At the time of this writing, the United States stands on the cusp of the longest economic expansion in its history—a period of uninterrupted growth spanning more than a decade and presidents of both parties.1 Enacting single-payer legislation could change all that.
By reshuffling the entire health-care market, passing a single-payer law would shock one of the largest sectors of the American economy. The repercussions of such a major economic change could lead to a recession, a prolonged period of sluggish growth, or both.
As of 2017, Americans spent 17.9% of the U.S. gross domestic product on health care, a percentage projected to rise to 19.4% of GDP by 2027.2 The United States spends more on health care than other industrialized nations do, both per person and as a percentage of gross domestic product.3
Some have argued that the United States needs to lower its level of health spending, or at minimum slow its growth. Policy makers often express their desire to “bend the cost curve,” such that health-care spending will not continue to grow faster than inflation, or the economy as a whole.
However, a single-payer system represents exactly the wrong approach to lower health care costs, for multiple reasons, including these:
Not only would single payer not lower health costs effectively; it would bring numerous adverse consequences, both within and outside the health sector. If enacted, the legislation would have negative effects that would ripple through the economy for many years to come.
First and most obviously, single payer would make private health insurance “unlawful,” effectively abolishing an entire industry. The New York Times noted that the legislation would unleash economic disruption on a scale never before seen in American history:
The private health insurance business employs at least a half a million people, covers about 250 million Americans, and generates roughly a trillion dollars in revenues. Its companies’ stocks are a staple of the mutual funds that make up millions of Americans’ retirement savings.5
Many health insurance companies do have other lines of business. For instance, insurer Aetna was recently acquired by pharmacy behemoth CVS. And some individuals currently working for insurers could end up working for the single-payer program, particularly because the federal government would need to build an alternative insurance infrastructure very quickly.6 But with health and medical insurance carriers employing 542,300 workers as of March 2019, a minimum of hundreds of thousands of Americans would face job disruption, if not outright unemployment, under single payer.7
Even talk of single-payer legislation has spooked investors in the health-care sector. On the day in February 2019 that Rep. Pramila Jayapal reintroduced her single-payer bill in the House, insurance industry stocks fell by nearly 5%.8 The sell-off continued throughout the beginning of 2019, such that health-care stocks have shown one of the widest divergences from the broader Standard and Poor’s 500 index—falling by 0.9%, even as the rest of the market gained a whopping 16%—this century.9
In response to news of the stock declines, Jayapal tweeted, “Sorry not sorry.”10 But the hundreds of thousands of American workers employed by health insurers, to say nothing of the millions of Americans with investments in the industry, might take a slightly less lackadaisical view toward massive disruption in their jobs, investments, and livelihoods.
In addition to its direct effects on the insurance industry, single payer will attempt to save money by paying doctors and hospitals less. The legislation would base reimbursements on the current Medicare program, which pays doctors 75% of private insurance rates, and hospitals 60% of private insurance.11 Medicare does not just pay doctors and hospitals less than private insurance—in many cases, it pays doctors and hospitals less than the cost of care. According to the Medicare actuary, 72% of hospitals lost money on their Medicare patients in 2017.12
Paying doctors and hospitals at much lower Medicare rates will lead to dramatic changes for the entire health-care sector. As the New York Times noted, job losses could represent the least of hospitals’ concerns:
Some hospitals, especially struggling rural centers, would close virtually overnight, according to policy experts. Others, they say, would try to offset the steep [reimbursement] cuts by laying off hundreds of thousands of workers and abandoning lower-paying services like mental health.13
One health policy professor the Times interviewed admitted that “I have no idea what would happen” should a single-payer system apply lower reimbursements to all hospital patients.14 But, should the Left succeed in forcing hospitals to become guinea pigs in this socialist experiment, one can credibly guess the likely outcome. As with many other elements of single payer, this change would hit the most vulnerable elements of the system—rural hospitals already struggling to make ends meet, or important yet unprofitable services and facilities—hardest.
