Tagged KHN & PolitiFact HealthCheck

Bernie Sanders Embraces A New Study That Lowers ‘Medicare For All’s’ Price Tag, But Skepticism Abounds

Defending his signature health plan — a single-payer system known “Medicare for All” that would move all Americans to government-funded coverage  — Vermont Sen. Bernie Sanders argued that the massive health care expansion would actually save the system hundreds of billions of dollars.

Sanders’ figures come from a study published Feb. 15 in The Lancet, a British medical journal.

“It said ‘Medicare for All’ will lower health care costs in this country by $450 billion a year and save the lives of 68,000 people who would otherwise have died,” Sanders said at the Feb. 25 Democratic presidential debate.

The price tag of Medicare for All has been fiercely debated, and some previous analyses have suggested that the proposal would increase health spending, not decrease it. But Sanders is relying on the Lancet paper — which has a cost estimate that is the lowest, in the neighborhood of $17 trillion over 10 years — to argue that the suite of financing mechanisms he has proposed would more than cover the cost of his health bill. (Funding would include taxes on high earners, a new payroll tax, and 4% income premiums for the majority of families.) Most other estimates place the cost between $30 trillion and $40 trillion over a decade, which would make paying for it far more difficult.  So we decided to take a closer look.

We reached out to one of the study’s authors, but never heard back. 

A spokesperson for the Sanders campaign said the paper is “similar to 22 other recent studies that have also shown that moving to a single-payer healthcare system will cost less than our current dysfunctional healthcare system.” (We asked for those 22 other studies but, as of publication, hadn’t received them.)

But independent experts were skeptical of the study’s estimate — arguing it exaggerates potential savings, cherry-picks evidence and downplays some of the potential tradeoffs.

“I don’t think this study, albeit in a prestigious, peer-reviewed journal, should be given any deference in the Medicare for All debate,” said Robert Berenson, a fellow at the Urban Institute who studies hospital pricing.

So, Savings?

Largely, the Lancet paper is more generous in its assumptions than other Medicare for All analysis, noted Jodi Liu, an economist at the RAND Corp., who studies single-payer plans. To the researchers’ credit, she said, they acknowledge that their findings are based on uncertain assumptions.

For instance, the researchers calculate $78.2 billion in savings from providing primary care to uninsured people — $70.4 billion from avoided hospitalizations and $7.8 from avoided emergency room visits. But previous evidence suggests that logic is suspect at best. 

When states expanded Medicaid under the Affordable Care Act, providing new insurance to people who had previously lacked coverage, avoidable hospitalizations and emergency room visits didn’t disappear because people could suddenly use preventive care, noted Ellen Meara, a professor at the Harvard T.H. Chan School of Public Health. That evidence doesn’t appear anywhere in the Lancet paper.

“The notion that we’re going to get rid of all these avoidable visits — that’s not been borne out,” she said. 

The researchers also assume that a Medicare for All system would pay hospitals at a maximum of Medicare rates.

That’s tricky. In 2017, the nonpartisan Medicare Payment Advisory Commission estimated that, on average, a hospital has a -9.9% margin on a patient who is insured through Medicare. (Private pay helps make up that difference.) Some hospitals certainly would be able to swallow this cost. But others would struggle to stay afloat, said Adrianna McIntyre, a health policy researcher at Harvard University 

Given the political influence hospitals in particular carry in Congress — where most members are sensitive to their concerns — passing a plan offering such a low payment rate would be politically challenging.

Sanders’ bill doesn’t actually  specify the rates at which hospitals would be paid.

Beyond the lower payments, the researchers also suggest hospitals would spend less money on overhead, only having to navigate a single insurance plan. That change accounts for $219 billion in their estimated savings.

But again, that ignores some of the reality of how hospitals work. While a single-payer system would undoubtedly cost less to administer — requiring a smaller back-end staff, for instance — it would not eliminate the need for expensive items like electronic health records, which coordinate care between hospitals.

The assumptions are unrealistic,” said Gerard Anderson, a health economist at Johns Hopkins University in Baltimore. “You are never going to save that much money from the various providers.” 

