incumbent election though, as they seem to set themselves up to legislate in the same anti-them format and when the ideal rorschach is replaced with an actual person, the expectation gap they set up screws them.
