# How the blazes can Sanders' UHC plan cost $32T? **URL:** \ **Category:** In My Humble Opinion\ **Created:** [July 31, 2018, 7:30pm UTC](https://boards.straightdope.com/t/how-the-blazes-can-sanders-uhc-plan-cost-32t/818889 "2018-07-31T19:30:18Z")\ **Posts on this page:** 20\ **Page:** 1
**Author:** ![Quartz](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/quartz/32/267_2.png) [@Quartz](https://boards.straightdope.com/u/Quartz)\ **Post date:** [July 31, 2018, 7:30pm UTC](https://boards.straightdope.com/t/how-the-blazes-can-sanders-uhc-plan-cost-32t/818889/1 "2018-07-31T19:30:18Z")
That’s for 10 years, mind, so $3.2T a year. I suspect I have hit on a hit-piece. Links: > **[Bernie Sanders' Medicare-for-All Plan Will Cost $32 Trillion Over 10 Years](https://reason.com/2018/07/30/bernie-sanders-medicare-all-32-trillion/)** > > Yes, that's trillion with a "t." [https://www.mercatus.org/system/files/blahous-costs-medicare-mercatus-working-paper-v1\_1.pdf](https://www.mercatus.org/system/files/blahous-costs-medicare-mercatus-working-paper-v1_1.pdf) I look at the UK where we pay approximately £150B per year for 65 million people. Multiply that by 5 for the US population of 300 million and you get £750B, which is approximately $1T. Even if you pad that a bit you don’t get anywhere near $3.2T. It seems to me that within the healthcare industry there should be major savings on salaries as hospitals and employees like doctors will no longer need to pay huge insurance premiums. And employers all over will no longer have to fund employee healthcare. And I’m sure Dopers can add further savings. I can follow their figures but the whole just doesn’t make sense. ---
**Author:** ![MichaelEmouse](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/michaelemouse/32/101_2.png) [@MichaelEmouse](https://boards.straightdope.com/u/MichaelEmouse)\ **Post date:** [July 31, 2018, 7:39pm UTC](https://boards.straightdope.com/t/how-the-blazes-can-sanders-uhc-plan-cost-32t/818889/2 "2018-07-31T19:39:29Z")
They’re taking the US GDP and multiplying it by the percentage of GDP spent on healthcare. I don’t know how reasonable that is but it’s unlikely that expanding coverage will shrink aggregate healthcare spending. High insurance premiums likely have much to do with tort law and the legal profession. If the same legal liabilities exist, someone still has to take on the costs even if it’s not employees. I’m not sure how employers no longer needing to fund employee healthcare will reduce government expenditure or public/private spending in the aggregate. In both cases of purported savings the OP provides, the spending is shifted from one group to another, not reduced in the aggregate. ---
**Author:** ![Ravenman](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/ravenman/32/2929_2.png) [@Ravenman](https://boards.straightdope.com/u/Ravenman)\ **Post date:** [July 31, 2018, 7:39pm UTC](https://boards.straightdope.com/t/how-the-blazes-can-sanders-uhc-plan-cost-32t/818889/3 "2018-07-31T19:39:57Z")
You’re looking at it the wrong way. The NHS costs 1.3 million pounds per square mile. Berniecare would be only $850 thousand bucks per square mile! ---
**Author:** ![Ludovic](https://avatars.discourse-cdn.com/v4/letter/l/7ab992/32.png) [@Ludovic](https://boards.straightdope.com/u/Ludovic)\ **Post date:** [July 31, 2018, 7:49pm UTC](https://boards.straightdope.com/t/how-the-blazes-can-sanders-uhc-plan-cost-32t/818889/4 "2018-07-31T19:49:01Z")
I agree with your premise, but one thing that would make it cost more than $1T, (but still far less than $3.2T), is that salaries are higher in general in the USA which means you would have to offer people more to work for health care. Also known as the [cost disease](https://en.wikipedia.org/wiki/Baumol%27s_cost_disease). But that would still only increase it to perhaps $1.5T based on some quick Googling. ---