To illustrate the impact of a single-payer system, the consulting firm Navigant outlined its effects on a hypothetical small hospital system, one with five hospitals, 1,000 total beds, and annual revenues of $1.2 billion. Navigant concluded that a single-payer system paying hospitals current Medicare rates would reduce the hospital network’s revenue by $330 million—approximately one-quarter—turning a slight annual surplus (2.3%) into a massive operating loss (22.1%).15 Obviously, a hospital couldn’t long survive under conditions like that.
Another study showed the sizable impact of these reimbursement reductions on hospitals and jobs within hospitals nationwide. This analysis, published in the prestigious Journal of the American Medical Association (JAMA), indicated a slightly smaller effect per hospital—an average 15.9% decline in revenue, as opposed to the one-quarter decline predicted by Navigant.16
However, the JAMA authors concluded that single payer would reduce hospital payments by $151 billion per year nationwide.17 They noted that “an estimated 1.5 million hospital clinical and administrative jobs could be lost if hospitals reduced labor costs to compensate for the entire clinical shortfall;” if hospitals were willing to absorb some of the losses by eating into their operating margins, job losses could total “only” 855,999 workers.18
Several figures put the size and scale of the losses contemplated by single payer into perspective:
The evidence strongly suggests that payment reductions on the magnitude single payer contemplates could result in millions of job losses, over and above those associated with eradicating the private insurance sector, and lead the economy into a recession.
In addition to destroying the private insurance industry, the House’s version of single payer will also disrupt the business models of many other health-care companies. While the Senate bill does not include this provision, Section 614(b) of the House legislation specifically states that “payments to providers…may not take into account…or be used by a provider for…the profit or net revenue of the provider, or increasing the profit or net revenue of the provider.”22 In other words, if the House bill passes, every for-profit hospital, hospice, nursing home, home care agency, and other medical provider will immediately have to convert to not-for-profit status to participate in the single-payer plan.
Single-payer advocates would no doubt cheer the abolition of for-profit health care providers. The House bill also includes “Sense of Congress” language discussing the “moral imperative… to eliminate profit from the provision of health care.”23 But millions of Americans may not appreciate having untold amounts of wealth—much of which has accumulated in their 401(k)s, IRAs, and other investment and retirement vehicles—eradicated instantaneously to satisfy someone else’s “moral imperative.”
Health-care companies have created tremendous wealth for their shareholders, but a single-payer bill would eliminate much, if not all, of that wealth in a stroke. At the end of the first quarter of 2018, the largest health insurers had a combined market capitalization of $428.5 billion, according to the Fortune 500.24 On top of these health insurers—whose main businesses would largely evaporate under both the House and Senate single-payer bills—many other health-care companies would have to convert to not-for-profit status under the House legislation, making their stockholders’ shares worthless:
When coupled with the losses from for-profit insurers outlined above, the House version of single payer would likely eradicate at least half a trillion dollars in stock market value from various health care-related companies, whether health insurers or for-profit medical providers.
With a majority of all Americans (54%)—and a majority (54%) of Americans with modest incomes ($30,000-$75,000)—owning stocks, either directly or indirectly through mutual funds and retirement accounts, this sudden evaporation of wealth will affect the entire economy, not just “the rich” or speculators on Wall Street.26 Besides destabilizing their retirements and futures, widespread stock market declines could lead to a negative “wealth effect,” in which Americans spend less because they see their investments and retirement accounts shrinking.
Apart from single payer’s impact on the health-care sector specifically, the legislation would also affect other areas of the economy. While the House bill includes no means to fund the tens of trillions in new spending, Sen. Bernie Sanders released a white paper discussing funding options along with his legislation.27 That white paper proposes a series of tax increases—some exclusively on “the rich,” but many on the middle class as well:
These proposals track closely with the 2013 version of Sanders’s single-payer legislation. That bill contained four explicit tax increases:
Unfortunately, however, Sanders’s proposed tax increases carry two major problems. First, it appears unlikely that even these tax increases will pay for the entire cost of his proposed system. Emory University economist Kenneth Thorpe analyzed a prior version of Sanders’s plan during the 2016 campaign, and concluded that the tax increases did not come close to fully paying for the cost of his proposed new spending:
The average annual cost of the plan would be approximately $2.5 trillion per year creating an average of over a $1 trillion per year financing shortfall. To fund the program, payroll and income taxes would have to increase from a combined 8.4 percent in the Sanders plan to 20 percent while also retaining all remaining tax increases on capital gains, increased marginal tax rates, the estate tax, and eliminating tax expenditures.30
Admittedly, Sanders’s plan has changed since Thorpe’s 2016 analysis. When releasing his 2019 single-payer bill, Sanders proposed greater payroll tax increases (7.5% versus 6.7%) and income tax increases (4% versus 2.2%) than his 2013 legislation. However, Sanders has also proposed even more spending in the updated single-payer bill.
