By Paul Waldman
The Washington Post, Sept. 15, 2015
The big policy headline today comes from the Wall Street Journal, which delivers this alarming message: “Price Tag of Bernie Sanders’ Proposals: $18 Trillion.”
Holy cow! He must be advocating for some crazy stuff that will bankrupt America! But is that really an accurate picture of what Sanders is proposing? And is this the kind of number we should be frightened of?
The answer isn’t quite so dramatic: while Sanders does want to spend significant amounts of money, almost all of it is on things we’re already paying for; he just wants to change how we pay for them. In some ways it’s by spreading out a cost currently borne by a limited number of people to all taxpayers. His plan for free public college would do this: right now, it’s paid for by students and their families, while under Sanders’ plan we’d all pay for it in the same way we all pay for parks or the military or food safety.
But the bulk of what Sanders wants to do is in the first category: to have us pay through taxes for things we’re already paying for in other ways. Depending on your perspective on government, you may think that’s a bad idea. But we shouldn’t treat his proposals as though they’re going to cost us $18 trillion on top of what we’re already paying.
And there’s another problem with that scary $18 trillion figure, which is what the Journal says is the 10-year cost of Sanders’ ideas: fully $15 trillion of it comes not from an analysis of anything Sanders has proposed, but from the fact that Sanders has said he’d like to see a single-payer health insurance system, and there’s a single-payer plan in Congress that has been estimated to cost $15 trillion. Sanders hasn’t actually released any health care plan, so we have no idea what his might cost.
But health care is nevertheless a good place to examine why these big numbers can be so misleading. At the moment, total health care spending in the United States runs over $3 trillion a year; according to the Centers for Medicare and Medicaid Services, over the next decade (from 2015-2024), America will spend a total of $42 trillion on health care. This is money that you and I and everyone else spends. We spend it in a variety of ways: through our health-insurance premiums, through the reduced salaries we get if our employers pick up part or all of the cost of those premiums, through our co-pays and deductibles, and through our taxes that fund Medicare, Medicaid, ACA subsidies, and the VA health care system. We’re already paying about $10,000 a year per capita for health care.
So let’s say that Bernie Sanders became president and passed a single-payer health care system of some sort. And let’s say that it did indeed cost $15 trillion over 10 years. Would that be $15 trillion in new money we’d be spending? No, it would be money that we’re already spending on health care, but now it would go through government. If I told you I could cut your health insurance premiums by $1,000 and increase your taxes by $1,000, you wouldn’t have lost $1,000. You’d be in the same place you are now.
By the logic of the scary $18 trillion number, you could take a candidate who has proposed nothing on health care, and say, “So-and-so proposes spending $42 trillion on health care!” It would be accurate, but not particularly informative.
There’s something else to keep in mind: every single-payer system in the world, and there are many of them of varying flavors, is cheaper than the American health care system. Every single one. So whatever you might say about Sanders’ advocacy for a single-payer system, you can’t say it represents some kind of profligate, free-spending idea that would cost us all terrible amounts of money.
Since Sanders hasn’t released a health care plan yet, we can’t make any assessment of the true cost of his plan, because there is no plan. Maybe what he wants to do would cost more than $15 trillion, or maybe it would cost less. But given the experience of the rest of the world, there’s a strong likelihood that over the long run, a single-payer plan would save America money. Again, you may think single-payer is a bad idea for any number of reasons, but “It’ll be too expensive!” is probably the least valid objection you could make.
There are some proposals that involve spending new money that we never would have spent otherwise, like starting a war that ends up costing $2 trillion. But in every case, whether we’re doing something new or doing something we’re already doing but in a new way, the question isn’t what the price tag is, the question is whether we think what we’d get for that money makes spending it worthwhile.
For instance, Sanders wants to spend $1 trillion over 10 years on infrastructure. That’s a lot of money, but it’s significantly less than experts say we need to repair all of our crumbling roads, bridges, water systems, and so on. And infrastructure spending creates immediate jobs and has economic benefits that persist over time, which we’d also have to take into account in deciding whether it’s a good idea. But just saying, “$1 trillion is a lot of money!” doesn’t tell you whether or not we should do it.
The conservatives who are acting appalled at the number the Journal came up with are also the same people who never seem to care what a tax cut costs, because they think cutting taxes is a moral and practical good, in the same way that liberals think providing people with health coverage is a moral and practical good. For instance, Jeb Bush recently proposed a tax cut plan whose 10-year cost could be as high as $3.4 trillion. That’s a lot of money that the government wouldn’t be able to spend on the things it’s doing right now, although the campaign argues that we’d get much of that money back in increased revenues because of the spectacular growth the tax cuts would create. If you remember the claims that George W. Bush’s tax cuts would create stunning growth and prosperity for all, you might be just a bit skeptical of the Jeb campaign’s similar assertions. But in any case, we can’t evaluate the value of Jeb’s plan just by saying that $3.4 trillion is a big number. If you knew that the average family in the middle of the income distribution would get less than $1,000 from Jeb’s plan, while the average family in the top one percent would get a tax cut of over $80,000, then you’d have a better sense of whether it’s a good or bad idea.
As a general matter, when you see a headline with an unimaginably large number, chances are it’s going to confuse you more than it will enlighten you. The question when it comes to government should always be not what we’re spending, but what we’re getting for what we spend.