**Author:** ![jasg](https://avatars.discourse-cdn.com/v4/letter/j/f0a364/32.png) [@jasg](https://boards.straightdope.com/u/jasg)\ **Post date:** [July 31, 2018, 9:10pm UTC](https://boards.straightdope.com/t/how-the-blazes-can-sanders-uhc-plan-cost-32t/818889/5 "2018-07-31T21:10:32Z")
> [@Ravenman](#): > > You’re looking at it the wrong way. The NHS costs 1.3 million pounds per square mile. Berniecare would be only $850 thousand bucks per square mile! No. Population distribution is not even - better to base it on pounds per stone 😃 ---
**Author:** ![Caldazar](https://avatars.discourse-cdn.com/v4/letter/c/8e8cbc/32.png) [@Caldazar](https://boards.straightdope.com/u/Caldazar)\ **Post date:** [July 31, 2018, 9:38pm UTC](https://boards.straightdope.com/t/how-the-blazes-can-sanders-uhc-plan-cost-32t/818889/6 "2018-07-31T21:38:07Z")
The analysis assumes no meaningful changes in healthcare delivery practices. It assumes reductions in administrative waste and for prices on services and drugs, and it also assumes an increase in the utilization of services (since several million people in the U.S. currently are not covered). It assumes no improvements in other areas of health care waste, such as over-prescription of medical services and drugs, inefficiencies in care delivery, fraud, etc… Under those assumptions, it makes sense that the projections would come in as being only slightly better than current health care projections. ---
**Author:** ![markn\_1](https://avatars.discourse-cdn.com/v4/letter/m/f9ae1b/32.png) [@markn\_1](https://boards.straightdope.com/u/markn_1)\ **Post date:** [July 31, 2018, 10:00pm UTC](https://boards.straightdope.com/t/how-the-blazes-can-sanders-uhc-plan-cost-32t/818889/7 "2018-07-31T22:00:22Z")
> [@jasg](#): > > No. Population distribution is not even - better to base it on pounds per stone 😃 That would be 14. ---
**Author:** ![Martin\_Hyde](https://avatars.discourse-cdn.com/v4/letter/m/47e85d/32.png) [@Martin\_Hyde](https://boards.straightdope.com/u/Martin_Hyde)\ **Post date:** [July 31, 2018, 10:06pm UTC](https://boards.straightdope.com/t/how-the-blazes-can-sanders-uhc-plan-cost-32t/818889/8 "2018-07-31T22:06:38Z")
The libertarian leaning think tank that put it out definitely isn’t in favor of the plan, but Vox covered this and actually concludes the price estimate is fairly reasonable: [Link](https://www.vox.com/policy-and-politics/2018/7/30/17631240/medicare-for-all-bernie-sanders-32-trillion-cost-voxcare) > [@](#): > > $32 trillion. > > That is how much federal spending would increase over 10 years under Bernie Sanders’s Medicare-for-all bill, according to a brand-new estimate from the libertarian-leaning Mercatus Center at George Mason University. > > Before you question the source (like Sanders did), you should know the left-leaning Urban Institute came up with the exact same number in 2016… America spends more per capita on healthcare (talking total spend) than the UK, there’s no magic reason to assume it would shrink to British per capita levels just because we went to Medicare for all. The Urban Institute and the Mercatus group are basically making what’s a pretty realistic bet–if we just “flip a switch” from today to tomorrow and go to Medicare for all, the total societal costs aren’t going to change that much. The Urban Institute and Vox point out that while costs wouldn’t change much in total, we’d actually be getting far more for our buck than we do now–because we’d be covering the whole country with comprehensive healthcare (something that isn’t true today.) The reality is we are never very likely to switch like this from what we have to Medicare for all, if we ever get to public healthcare it’ll likely be a gradual phase in system of some sort (which was what Obamacare envisioned with the public option, which didn’t make it into the final bill.) It’s actually very likely that on a per capita basis over time we WOULD shrink the difference between what we spend per capita on healthcare and what other OECD countries spend, but it likely would take time for efficiencies to work themselves out and for various practices to change in order to drive down costs. ---