The Cost-Sharing Question

Medicare for All would enroll all Americans in coverage far more generous than what most experience now — eliminating virtually all cost-sharing associated with using health care. 

That’s a major change, researchers told us. Previous evidence suggests that such a shift would encourage consumers to use health care more than they currently do. 

The Lancet paper acknowledges that — but only partially. It allows that people who are uninsured or “underinsured” — that is, who have particularly high levels of cost-sharing now — would use more medical care under Sanders’ system than they currently do. It factors that into the price tag. 

But its estimate does not account for people who already have decent or adequate insurance and who would still be moving to a richer benefit, and therefore more likely to use their insurance. 

“It drastically underestimates the utilization increases we would expect to see under Medicare for All,” McIntyre said. “People have different views on whether the increased utilization is good or bad,” she added — it makes the program more expensive, but also means more people are getting treatment.

Other Estimates?

Context is helpful, too. Other estimates — namely, a projection by the Urban Institute — of Medicare for All have suggested it would increase federal health spending by about $34 trillion over 10 years. But elimination of other health spending would make the overall change smaller. 

To implement the Sanders proposal, national health spending — public and private dollars, both — would increase by $7 trillion over a decade, Urban said. And Medicare for All would be bringing new services: more insurance for more people, and more generous coverage for those already covered.

Urban’s estimate of $7 trillion more in spending over 10 years is far removed from the study’s estimate of $450 billion less annually. And, experts said, relying on the latter figure isn’t a good idea.

“I think they need more work to prove” the savings, Meara said. “They’re not being complete, and by not being complete, they’re not being honest.”

It’s also worth noting that the study’s lead author was also an informal unpaid adviser to the Sanders staff in drafting its 2019 version of the Medicare for All bill, according to the paper’s disclosures section.

The “Lives Saved”

Experts agree that expanding access to health insurance would probably reduce early mortality. But the 68,000 figure is another example of cherry-picking, Meara said.

The figure is based on a 2009 paper. It doesn’t acknowledge a body of research that came after, including multiple studies that examined how expanding Medicaid  affected mortality — and maybe offered less dramatic numbers.

“When they so clearly are cherry-picking, when they clearly have all the  information on studies in front of them, it’s concerning,” Meara said. “It’s a situation where you’re going to overpromise and underdeliver.”

Our Ruling

Sanders said a recent study suggested Medicare for All would save $450 billion annually and saves 68,000 lives.

That study does exist. And it cites some evidence. But many of its assumptions are flawed, and experts uniformly told us it overestimates the potential savings. It cherry-picks data in calculating mortality effects.

This statement has some truth, but ignores context that would create a dramatically different impression. We rate it Mostly False.

Related Topics

Elections Health Care Costs Insurance Medicare

Trump’s Medicaid Chief Labels Medicaid ‘Mediocre.’ Is It?

The Trump administration’s top Medicaid official has been increasingly critical of the entitlement program she has overseen for three years.

Seema Verma, administrator of the Centers for Medicare & Medicaid Services, has warned that the federal government and states need to better control spending and improve care to the 70 million people on Medicaid, the state-federal health insurance program for the low-income population. She supports changes to Medicaid that would give states the option to receive capped annual federal funding for some enrollees instead of open-ended payouts based on enrollment and health costs. This would be a departure from how the program has operated since it began in 1965.

In an early February speech to the American Medical Association, Verma noted how changes are needed because Medicaid is one of the top two biggest expenses for states, and its costs are expected to increase 500% by 2050.

“Yet, for all that spending, health outcomes today on Medicaid are mediocre and many patients have difficulty accessing care,” she said.

Verma’s sharp comments got us wondering if Medicaid recipients were as bad off as she said. So we asked CMS what evidence it has to back up her views.

A CMS spokesperson responded by pointing us to a CMS fact sheet comparing the health status of people on Medicaid to people with private insurance and Medicare. The fact sheet, among other things, showed 43% of Medicaid enrollees report their health as excellent or very good compared with 71% of people with private insurance, 14% on Medicare and 58% who were uninsured.

