For the Wall Street Journal (and Harvard’s Gregory Mankiw), presidential candidate Bernie Sanders is proposing to spend a really big amount of money! $18 trillion! “The largest peacetime expansion of government in modern American history”!
However, as James Kwak explains, that spending figure is meaningless on its own.
Most of that money—$15 trillion—is the expansion of Medicare to cover all Americans. Yes, that’s a lot of money. But we are already spending a ton of money on health care—with embarrassingly poor results. In 2013, total premiums for private health insurance cost Americans $962 billion, individuals and families paid $339 billion out of their own pockets and “other private revenues” accounted for another $121 billion of health care (data here). That’s $1.4 trillion of health care spending, paid for by families and businesses, most of which would be replaced by Sanders’s plan. Project that out for ten years, add health care inflation, and you’re talking about a lot more than $15 trillion.
At the end of the day, what matters isn’t the amount of money that the federal government spends for health care. What matters is the amount of money that the American people spend for health care. The government is just a device that we use to provide certain services that are better handled collectively than individually. If the government can provide equivalent service at lower prices, then the gross dollar amount involved doesn’t matter.
And, as the folks at the Center for Economy Policy Research add,
This still leaves $3 trillion for us to get frightened over, and this still looks like a really big number. As a point of reference, GDP over the next decade is projected at roughly $240 trillion. This makes the cost of the rest of Sanders’ plans equal to less than 1.3 percent of GDP.
Should we worry about that? The increase in annual military spending from 2000 to the peaks of Iraq/Afghanistan wars was roughly 1.8 percent of GDP. This was also the size of military buildup that took place under President Reagan. Jeb Bush is proposing to cut taxes by roughly this amount if he gets elected.
In short, the additional spending that Senator Sanders has proposed is not trivial, but we have seen comparable increases in the past for other purposes. We can clearly afford the tab, the question is whether free college, rebuilding the infrastructure, early childhood education and the other items on the list are worth the price.
Let’s see, then: $18 trillion over ten years to get decent, affordable healthcare for all, plus fully funded Social Security, improved infrastructure, more affordable college education, paid family and medical leave, strengthening workers’ pensions, jobs for unemployed young people, and better child care.
Sounds like a pretty good deal to me.