**Author:** ![elfkin477](https://avatars.discourse-cdn.com/v4/letter/e/a9a28c/32.png) [@elfkin477](https://boards.straightdope.com/u/elfkin477)\ **Post date:** [July 31, 2018, 10:12pm UTC](https://boards.straightdope.com/t/how-the-blazes-can-sanders-uhc-plan-cost-32t/818889/9 "2018-07-31T22:12:21Z")
> [@Quartz](#): > > I look at the UK where we pay approximately £150B per year for 65 million people. Multiply that by 5 for the US population of 300 million and you get £750B, which is approximately $1T. Even if you pad that a bit you don’t get anywhere near $3.2T. > > It seems to me that within the healthcare industry there should be major savings on salaries as hospitals and employees like doctors will no longer need to pay huge insurance premiums. And employers all over will no longer have to fund employee healthcare. And I’m sure Dopers can add further savings. > > I can follow their figures but the whole just doesn’t make sense. Unless something changed radically, healthcare costs would increase if everyone had medicare. Countries around the world, like yours, pay less in drug costs because we pay a lot more (well, that and the US being one of only two first world counties that allow direct-to-consumer drug advertising, the cost of which are now higher than the R&D we subsidize). Private insurance companies are allowed to negotiate drug costs, but medicare is not. Imagine how much drugs would cost if you completely eliminated the only entities allowed to negotiate the prices! ---
**Author:** ![Quartz](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/quartz/32/267_2.png) [@Quartz](https://boards.straightdope.com/u/Quartz)\ **Post date:** [July 31, 2018, 11:22pm UTC](https://boards.straightdope.com/t/how-the-blazes-can-sanders-uhc-plan-cost-32t/818889/10 "2018-07-31T23:22:34Z")
> [@Ludovic](#): > > I agree with your premise, but one thing that would make it cost more than $1T, (but still far less than $3.2T), is that salaries are higher in general in the USA But salaries are higher in part to cover - in part - the high healthcare costs, right? So if you socialise healthcare then you don’t need to pay such high salaries. > [@elfkin477](#): > > Unless something changed radically, healthcare costs would increase if everyone had medicare. Countries around the world, like yours, pay less in drug costs because we pay a lot more Cite? Don’t forget that many medicines and medical techniques are developed outside the USA. Test tube babies were a British invention, for example. Regardless, the USA has the power of Eminent Domain, doesn’t it? So if a company wanted to charge too much for a medicine then the USA could invoke Eminent Domain. ---
**Author:** ![SmartAleq](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/smartaleq/32/163_2.png) [@SmartAleq](https://boards.straightdope.com/u/SmartAleq)\ **Post date:** [July 31, 2018, 11:30pm UTC](https://boards.straightdope.com/t/how-the-blazes-can-sanders-uhc-plan-cost-32t/818889/11 "2018-07-31T23:30:09Z")
> [@Caldazar](#): > > The analysis assumes no meaningful changes in healthcare delivery practices. It assumes reductions in administrative waste and for prices on services and drugs, and it also assumes an increase in the utilization of services (since several million people in the U.S. currently are not covered). It assumes no improvements in other areas of health care waste, such as over-prescription of medical services and drugs, inefficiencies in care delivery, fraud, etc… > > Under those assumptions, it makes sense that the projections would come in as being only slightly better than current health care projections. Didja notice the part where they concluded Medicare For All will actually save the US 2 trillion over current spending in the first ten years while covering 30 million more people? I bet the Koch brothers are pretty pissed about that and relying on the MSM to not bother covering that part. > **[That study going around on Bernie Sanders' 'Medicare for All' plan comes with...](https://www.businessinsider.com/bernie-sanders-medicare-for-all-plan-cost-save-money-2018-7)** > > A new report found that Sen. Bernie Sanders' "Medicare for All" plan would cause healthcare costs for the federal government to skyrocket, but it would also end up saving the US money. ---