As the last chapter noted, the 2019 version of single payer would also cover long-term supports and services—an addition that could raise government spending by approximately $3 trillion over a decade.31 It therefore remains unlikely that, despite the greater tax increases Sanders outlined in 2019, these tax hikes would come close to paying for all the new spending he has proposed.
More to the point, would those tax increases be “worth it” to the average American? To put it another way, would people pay more or less under single payer than they do under the status quo? At an April 2019 town hall, Sanders claimed that “the overwhelming majority of people are going to end up paying less for health care because they’re not paying premiums, co-payments, and deductibles.”32
But a Bloomberg article notes the inherent problem with these types of claims: almost by definition, a single-payer plan would have to raise taxes on lower and middle-income families:
To pay for [expensive government] programs, [2020 presidential candidates] have focused on taxing the rich. But many of the plans they’ve put on the table would require across-the-board tax increases that would hit middle-earners as well as the wealthy, public policy analysts say. None more than [single payer.]
Raising the more than $30 trillion needed to fund Sanders’s health plan over a decade would require doubling all personal and corporate income taxes or tripling payroll taxes, which are split between employees and employers, said Marc Goldwein, a senior vice president at the non-partisan Committee for a Responsible Federal Budget.
“There’s a lot of money out there, but there isn’t $30 trillion sitting around from high earners,” he said. “It just doesn’t exist.”33
The Bloomberg article noted that the list of tax increases Sanders has outlined to pay for his proposal to date would cover only about half its estimated costs. Moreover, a tripling of the payroll tax would cause the average family’s tax bills to increase significantly.34
The sole analysis that attempted to quantify winners and losers under the Sanders plan found his claim wanting, and that most people would pay more under single payer. In his 2016 analysis, Thorpe also concluded that, if fully paid for via income and payroll tax increases, the Sanders plan would leave nearly three-quarters (71%) of American households worse off financially than the status quo—even after accounting for the elimination of health insurance premiums and cost-sharing under the plan.35
Worse yet, according to Thorpe: “Some 85 percent of low income working populations on Medicaid would also pay more in taxes and reduced wage growth compared to any additional single payer benefits” if Sanders funded his plan through tax increases.36 In other words, single payer would in yet another way most harm the vulnerable patients that Sanders claims it would help.
Moreover, Sanders’s claim about millions of Americans saving money through single payer defies common sense. As one researcher from the liberal Urban Institute noted:
We should always be suspect of any public policy—especially when it comes to something as complicated as health care—when anybody tells us everybody is going to get more and pay less for it. It’s really not possible.37
We’ve seen these types of claims before, of course. Barack Obama famously pledged dozens of times that “If you like your plan, you can keep it.”38 He also claimed that his health plan would lower Americans’ health insurance premiums—not merely slow the rate of increase, mind you, but reduce them in absolute terms—by an average of $2,500 per family per year.39 He also promised the American people that he would televise all his health care negotiations on C-SPAN, “so that people can see who is making arguments on behalf of their constituents, and who are making arguments on behalf of the drug companies or the insurance companies.”40 None of these so-called promises proved true.
If Sanders believes his claim that single payer will save American families money so fervently, then he should ask the Congressional Budget Office to analyze all the fiscal effects of his proposal. Because Sanders serves as ranking member of the Senate Budget Committee, CBO would almost certainly prioritize his request.