The spokesperson also pointed to a 2017 report by the Medicaid and CHIP Payment and Access Commission (MACPAC), a congressional advisory board, that noted: “Medicaid enrollees have more difficulty than low-income privately insured individuals in finding a doctor who accepts their insurance and making an appointment; Medicaid enrollees also have more difficulty finding a specialist physician who will treat them.”

We opted to look at those issues separately.

What About Health Status?

Several national Medicaid experts said Verma is wrong to use health status as a proxy for whether Medicaid helps improve health for people. That’s because to be eligible for Medicaid, people must fall into a low-income bracket, which can impact their health in many ways. For example, they may live in substandard housing or not get proper nutrition and exercise. In addition, lack of transportation or child care responsibilities can hamper their ability to visit doctors.

Benjamin Sommers, a health economist at Harvard University, said Verma’s comparison of the health status of Medicaid recipients against people with Medicare or private insurance is invalid because the populations are so different and face varied health risks. “This wouldn’t pass muster in a first-year statistics class,” he said.

Death rates, for example, are higher among people in the Medicare program than those in private insurance or Medicaid, he said, but that’s not a knock on Medicare. It’s because Medicare primarily covers people 65 and older.

By definition, Medicaid covers the most vulnerable people in the community, from newborns to the disabled and the poor, said Rachel Nuzum, a vice president with the nonpartisan Commonwealth Fund. “The Medicaid population does not look like the privately insured population.”

Joe Antos, a health economist with the conservative American Enterprise Institute, also agreed, saying he is leery of any studies or statements that evaluate Medicaid without adjusting for risk.

For a better mechanism to gauge health outcomes under Medicaid, experts point to dozens of studies that track what happened in states that chose in the past six years to pursue the Affordable Care Act’s Medicaid expansion. The health law gave states the option to extend Medicaid to everyone with incomes up to 138% of the federal poverty level, or about $17,600 annually for an individual. Thirty-six states and the District of Columbia have adopted the expansion.

“Most research demonstrates that Medicaid expansion has improved access to care, utilization of services, the affordability of care, and financial security among the low-income population,” concluded the Kaiser Family Foundation in summarizing findings from more than 300 studies. “Studies show improved self-reported health following expansion and an association between expansion and certain positive health outcomes.” (Kaiser Health News is an editorially independent program of the foundation.)

Studies found the expansion of Medicaid led to lower mortality rates for people with heart disease and among end-stage renal disease patients initiating dialysis.

Researchers also reported that Medicaid expansion was associated with declines in the length of stay of hospitalized patients. One study found a link between expansion and declines in mechanical ventilation rates among patients hospitalized for various conditions.

Another recent study compared the health characteristics of low-income residents of Texas, which has not expanded Medicaid, and those of Arkansas and Kentucky, which did. It found that new Medicaid enrollees in the latter two states were 41 percentage points more likely to have a usual source of care and 23 percentage points more likely to say they were in excellent health than a comparable group of Texas residents.

Medicaid’s benefits, though, affect far more than the millions of nondisabled adults who gained coverage as a result of the ACA. “Medicaid coverage was associated with a range of positive health behaviors and outcomes, including increased access to care; improved self-reported health status; higher rates of preventive health screenings; lower likelihood of delaying care because of costs; decreased hospital and emergency department utilization; and decreased infant, child, and adult mortality rates,” according to a report issued this month by the nonpartisan Robert Wood Johnson Foundation.

Children — who make up nearly half of Medicaid enrollees — have also benefited from the coverage, studies find. Some studies report that Medicaid contributes to improved health outcomes, including reductions in avoidable hospitalizations and lower child mortality.

Research shows people on Medicaid are generally happy with the coverage.

A Commonwealth Fund survey found 90% of adults with Medicaid were satisfied or very satisfied with their coverage, a slightly higher percentage than those with employer coverage.

Accessible Care?

The evidence here is less emphatic.