**Author:** ![Ludovic](https://avatars.discourse-cdn.com/v4/letter/l/7ab992/32.png) [@Ludovic](https://boards.straightdope.com/u/Ludovic)\ **Post date:** [August 1, 2018, 12:01am UTC](https://boards.straightdope.com/t/how-the-blazes-can-sanders-uhc-plan-cost-32t/818889/12 "2018-08-01T00:01:06Z")
> [@Quartz](#): > > But salaries are higher in part to cover - in part - the high healthcare costs, right? So if you socialise healthcare then you don’t need to pay such high salaries. I’d meant to include that in my post but I thought it would be too long. It seems to me that the average wage would only be 10% or so lower at the most if you factored in healthcare. It’s personally a price I’d be willing to pay for the security but IIWII. I think one thing America could do to decrease the price demanded to go into health care is to subsidize the supply, i.e. create more accredited doctor’s and other medical professionals schools so that the graduates are competing for our consumer and/or government dollars. ---
**Author:** ![elfkin477](https://avatars.discourse-cdn.com/v4/letter/e/a9a28c/32.png) [@elfkin477](https://boards.straightdope.com/u/elfkin477)\ **Post date:** [August 1, 2018, 12:33am UTC](https://boards.straightdope.com/t/how-the-blazes-can-sanders-uhc-plan-cost-32t/818889/13 "2018-08-01T00:33:20Z")
> [@Quartz](#): > > But salaries are higher in part to cover - in part - the high healthcare costs, right? So if you socialise healthcare then you don’t need to pay such high salaries. > > Cite? Don’t forget that many medicines and medical techniques are developed outside the USA. Test tube babies were a British invention, for example. Regardless, the USA has the power of Eminent Domain, doesn’t it? So if a company wanted to charge too much for a medicine then the USA could invoke Eminent Domain. IVF is not a drug, and I was only talking about drugs. Here are cites: [This Is Why the U.S. Pays More for Prescription Drugs Than Other Countries](http://amp.timeinc.net/time/money/4130688/prescription-drug-prices-america) [How The US Subsidizes Cheap Drugs For Europe](https://www.ibtimes.com/how-us-subsidizes-cheap-drugs-europe-2112662?amp=1) ---
**Author:** ![RealityChuck](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/realitychuck/32/195_2.png) [@RealityChuck](https://boards.straightdope.com/u/RealityChuck)\ **Post date:** [August 1, 2018, 12:36am UTC](https://boards.straightdope.com/t/how-the-blazes-can-sanders-uhc-plan-cost-32t/818889/14 "2018-08-01T00:36:58Z")
> [@MichaelEmouse](#): > > High insurance premiums likely have much to do with tort law and the legal profession. If the same legal liabilities exist, someone still has to take on the costs even if it’s not employees… That’s actually only a very small percentage of medical costs – less than 1%. The narrative of defensive medicine is also suspect. Doctors rarely run “unnecessary” tests; they run the tests they need to find out the problem (and sometimes patients insist on or expect the tests). More of an issue in that respect is doctors who own medical facilities (like MRI facilities) and recommend them to their patients (and, incidentally, improve their bottom line). The biggest inflation in medical costs right now are the cost of drugs and the cost of hospital stays. Drug companies increase the prices of even generic drugs every year. Remember the Pharma Bro? Or Epipen jacking up their prices? Those are egregious examples, but it’s happening with just about every prescription drug out there. Even generics seem to be price fixing. Hospitals, meanwhile, often have regional monopolies, and use it to their advantage. A major advantage of single payer is that it can eliminate this sort of price gouging. ---
**Author:** ![Quartz](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/quartz/32/267_2.png) [@Quartz](https://boards.straightdope.com/u/Quartz)\ **Post date:** [August 1, 2018, 9:01am UTC](https://boards.straightdope.com/t/how-the-blazes-can-sanders-uhc-plan-cost-32t/818889/15 "2018-08-01T09:01:02Z")
> [@elfkin477](#): > > IVF is not a drug, and I was only talking about drugs. > > Here are cites: Those articles make the claim, but don’t actually back it up with actual evidence. A drug costing more in the US than in the UK is not evidence of the US subsidising the UK in the same way that a computer costing more in the UK than the US is not evidence of the UK subsidising the US. ---