Sanders should also propose specific tax increases—not a menu of options, but drafted legislative language—necessary to fund the cost of the bill that CBO determines. Then, and only then, could scorekeepers at CBO and elsewhere analyze the veracity of Sanders’s claims that most people will pay less.41 That he’s not willing to do this so far suggests he’s only a politician trying to avoid telling the American people a politically inconvenient truth.
If Sanders wants evidence that single payer would destroy the economy through a series of devastating tax increases, he need look no further than his home state of Vermont. Late in 2014, Vermont’s Democratic governor, Peter Shumlin, announced he could not move forward with his state’s plan to create a single-payer system for the Green Mountain State.
As the Washington Post noted in a feature-length story about Vermont’s failed experiment in socialized medicine, single-payer supporters fail to “acknowledg[e], let alone wrestl[e] with, the gritty complexities” needed to create such a system:
Then as now, many of the advocates shared “a belief that borders on the theological” that such a system would save money, as one analyst put it—even though no one knew what it would cost when it passed in Vermont.
That believe would prove naïve. The choices Shumlin favored would essentially have doubled Vermont’s budget, raising state income taxes by up to 9.5 percent and placing an 11.5 percent payroll tax on employers—a burden Shumlin said would pose “a risk of an economic shock”—even though Vermonters would no longer pay for private health plans.42
In attempting to create a single-payer system, Vermont had many advantages that the United States as a whole does not. Vermont has a comparatively low uninsured rate, and a relatively homogenous and healthy population. Moreover, Vermont proposed a benefit plan covering “only” 94% of residents’ health-care costs on average—as opposed to the House and Senate single-payer bills, which would cover virtually all of Americans’ health spending without cost-sharing.43
Yet Shumlin admitted to the Post that “We were pretty shocked at the tax rates we were going to have to charge.44 The tax increases discussed in Vermont—9.5% for the income tax, and 11.5% for payroll taxes—far exceed Sanders’s proposed income and payroll tax increases of 4% and 7.5%, respectively.45 Vermont’s experience, like Thorpe’s 2016 analysis of Sanders’s plan (Thorpe also consulted on the Vermont plan), demonstrate that Sanders’s current financing mechanisms likely come nowhere close to paying for a single-payer system’s new spending.
Perhaps unsurprisingly, given the way that facts from his own state undercut his “theological” belief in socialized medicine, Sanders has said little about Vermont’s failed single-payer experiment.46 But Shumlin provided some wise, albeit unsolicited, advice to Sanders and his single-payer brethren: “If I were running for president of the United States, I would have a team working on a plan so I don’t sell an idea to Americans that you can’t achieve. That’s the mistake I made.”47
Over and above whether people would pay more or less under single payer, the tax increases will have a major impact, as the deadweight losses from higher taxes will lead to lower overall growth. A term frequently used by economists, deadweight losses refer to the inefficiencies that result from government taxation. For instance, a $100,000 per-passenger tax on airplane travel would yield next to no revenue, since most people would choose other forms of travel, but it would yield massive dead-weight losses, because traveling by bus, rail, or boat would take much longer than travel by plane.48 In other words, deadweight losses refer not just to a tax of money but also a tax on citizens’ time and effort, which may be even more valuable.
The White House’s Council of Economic Advisers (CEA) analyzed the ways single payer would profoundly affect economic growth. Specifically, the CEA model found that single payer would reduce national income and long-run GDP by 9%.49 Regardless of what single-payer supporters claim their proposal would do to our nation’s health-care system, it would make the American economy as a whole much smaller.
Total national income excluding taxes and health spending would fall by an even greater 19%, or about $17,000 per household.50 Imagine losing that amount from your disposable income every year, after you pay the massive tax increases needed to fund this socialist scheme. As the CEA notes,
[Single payer] is not just a swap of taxes for private health spending. Moving health spending onto the Federal budget reduces private sector economic activity so much that households are spending 19 percent less on non-health items than they would be without [single payer].51
Single payer presents a triple whammy to the American people: It raises taxes on individuals and shrinks the non-health portion of the economy, thereby making health care more expensive by comparison.