A 2017 study published in JAMA Internal Medicine found 84% of Medicaid recipients felt they were able to get all the medical care they needed in the previous six months. Only 3% said they could not get care because of long wait times or because doctors would not accept their insurance.

Verma cites a 2017 MACPAC report that noted some people on Medicaid have issues accessing care. But that report also noted: “The body of work to date by MACPAC and others shows that Medicaid beneficiaries have much better access to care, and much higher health care utilization, than individuals without insurance, particularly when controlling for socioeconomic characteristics and health status.” It also notes that “Medicaid beneficiaries also fare as well as or better than individuals with private insurance on some access measures.”

The report said people with Medicaid are as likely as those with private insurance to have a usual source of care, a doctor visit each year and certain services such as a Pap test to detect cervical cancer.

“Medicaid is not great coverage, but it does open the door for health access to help people deal with medical problems before they become acute,” Antos said.

On the negative side, the report said Medicaid recipients are more likely than privately insured patients to experience longer waiting times to see a doctor. They also are less likely to receive mammograms, colorectal tests and dental visits than the privately insured.

“Compared to having no insurance at all, having Medicaid improves access to care and improves health,” said Rachel Garfield, a vice president at the Kaiser Family Foundation. “There is pretty strong evidence that Medicaid helps patients get the care they need.”

Our Ruling

Verma said that “health outcomes today on Medicaid are mediocre and many patients have difficulty accessing care.”

Numerous studies show people’s health improves as a result of Medicaid coverage. This includes lower mortality rates, shorter hospital stays and more people likely to get cancer screenings.

While it’s hard to specify what “many patients having difficulty accessing care” means, research does show that Medicaid enrollees generally say they have no trouble accessing care most of the time.

We rate the claim as Mostly False.

Related Topics

Cost and Quality Insurance Medicaid States Uninsured

Obamacare A Disgrace? Biden Highlights Bloomberg’s Negative Remarks About The Affordable Care Act.

Sparring over health care during the Nevada Democratic presidential primary debate, former Vice President Joe Biden took issue with former New York City Mayor Michael Bloomberg’s record on the Affordable Care Act.

“From the moment we passed that signature legislation, Mike called it a disgrace,” Biden said, a claim he repeated another time during the debate. 

Bloomberg sought to refute that charge, arguing that he defended the law and believed it should be expanded.

It was a heated moment. Both candidates are trying to tie themselves to former President Barack Obama, who spearheaded the 2010 legislation. So we decided to dig in.

We reached out to both campaigns for comment. We didn’t hear back from Bloomberg’s campaign. The Biden campaign sent a CNN article, which cited a speech Bloomberg gave at the Dartmouth Presidential Lecture in July 2010 — just a few months after the health care legislation was passed in March. In the speech, Bloomberg called the Affordable Care Act “a disgrace.” We found a video of the speech on YouTube. 

The remarks 

In the video, Bloomberg was unsparing. 

“We passed a health care bill that does absolutely nothing to fix the big health care problems in this country. It is just a disgrace,” he said. “The president, in all fairness, started out by pointing out what the big problems were, but then turned it over to Congress, which didn’t pay any attention to any of those big problems and just created another program that’s going to cost a lot of money.”

Those aren’t standalone remarks. As recently as 2014, Bloomberg called the law “really dysfunctional” during a talk he gave at the annual meeting of SIFMA, one of the financial industry’s trade groups. 

Both times, Bloomberg was still a registered Independent — he didn’t become a Democrat until 2018.

It’s also worth noting that Bloomberg wasn’t espousing a minority view. The ACA’s approval rating was underwater until 2017, according to polling by the Kaiser Family Foundation. (KHN is an editorially independent program of the Foundation.)

Bloomberg’s response

On the debate stage, Bloomberg sought distance from those remarks, saying he is a “fan of Obamacare.”

“I wrote something supporting it either in the New York Post or the Daily News,” he said.

The op-ed he appears to be referring to — published March 27, 2017, in the New York Post — does indeed talk about the ACA. But it comes years after Bloomberg’s mayorship ended. And while words like “disgrace” don’t appear, calling the piece a “defense” of the law isn’t entirely fair.