**Author:** ![Budget\_Player\_Cadet](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/budget_player_cadet/32/205_2.png) [@Budget\_Player\_Cadet](https://boards.straightdope.com/u/Budget_Player_Cadet)\ **Post date:** [August 1, 2018, 10:27am UTC](https://boards.straightdope.com/t/how-the-blazes-can-sanders-uhc-plan-cost-32t/818889/16 "2018-08-01T10:27:59Z")
> [@Caldazar](#): > > The analysis assumes no meaningful changes in healthcare delivery practices. It assumes reductions in administrative waste and for prices on services and drugs, and it also assumes an increase in the utilization of services (since several million people in the U.S. currently are not covered). It assumes no improvements in other areas of health care waste, such as over-prescription of medical services and drugs, inefficiencies in care delivery, fraud, etc… > > Under those assumptions, it makes sense that the projections would come in as being only slightly better than current health care projections. First of all, I’m not sure those assumptions are horribly unreasonable. They seem at least grounded in reality, and not stupendously unfair to the program or stupendously optimistic. That said, a 6,25% cost reduction while covering 10% more people (note: that second figure may be a bit mangled, if I get it wrong please correct it :o ) is “only slightly better”? That seems like an understatement, to put it bluntly, and this also implicitly assumes the same quality of service - which [probably isn’t quite reasonable - medicare users seem quite a bit happier with their insurance than the privately insured](https://www.commonwealthfund.org/publications/journal-article/2002/oct/medicare-vs-private-insurance-rhetoric-and-reality). Far from being some huge slam against Medicare-For-All, this study should be shouted from the hilltops as proof that even libertarians realize that it would be a clear improvement - [as Jacobin was so kind to point out](https://www.jacobinmag.com/2018/07/medicare-for-all-mercatus-center-report). That the abstract and introduction are [a little bit intellectually dishonest](https://boards.straightdope.com/sdmb/showpost.php?p=21120844&postcount=44) shouldn’t distract us from the way that this is pretty clearly an argument in favor of implementing this _yesterday_. So to answer the OP’s question - Sanders’ UHC plan can cost $32T because our baseline is something like $34T. ---
**Author:** ![puddleglum](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/puddleglum/32/137_2.png) [@puddleglum](https://boards.straightdope.com/u/puddleglum)\ **Post date:** [August 1, 2018, 4:04pm UTC](https://boards.straightdope.com/t/how-the-blazes-can-sanders-uhc-plan-cost-32t/818889/17 "2018-08-01T16:04:01Z")
32 trillion is wildly optimistic in that it assumes very little change in the current system. The political pressure to expand coverages and be more generous to healthcare workers would be irrestible. For example the original estimate of how much Medicare would cost were off by 64%. Each country has its own system and those costs vary. If the UK spent what Hungary does per capita it could save 100 billion dollars a year. ---
**Author:** ![Horatius](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/horatius/32/3572_2.png) [@Horatius](https://boards.straightdope.com/u/Horatius)\ **Post date:** [August 1, 2018, 4:40pm UTC](https://boards.straightdope.com/t/how-the-blazes-can-sanders-uhc-plan-cost-32t/818889/18 "2018-08-01T16:40:15Z")
> [@elfkin477](#): > > Private insurance companies are allowed to negotiate drug costs, but medicare is not. Imagine how much drugs would cost if you completely eliminated the only entities allowed to negotiate the prices! The first sentence was a point I was going to raise, but you’ve managed to put a uniquely American spin on it. The limitation on