One of Sen. Bernie Sanders’ (I-VT) most notable and far-reaching campaign promises is his pledge to impose a national “Medicare-for-All” (M4A) health care program, one that has been endorsed by numerous Democratic presidential candidates, including Sen. Elizabeth Warren (D-MA).
According to Sanders, “The giant pharmaceutical and health insurance lobbies have spent billions of dollars over the past decades to ensure that their profits come before the health of the American people. We must defeat them, … [by joining] every other major country on Earth and guaranteeing health care to all people as a right, not a privilege, through a Medicare-for-all, single-payer program.”
Sanders’ plan would “create a federal universal health insurance program to provide comprehensive coverage for all Americans including inpatient and outpatient hospital care; emergency services; primary and preventive services; prescription drugs; mental health and substance abuse treatment; maternity and newborn care; pediatrics; home- and community-based long-term services and supports; dental, audiology, and vision services.”
Sanders’ proposal was co-sponsored by 14 members of the Senate, including four leading Democratic candidates for president: Sens. Cory Booker (D-NJ), Kirsten Gillibrand (D-NY), Kamala Harris (D-CA), and Elizabeth Warren (D-MA).
Similar proposals have been offered by Democrats in the U.S. House of Representatives. In February 2019, Rep. Pramila Jayapal (D-WA) introduced legislation that “would transition the U.S. healthcare system to a single-payer ‘Medicare for All’ program funded by the government in two years.”
Despite the fact Democrats have offered numerous proposals to eliminate private health insurance and put the federal government in charge, directly or indirectly, of the U.S. health care industry, none have offered plans that would fully fund their programs. For example, Sanders’ Senate office released a document providing “Options to Finance Medicare for All”—which mostly consists of proposals to increase or create taxes—but the sum total of all the plan’s projected revenue amounts to less than $17 trillion over 10 years, about half of what many analysts say would be the minimum funding required to pay for a Medicare-for-All plan.
Numerous analyses exist estimating the cost of Sanders’ “Medicare for All” proposal, but perhaps the most widely cited is a study titled “The Costs of a National Single-Payer Healthcare System,” authored by Charles Blahous, the J. Fish and Lillian F. Smith chair and senior research strategist at the Mercatus Center at George Mason University. Blahous estimates Sanders’ proposal would “increase federal budget commitments by approximately $32.6 trillion during its first 10 years of full implementation (2022–2031).”
Blahous’ estimate is in line with other single-payer cost projections, including those by the American Action Forum’s Douglas Holtz-Eakin et al., who determined a national “universal health care” plan would cost $36 trillion in its first 10 years.
Although the total costs of Medicare for All have been analyzed in detail in multiple studies, few have considered how these costs would affect U.S. taxpayers in specific income brackets.
This paper estimates Medicare for All’s potential impact on income taxes for filers across the country. It reveals that if Americans were required to fund the bulk of M4A’s costs through income taxes, many U.S. filers who pay taxes would be forced to pay significantly more in new income levies as a result of Sanders’ single-payer scheme, and all tax filers would likely experience a near doubling of their income tax bills. As the figures in Section 3 show (see page 7), some filers would likely be financially decimated by these new taxes, and tens of millions of filers would be required to pay substantially more for health coverage.