Moreover, even this estimate of a 19% reduction in non-health spending does not consider all the deadweight effects of single payer on the American economy. For instance, the CEA model could not accurately capture the effects of the vast changes within the health-care sector, and the discouragement of innovation, that would accompany the transition to a single-payer system.52 These changes will have undoubted economic impacts, and even more profound impacts on the quality of patient care, as later sections of this book will highlight.
The single-payer bills do acknowledge the disruption this new system will inflict on the American economy. However, the proposed “solutions” to the problem seem vastly insufficient, demonstrating the foolishness of enacting the legislation to begin with.
In discussing the new national budget for health care, Section 601 of the Senate legislation includes the following language:
For up to 5 years following the date on which benefits first become available as described in section 106(a), up to 1 percent of the budget may be allocated to programs providing assistance to workers who perform functions in the administration of the health insurance system and who may experience economic dislocation as a result of the implementation of this Act.53
The House bill includes similar language, although it states that the federal government “shall” allocate “at least 1 percent” of the health budget for a period of up to five years for job training.54
Regardless, assuming an expenditure of 1% of total health expenditures for five years, the amounts seem paltry compared to the scale of the need this program would create. In 2018, national health expenditures totaled $3.6 trillion.55 Assuming modest inflation, spending 1% of national health spending on economic assistance would represent approximately $40-50 billion per year. Compare that to the impact of the legislation itself, based on some of the surveys and data cited:
The language in the House bill applies the transition fund only to those directly affected by single payer, but its harmful effects will trickle throughout the economy. The worker retraining funds will do nothing to compensate individuals for stock market losses due to the virtual elimination of for-profit medical providers, or the harmful effects of the tax increases needed to fund the new system. Nor would it address the knock-on effects of the law’s dislocations—for instance, the café owner across from a hospital or insurance company who sees fewer lunch customers when the big employer next door has to lay off workers.
Just as the American people and economy are beginning to recover from the effects of the Great Recession, single payer could well lead to another period of prolonged stagnation and economic malaise. The extremely risky idea would inflict many varieties of pain upon Americans and, given the United States’ global influence, upon the world.
Worst of all, single payer would likely inflict its harshest pain upon those least able to absorb it. Thorpe’s 2016 analysis clearly demonstrates how, no matter how much Sanders or other supporters claim that “the rich” will pay for all or most of single payer’s massive spending bill, the real burden will fall on poor and vulnerable Americans.
As it is, most lower-income Americans already qualify for “free” health care. Due to Obamacare’s expansion of Medicaid to able-bodied adults, many can receive coverage with no premiums, deductibles, co-payments, or any other forms of cost-sharing. Therefore, any single-payer plan that raises their income or payroll taxes—even by as little as one dollar—will by definition make them worse off. Small wonder then that Thorpe concluded more than five in six (85%) Medicaid households would lose out under the Sanders plan.
Middle- and working-class Americans already face high (and rising) health costs, stagnant incomes, and the loss of jobs and economic vibrancy in many rural areas. But single payer would give them gut punch after gut punch: At least a 4% increase in their income taxes, at least a 7.5% increase in payroll taxes—which firms will of course pass on to their workers in the form of lower take-home pay—and millions of job losses to boot.
As with Obamacare, single-payer supporters hope they can highlight the very tangible “winners” from their proposal, while hiding any mention of the “losers.” They would advertise newly insured individuals receiving care, while avoiding discussion of the jobs never created, the raises never granted, the rising tax bills that would increasingly eat away at families’ hard-earned income and savings.
But to reiterate a point from the last chapter, single payer will cost taxpayers at least $32 trillion in the coming decade—and likely much more than that. No politician, however skilled in the art of rhetoric, could hide the ill effects of a program that massive. At some point, the reality of single payer would rapidly catch up to leftists’ rhetoric. But better that American workers and businesses never become guinea pigs for socialists’ failed theories in the first place.