medicare negotiating for drug prices is purely political in nature, and can be eliminated any time the US really wants to do so. I can’t imagine a situation in which you’d have the political capital to push through UHC, but not eliminate this silly restriction. This is one big reason why the proposed costs for US medicare for all seems so far out of line with the equivalent systems in the UK and Canada: on a per-person basis, medicare is already more expensive, and if you’re just projecting that forward, of course it gets even worse. > [@Budget\_Player\_Cadet](#): > > That said, a 6,25% cost reduction while covering 10% more people (note: that second figure may be a bit mangled, if I get it wrong please correct it :o ) is “only slightly better”? That seems like an understatement, to put it bluntly, and this also implicitly assumes the same quality of service - which [probably isn’t quite reasonable - medicare users seem quite a bit happier with their insurance than the privately insured](https://www.commonwealthfund.org/publications/journal-article/2002/oct/medicare-vs-private-insurance-rhetoric-and-reality). This is another factor not given enough consideration. Completely aside from the relative cost, and the lack of coverage for so many people, there are other factors that make the US system a bad idea. Number one would be tying your health coverage to your job, so that in changing jobs you run the risk of losing your coverage. That just never happens in a UHC system. Number two would be the profit-motive incentives to deny or restrict care. I’ve never once had, or even heard of, a problem with any health care being denied here in Canada because someone went to the wrong doctor, or the wrong hospital, but such stories are apparently commonplace in the US. This is another thing that basically would never happen with UHC. So even if the costs were exactly the same overall, you’d get better service, for more people, with less stress. That’s a huge win. ---
**Author:** ![Shodan](https://avatars.discourse-cdn.com/v4/letter/s/9f8e36/32.png) [@Shodan](https://boards.straightdope.com/u/Shodan)\ **Post date:** [August 1, 2018, 5:02pm UTC](https://boards.straightdope.com/t/how-the-blazes-can-sanders-uhc-plan-cost-32t/818889/19 "2018-08-01T17:02:08Z")
> [@puddleglum](#): > > 32 trillion is wildly optimistic in that it assumes very little change in the current system. The political pressure to expand coverages and be more generous to healthcare workers would be irrestible. For example the original estimate of how much Medicare would cost were off by 64%. You are correct that it is wildly optimistic, but it does assume changes, like reductions in administrative waste and for prices on services and drugs. As has been pointed out in the past, and is mentioned in the article in the OP > [@](#): > > Even though single-payer advocates point to potential administrative savings by having the government step-in to replace health insurance companies, but those numbers usually require a degree of deception—for example, not counting current Medicare costs as “administrative costs” of the existing health care system. If we could simply reduce prices on services and drugs, we wouldn’t need UHC. We have to ration care - there is no answer apart from that. As in “we are going to let you die to save money”. If we do that, almost any system will work. If we don’t, no system will work. Regards, Shodan ---
**Author:** ![Budget\_Player\_Cadet](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/budget_player_cadet/32/205_2.png) [@Budget\_Player\_Cadet](https://boards.straightdope.com/u/Budget_Player_Cadet)\ **Post date:** [August 1, 2018, 7:22pm UTC](https://boards.straightdope.com/t/how-the-blazes-can-sanders-uhc-plan-cost-32t/818889/20 "2018-08-01T19:22:10Z")
> [@Shodan](#): > > We have to ration care - there is no answer apart from that. As in “we are going to let you die to save money”. Just so we’re clear, you _are_ aware that that’s what we do right now, right? [Next page](https://boards.straightdope.com/t/how-the-blazes-can-sanders-uhc-plan-cost-32t/818889.md?page=2)