In it, Bloomberg noted some key shortcomings — for instance, the health law left 30 million people uninsured. He also argued in support of some ideas more popular with Republicans, such as high-risk insurance pools, as a way to bring down costs.

“It’s regrettable that none of these ideas was seriously considered in the rush to repeal ObamaCare,” Bloomberg wrote at the time.

It is worth noting that Bloomberg’s current health care plan would build on the ACA, largely by increasing subsidies for people buying private insurance on the exchanges, and by installing a Medicare-like public option. (That plan is quite similar to what’s been touted by Biden himself, as well as by candidates like former South Bend, Ind., Mayor Pete Buttigieg.)

Our ruling

Biden said that Bloomberg called the ACA “a disgrace.”

Evidence supports that. And it’s not the only time Bloomberg took issue with the law — even if it is a core component of his current proposal for health reform. 

We rate this claim True.

Related Topics

Cost and Quality Elections Insurance States The Health Law

Sanders’ Claim That Buttigieg Is ‘Favorite Of The Health Care Industry’ Is Broad And Needs Context

As Pete Buttigieg gained momentum in the Democratic presidential primary race ― finishing second in the New Hampshire primary and a front runner in the Iowa caucuses ― he has increasingly been on the receiving end of shade from his rivals.

The campaign of Sen. Bernie Sanders (I-Vt.), for instance, distributed talking points that zeroed in on fundraising, saying “Pete Buttigieg is a favorite candidate of Wall Street and the health care industry.”

The former mayor of South Bend, Indiana, already faced criticism over his “billionaire donors,” which famously manifested during the Dec. 19 Democratic debate. It was then that Sen. Elizabeth Warren (D-Mass.) described a Buttigieg fundraiser as held in “a wine cave full of crystals.”

Sanders’ comments led us to wonder if Buttigieg really is the sweetheart of the health care industry. We asked the Sanders campaign for its evidence. Staffers pointed us to data from the Center for Responsive Politics, a nonprofit group that operates the website OpenSecrets.org and tracks money from individuals and political action committees donated to political candidates and members of Congress. The center analyzes Federal Election Commission data and sorts contributions by categories based on the economic sector from which they come.

A Deep Dive Into The Numbers

The Sanders campaign used OpenSecrets data it obtained in December 2019. But the OpenSecrets website has since been updated with fourth-quarter filings, so we couldn’t confirm the figures the campaign cited.

Instead, Doug Weber, a senior CRP researcher, pointed to the 2020 presidential race section of OpenSecrets, saying it contains the most accurate data for presidential campaign contributions. It also highlights industry contribution trends focused only on the presidential giving ― in other words, excluding contributions made to Senate campaign accounts.

We asked Weber if Sanders’ talking point about Buttigieg is true. That “depends on what you mean by ‘health care industry,’” Weber wrote in an email. OpenSecrets defines its health sector by contributions from PACs and individuals working in various health industries, he said, and “for our data, that’s our broadest definition of health care.”

Based on this sweeping categorization, Sanders is ahead of Buttigieg in health sector donations. The Vermont senator received $2,910,894, while the former South Bend mayor trailed closely behind with $2,713,038.

However, when you break down this data by industries within the health sector, Buttigieg comes out ahead of Sanders in contributions from pharmaceutical companies and also for health services/HMOs ― which includes groups like large insurance companies.

But even this point is nuanced. Former Vice President Joe Biden has received the most money of any Democratic candidate from the pharmaceuticals and health products sector if contributions from his leadership political action committee are included. Leadership PACs are committees unaffiliated with campaigns that can still receive contributions and financially support candidates.

In the health care industry categories of hospitals/nursing homes and health professionals, Sanders has received the most in dollar contributions.

When asked to clarify how the Sanders campaign is defining the health care industry, a staffer responded that “Bernie Sanders issued a pledge to not accept money from top officials of the insurance and pharmaceutical industries (as distinct from rank-and-file workers in those industries, which the aggregate data you cite deals with). He asked other candidates to do the same. Pete Buttigieg has refused to take that pledge, and has instead raised money from those top officials…These clear, demonstrable and verifiable facts makes very clear precisely what we are referring to.”