Over the past several years, liberals have cited Keynesian economic principles as one reason for recalcitrant states to embrace Obamacare’s Medicaid expansion to the able-bodied. Bringing new federal dollars will grow jobs inside and outside the health sector, they claimed, benefiting a state’s entire economy. The Obama administration even compiled a report claiming that expansion created 78,600 jobs in states that embraced it, and would create an additional 84,800 jobs if all states did so.56
Single payer would throw that “multiplier” calculus entirely on its head. Because liberals view single payer as a way to lower health spending, the new system would take money out of the economy, through the reductions in reimbursements to hospitals and other medical providers outlined above. According to Keynesian theory, those reductions would lead to negative effects—layoffs, or wage reductions, by hospitals and medical providers, leading to a reduction in spending among medical workers that would cascade throughout the economy.
Of course, “health care is not a jobs program.” It exists to make people healthier.57 If a hospital takes 20 people to do work easily performed by ten, the additional jobs “created” ultimately benefit neither the hospital nor the economy. The key question lies in whether spending on health care improves efficiency—by “achiev[ing] better health outcomes and improv[ing] overall economic productivity.”58
On that front, single payer seems highly unlikely to deliver its promised benefits. Rather than allowing individuals to make their own choices about health-care consumption and quality, single payer will centralize those decisions in the hands of government bureaucrats. Moreover, providing health care “free” to consumers will only encourage them to use more than they need while billing taxpayers, exacerbating the current problem in health care whereby individuals too easily spend other people’s money.
From an economic perspective, single payer appears the worst of all possible worlds. Having increased demand, the system will constrain costs by arbitrarily limiting supply. Its lower reimbursements to doctors and hospitals, to say nothing of its elimination of private health insurance, will result in job losses in the short term. The dramatically higher taxes needed to fund single payer will drag on economic growth in the long term.
To top it off, implementing the new system will require a massive increase in federal authority and regulations, which will also hinder economic growth—and further entrench government bureaucrats in American health-care markets. As the next chapter shows, these bureaucrats have plenty other than your best interests in mind.
1 Chris Isidore, “Where the Current Economic Boom Ranks in American History,” CNN, January 30, 2018, https://money.cnn.com/2018/01/30/news/economy/us-economy-boom-history/index.html.
2 Centers for Medicare and Medicaid Services Office of the Actuary, “National Health Expenditure Projections 2018-2027: Forecast Summary,” February 20, 2019, https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/ForecastSummary.pdf.
3 Organization for Economic Cooperation and Development, Health at a Glance 2017: OECD Indicators, February 2018, http://dx.doi.org/10.1787/health_glance-2017-en, chap. 7, “Health Expenditures,” pp. 131-45.
4 Charles Blahous, “The Costs of a National Single Payer Health Care System” Mercatus Center, July 30, 2018, https://www.mercatus.org/system/files/blahous-costs-medicare-mercatus-working-paper-v1_1.pdf.
5 Reed Abelson and Margot Sanger-Katz, “Medicare for All Would Abolish Private Insurance: ‘There’s No Precedent in American History,’” The New York Times March 23, 2019, https://www.nytimes.com/2019/03/23/health/private-health-insurance-medicare-for-all-bernie-sanders.html.
6 Ibid.
7 Bureau of Labor Statistics, “Employment, Hours, and Earnings from the Current Employment Statistics Survey: Direct Health and Medical Insurance Carriers,” May 12, 2019, https://data.bls.gov/timeseries/CES5552411401.
8 Tatiana Darie, “Health Insurers Sink as ‘Medicare for All’ Idea Gains Traction,” Bloomberg, February 27, 2019, https://www.bloomberg.com/news/articles/2019-02-27/health-insurers-sink-as-medicare-for-all-idea-gains-traction.
9 Amrith Ramkumar, “Health Care Stock Rout Deepens Amid Political Pressure,” Wall Street Journal, April 17, 2019, https://www.wsj.com/articles/health-care-stock-rout-deepens-amid-political-pressure-11555516882.
10 Rep. Pramila Jayapal, February 27, 2019, https://twitter.com/RepJayapal/status/1100911532882477056.
11 See for instance Section 612(b) of H.R. 1384 and Section 611 of S. 1129, the Medicare for All Act of 2019. John Shatto and Kent Clemens, “Projected Medicare Expenditures under an Illustrative Scenario with Alternative Payment Updates to Medicare Providers,” Centers for Medicare and Medicaid Services Office of the Actuary memorandum, April 22, 2019, https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/ReportsTrustFunds/Downloads/2019TRAlternativeScenario.pdf.
