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During the Feb. 7 Democratic presidential debate, former Vice President Joe Biden once again questioned the price tag of "Medicare for All," the single-payer health care proposal championed by one of his key rivals, Vermont Sen. Bernie Sanders.
Biden argued that the plan was fiscally irresponsible and would require raising middle-class taxes. Specifically, he claimed, the plan "would cost more than the entire federal budget that we spend now."
Medicare for All’s price — and whether it’s worth it ― is a subject of fierce discussion among Democratic presidential candidates. But we had never heard this figure before. It caught our attention, so we decided to dig in.
Biden’s campaign directed us to the 2018 federal budget, which totaled $4.1 trillion. It compared that amount to the estimated cost of Sanders’ single-payer proposal: between $30 trillion and $40 trillion over a decade. The math, they said, shows Medicare for All would cost more than the national budget.
But it turns out, based on the numbers and interviews with independent experts, Biden’s comparison of Medicare for All’s price to total federal spending misses the mark because the calculation is flawed.
Sanders has said publicly that economists estimate Medicare for All would cost somewhere between $30 trillion and $40 trillion over 10 years. Research by the nonpartisan Urban Institute, a Washington D.C. think tank, puts the figure in the $32 trillion to $34 trillion range.
We pointed out to Biden’s campaign that comparing 10-year spending estimates to one-year budgets is like comparing apples to oranges. The campaign suggested that if you take 10 times the current federal budget, you get a figure smaller than the estimated cost of Medicare for All over that 10-year window.
That calculation would lead you to multiply $4.1 trillion by 10 to get $41.1 trillion. That result is close to the high mark Sanders set for his program’s cost but well above the $34 trillion that Urban researchers projected.
Still, that’s not the correct way to formulate a comparison, experts say. "That’s not good math," said Marc Goldwein, the senior vice president and senior policy director at the Committee for a Responsible Federal Budget. "That’s taking a 2018 number, and multiplying it by 10, whereas the $34 trillion is a 10-year number that assumes a lot of growth."
What you would need to do is add up the Congressional Budget Office’s projected budget outlays from 2020 to 2029, and compare the sum to the Medicare for All spending figure.
So we spoke to Linda Blumberg, an institute fellow at Urban’s Health Policy Center, who arrived at the $34 trillion estimate. She ran the CBO’s numbers: The next 10 years of on-budget outlay, the government office projects, add up to $44.8 trillion.
To be clear, $34 trillion (34 followed by 12 zeros) is no small sum. It accounts for about 75% of that nearly $45 trillion budget estimate and would represent a bigger single increase to the federal budget than we’ve ever experienced, Blumberg said.
That raises one point on which Biden may have some ground. Goldwein argued that you would indeed need significant tax increases to finance the Sanders proposal.
But its price tag still would be less than the projected budget.
"If he said [Medicare for All] was as big as the current federal budget, that would be incorrect," Blumberg said.
Goldwein looked at the numbers another way: Including interest, he found, the federal budget would consume about $55 trillion between now and 2030. Again, that’s more than what Medicare for All would cost during the same period.
Big picture: No matter how you slice Biden’s math, his numbers are off.
"If what he said was Medicare for All will cost as much as the entire rest of the budget, that would be fair," Goldwein said. But that’s not the same thing.
Biden argued that Medicare for All "would cost more than the entire federal budget that we spend now."
This relies on faulty math. Medicare for All would certainly represent a substantial increase to the federal budget. But it would neither match nor dwarf current federal spending overall. We rate this claim False.
ABC News / WMUR Democratic debate, Feb. 7, 2019.
Centers for Medicare & Medicaid Services, "National Health Expenditure Data," Dec. 17, 2019.
Congressional Budget Office, "The Budget and Economic Outlook," January 2020.
Telephone interview with Linda Blumberg, Urban Institute, Feb. 7, 2020.
Telephone interview with Marc Goldwein, Center for Responsible Federal Budget, Feb. 11, 2020.
Urban Institute, "Don’t Confuse Changes in Federal Health Spending with National Health Spending," Oct. 16, 2019.
Urban Institute, "From Incremental to Comprehensive Health Reform: How Various Reform Options Compare on Coverage and Costs," Oct. 16, 2019.
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