The Sanders campaign sent us a list of pharmaceutical and health insurance executives that have contributed to Buttigieg, including employees and executives from AbbVie, Aetna, Anthem, Eli Lilly and Co., Merck & Co. and Pfizer. We checked that list against the Federal Election Commission database to ensure its accuracy. In addition, the Sanders’ campaign shared an October 2019 article from Sludge, an investigative journalism outlet focused on money in politics, which estimated Buttigieg’s third-quarter health care industry donations approached $97,000.

We also checked in with the Buttigieg campaign for a response, which replied that “more than 800,000 Americans” have donated to its candidate. The campaign’s emailed statement noted that Buttigieg’s “Medicare for All Who Want It” plan draws industry attacks because the health system “will have to provide more affordable coverage and better care or they will lose customers as people enroll in the public option.”

What Does It All Mean?

It seems the Sanders’ claim is “imprecise,” said Robert Maguire, research director at the nonprofit group Citizens for Responsibility and Ethics in Washington (CREW).

“Given that the health industry itself is vast, what I assume the Sanders’ campaign … meant to say was that the more corporate aspects of the health industry ― like the pharmaceutical industry and the health insurance industry ― were funding Buttigieg disproportionately to others,” he added.

Michael Beckel, research director of Issue One, a nonprofit organization focused on transparency and enforcement of campaign finance laws, said the key to understanding this claim is that the Sanders campaign is characterizing money from the health insurance and pharmaceutical industry differently than campaign contributions from individuals, such as nurses and other health professionals.

“Rank-and-file employees in one industry don’t always express the same political preferences as executives in that industry,” Beckel wrote in an email. “Even as he’s railed against the pharmaceutical industry and insurance industry, Sen. Sanders has welcomed support from labor unions representing nurses.”

Michael Malbin, a political science professor at the University at Albany-State University of New York, also took issue with the idea that an individual giving the maximum amount of money to a campaign could sway the candidate’s policies.

“Every time election season rolls around, there are stories about individuals employed in one industry favoring one candidate over another, and it could be for whatever reason,” said Malbin. “But, you cannot make the inference from industry coding … that they are giving just for a certain economic interest. Let alone that it’s remotely enough money to drive a presidential campaign. … It’s a $2,800 maximum, for crying out loud.”

The actual composition of donors in the health category can’t be known without analyzing OpenSecrets’ full data set ― which we could not do since it’s not publicly available.

OpenSecrets does, however, analyze the percentage of small donor donations (less than $200) and large contributions for each presidential candidate. And 56% of Sanders’ contributions are from small donors, while 45% of Buttigieg’s campaign contributions come from that same group.

Our Ruling

Sanders’ use of the phrase “health care industry” in this instance is too broad to support the point he is trying to make.

According to recently updated OpenSecrets data, Sanders has received more donations from the health sector than any other 2020 presidential candidate.

However, when the broad “health sector” category is narrowed down to pharmaceutical and health insurance companies, which are two targets of Sanders’ campaign, Buttigieg is shown to have received more donations than Sanders. He has also received donations from top pharmaceutical executives ― offering evidence to support Sanders’ claim. But in specifying donations from the pharmaceutical/health products sector, Biden tops Buttigieg when factoring in contributions to Biden’s leadership PAC.

Context is also important. It’s likely a large number of Sanders’ health care contributions are from nurses and doctors as individuals. There’s no way to identify whether this support was related to the candidate’s health policies or motivated by other reasons.

Sanders’ claim has some truth to it but is imprecise. For this reason, we rate the claim Half True.

Related Topics

Elections Health Industry Insurance

Would ‘Medicare For All’ Cost More Than U.S. Budget? Biden Says So. Math Says No.

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, Sen. Bernie Sanders of Vermont.

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 with 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.

The Numbers

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.

Our Ruling

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.

Related Topics

Elections Health Care Costs Insurance Medicare