12 Stephen Heffler, et al., “Simulations of Affordable Care Act Medicare Payment Update Provisions on Part A Provider Margins,” Centers for Medicare and Medicaid Services Office of the Actuary memorandum, April 22, 2019, https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/ReportsTrustFunds/Downloads/ACAmarginsimulations2019.pdf.
13 Reed Abelson, “Hospitals Stand to Lose Billions under ‘Medicare for All,’” New York Times, April 21, 2019, https://www.nytimes.com/2019/04/21/health/medicare-forall-hospitals.html.
14 Ibid.
15 Jeff Goldsmith, Jeff Leibach, and Kurt Eicher, “Medicare Expansion: A Preliminary Analysis of Hospital Financial Impacts,” Navigant Consulting, March 2019, https://www.navigant.com/-/media/www/site/insights/healthcare/2019/medicare-expansion-analysis.pdf.
16 Kevin Schulman and Arnold Milstein, “The Implications of ‘Medicare for All’ for U.S. Hospitals,” Journal of the American Medical Association, April 4, 2019, https://jamanetwork.com/journals/jama/fullarticle/2730485.
17 Ibid.
18 Ibid.
19 Bureau of Economic Analysis, “Gross Domestic Product: Fourth Quarter 2018 and Annual 2018 (Third Estimate),” Report BEA 19-12, March 28, 2019, https://www.bea.gov/system/files/2019-03/gdp4q18_3rd_1.pdf, Table 3, Gross Domestic Product: Level and Change from Preceding Period, p. 9.
20 Bureau of Labor Statistics, “The Employment Situation—March 2019,” April 5, 2019, https://www.bls.gov/news.release/archives/empsit_04052019.pdf.
21 Centers for Medicare and Medicaid Services Office of the Actuary, “National Health Expenditure Projections,” February 20, 2019, https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/Proj2018Tables.zip, Table 2, National Health Expenditure Amounts and Annual Percent Change by Type of Expenditure: Calendar Years 2011-2027.
22 Section 614(b) of H.R. 1384.
23 Section 614(a) of H.R. 1384.
24 Total includes the market capitalization of UnitedHealthGroup ($207.1 billion), Anthem ($56.2 billion), Aetna ($55.2 billion), Humana ($37.1 billion), Centene ($18.7 billion), Cigna ($40.7 billion), Molina Health Care ($4.9 billion), and WellCare Health Plans ($8.6 billion). Figures accurate as of March 29, 2018. See “Fortune 500,” Fortune, http://fortune.com/fortune500/.
25 Ibid.
26 Jeffery M. Jones, “U.S. Stock Ownership Down Among All but Older, Higher-Income,” Gallup, May 24, 2017, https://news.gallup.com/poll/211052/stock-ownership-down-among-older-higher-income.aspx.
27 Sen. Bernie Sanders, “Financing Medicare for All,” April 10, 2019, https://www.sanders.senate.gov/download/medicare-for-all-2019-financing?id=860FD1B9-3E8A-4ADD-8C1F-0DEDC8D45BC1&download=1&inline=file.
28 Ibid.; Mark Koba, “How the Gingrich-Edwards Tax Loophole Works,” CNBC, March 5, 2014, https://www.cnbc.com/2014/03/05/cnbc-explains-the-gingrich-edwards-tax-loophole.html.
29 Title VIII of S. 1782 (113th Congress), the American Health Security Act of 2013.
30 Kenneth Thorpe, “An Analysis of Sen. Sanders’s Single Payer Plan,” January 27, 2016, https://www.healthcare-now.org/296831690-Kenneth-Thorpe-s-analysis-of-Bernie-Sanders-s-single-payer-proposal.pdf, p. 1.
31 John Holahan and Linda Blumberg, “Estimating the Cost of a Single Payer Plan,” Urban Institute, October 9, 2018, https://www.urban.org/sites/default/files/publication/99151/estimating_the_cost_of_a_single-payer_plan_0.pdf, p. 2 (see chap. 2, n. 37).
32 Tami Luhby, “Can Taxing the Rich Pay for Bernie Sanders’s Medicare for All Plan?” CNN April 16, 2019, https://www.cnn.com/2019/04/16/politics/medicare-for-all-rich-taxes/index.html.
33 Laura Davison, “Tax Hikes on the Wealthy Alone Can’t Pay for ‘Medicare for All,’” Bloomberg, May 9, 2019, https://www.bloomberg.com/news/articles/2019-05-09/tax-hikes-on-wealthy-alone-can-t-pay-for-medicare-for-all-plan.
34 Ibid.
35 Thorpe, “An Analysis,” Table 3, Number of Health Insurance Units Paying More and Less for Health Care Under Single Payer Compared to Current Law When Plan Is Fully Financed, p. 5.
36 Ibid.
37 Paige Winfield Cunningham, “The Health 202: Bernie Sanders Says Medicare for All Would Reduce Health Spending, But That’s Unclear,” Washington Post April 17, 2019, https://www.washingtonpost.com/news/powerpost/paloma/the-health-202/2019/04/17/the-health-202-bernie-sanders-says-medicare-for-all-would-reduce-health-spending-but-that-s-unclear/5cb60483a7a0a475985bd484/.
38 “36 Times Obama Said You Could Keep Your Health Care Plan,” Washington Free Beacon November 5, 2013, https://www.youtube.com/watch?v=qpa-5JdCnmo.
39 “Flashback: Obama’s Health Care Cost Promises,” BlackandRight, October 6, 2013, https://www.youtube.com/watch?v=LW9tPdpu2jY.
40 “President Obama Making C-SPAN Promise Eight Separate Times,” Republican Study Committee January 6, 2010, https://www.youtube.com/watch?v=kPMf6kW_1Nw.
41 Chris Jacobs, “The CBO Report on Single Payer Isn’t the One We Deserve to See,” The Federalist May 3, 2018, https://thefederalist.com/2019/05/03/cbo-report-single-payer-isnt-one-deserve-see/.
42 Amy Goldstein, “Why Vermont’s Single Payer Effort Failed, and What Democrats Can Learn from It,” Washington Post, April 29, 2019, https://www.washingtonpost.com/national/health-science/why-vermonts-single-payer-effort-failed-and-what-democrats-can-learn-from-it/2019/04/29/c9789018-3ab8-11e9-a2cd-307b06d0257b_story.html?utm_term=.c8bce12aab07.
43 Ibid.
44 Ibid.
45 Sanders, “Financing Medicare for All.”
46 Goldstein, “Why Vermont’s Single Payer Effort Failed.”
47 Ibid.
48 Council of Economic Advisers, Economic Report of the President, March 2019, https://www.whitehouse.gov/wp-content/uploads/2019/03/ERP-2019.pdf, p. 227.
49 Ibid., pp. 424-25.
50 Ibid., Table 8–7, National Accounts With and Without “Medicare for All,” 2022, p. 425.
51 Ibid., p. 424.
52 Casey Mulligan, Council of Economic Advisers, personal communication, April 11, 2019.
53 Section 601(a)(4) of S. 1129.
54 Section 601(a)(8)(A) of H.R. 1384.
55 CMS Office of the Actuary, “National Health Expenditure Projections.”
56 Council of Economic Advisers, “Missed Opportunities: The Consequences of State Decisions Not to Expand Medicaid,” July 2014, https://obamawhitehouse.archives.gov/sites/default/files/docs/missed_opportunities_medicaid_0.pdf, p. 5.
57 Zeke Emanuel, “We Can Be Healthy and Rich,” New York Times, February 2, 2013, https://opinionator.blogs.nytimes.com/2013/02/02/we-can-be-healthy-and-rich/.
58 Katherine Baicker and Amitabh Chandra, “The Health Care Jobs Fallacy,” New England Journal of Medicine, June 28, 2012, https://wcfia.harvard.edu/files/wcfia/files/chandra_hc_jobs.pdf.