Left-leaning economists question cost of Sanders’ plans

WASHINGTON — With his expansive plans to increase the size and role of government, Sen. Bernie Sanders has provoked a debate not only with his Democratic rival for president, Hillary Clinton, but also with liberal-leaning economists who share his goals but question his numbers and political realism.

The reviews of some of these economists, especially on Sanders’ health care plans, suggest that Clinton could have been too conservative in their debate last week when she said that his agenda in total would increase the size of the federal government by 40 percent. That level would surpass any government expansion since the buildup in World War II.

The increase could exceed 50 percent, some experts suggest, based on an analysis by a respected health economist that Sanders’ single-payer health plan could cost twice what the senator, who represents Vermont, asserts, and on critics’ belief that his economic assumptions are overly optimistic.

His campaign strongly contests both critiques, defending its numbers and attacking prominent critics as Clinton sympathizers and industry consultants.

Sanders, on “Fox News Sunday,” defended his comment in a debate Thursday that critics have assailed: “A family right in the middle of the economy would pay $500 more in taxes and get a reduction in their health costs of $5,000.”

But by the reckoning of the left-of-center economists, none of whom are working for Clinton, the proposals would add $2 trillion to $3 trillion a year on average to federal spending; by comparison, total federal spending is projected to be above $4 trillion in the next president’s first year.

“The numbers don’t remotely add up,” said Austan Goolsbee, formerly chairman of President Barack Obama’s Council of Economic Advisers, now at the University of Chicago.

Alluding to one progressive analyst’s early criticism of the Sanders agenda as “puppies and rainbows,” Goolsbee said that after his and others’ further study, “They’ve evolved into magic flying puppies with winning Lotto tickets tied to their collars.”

Unlike Republican presidential candidates who have proposed trillions of dollars in tax cuts for the wealthy and businesses without offsetting savings — Donald J. Trump’s plans could add $15 trillion to the debt over 10 years, the centrist Committee for a Responsible Federal Budget estimates — Sanders has proposed higher taxes on the wealthy and businesses to pay for his plans, besides the health care savings he counts on.

Clinton has also proposed tax increases on the rich and corporations to pay for her agenda, which she estimates would cost an additional $100 billion a year, or $1.2 trillion over 10 years. That tally does not include middle-class tax cuts she is planning but has yet to unveil.

Sanders’ plan also includes a new, across-the-board 2.2 percent income tax to help pay for his single-payer, government-run health plan for all. But progressive economists as well as business groups say middle-class taxpayers would inevitably pay more for the European-style social welfare state that Sanders envisions.

They dispute his contention that all but the richest Americans would be better off, on balance, with higher wages and benefits like expanded Social Security, free public colleges and, most of all, free health care.

His policy director, Warren Gunnels, dismissed the critics in an interview, saying, “They’ve picked sides with Hillary Clinton.” The campaign has a list of 130 endorsees, including some economists.

“If, at the end of the day, people don’t believe that we can achieve the same savings as Canada, Britain, France, Japan, South Korea, Australia are achieving on health care, then we have a fundamental disagreement,” Gunnels said, naming countries with single-payer systems.

It is not just Sanders’ assumptions for health care savings that critics contest. Jared Bernstein, the former economic adviser to Vice President Joe Biden who is now at the liberal Center on Budget and Policy Priorities, examined a 53-page paper by the economist advising Sanders, Gerald Friedman of the University of Massachusetts at Amherst, that is widely circulating on the left.

While calling Friedman’s work a good effort, Bernstein cited several assumptions as “wishful thinking.” Among them were minimal health-cost inflation, economic growth reaching 5.3 percent and, in the face of that heated-up economy, no action from the Federal Reserve to apply brakes.

“We need a deep investment in infrastructure, more-efficient health care and less student debt,” Bernstein said. “But when you put it all together, government’s role in the economy goes well beyond anything we’ve ever considered.”

He also said that protecting the Affordable Care Act against Republican opposition should be a higher priority — a critique echoed by Clinton.

Sanders has described his health care plan as “Medicare for All,” but it would be far more generous, giving all Americans broader coverage without premiums, deductibles or co-payments. It would replace not only Medicare but also Medicaid and the Children’s Health Insurance Program.

A table in his economic adviser’s analysis shows that all public spending currently going to military, veterans’, American Indian and other health programs would become part of the financing for his single-payer plan, yet Gunnels said that veterans’ and American Indian health programs would remain intact. That suggests double-counting, or financing the existing programs while claiming the sums to offset the single-payer plan. He did not address military health benefits in an email exchange.

The critics — many of whom support the concept of single-payer plans, including Paul Krugman, the Nobel Prize-winning economist and op-ed columnist for The New York Times — note the difficulty that Obama has had in winning and putting into effect his less-ambitious law, which keeps the private insurance and health care sectors in place. They worry that Sanders, as president, would exhaust his political capital on what they call a fool’s errand, at the expense of other initiatives on education, infrastructure, climate change, worker benefits — and the Affordable Care Act itself.

“The single-payer idea has enormous appeal: coverage for everyone, some effort to use the government’s bargaining power to hold down overall costs, clean out the godawful administrative mess that the U.S. health care system is and save money there,” said Henry J. Aaron, a longtime health economist at the Brookings Institution in Washington.

But he called it a “fairy tale” in this polarized political climate. Along with other economists in a “lefty chat group” he joins online, Aaron said he believes that if Sanders were elected and fought for a single-payer plan, it “would rapidly destroy his administration by using up every ounce of political capital he’s got.”

On his campaign website, Sanders proposes more than $18 trillion in new spending over 10 years; he does not account for some ideas he favors, like universal prekindergarten and child care, that could put the total above $20 trillion. About $14 trillion of the total is for health care; the rest is chiefly for infrastructure, free college, Social Security, paid family leave and clean-energy initiatives.

Adding $20 trillion to projected federal spending would mean about a 37 percent increase in spending through fiscal year 2026 — close to the 40 percent that Clinton suggested. But Kenneth E. Thorpe, a prominent health policy economist at Emory University who advised the Clintons in the 1990s, recently concluded that Sanders’ health plan would actually cost $27 trillion, not $14 trillion, which would put total spending for all of Sanders’ initiatives above $30 trillion through 2026.

Thorpe and Sanders’ aides and allies have been battling online. Their trillion-dollar disputes mainly involve the amount of savings that would be achieved by reducing red tape and bargaining for lower-cost brand-name drugs, and whether states would continue to pay what they currently do toward health programs that would cease in a single-payer system.

Thorpe in recent years helped Gov. Peter E. Shumlin in Sanders’ home state of Vermont to design a single-payer plan there. It was unsuccessful.

“The problem was that the price tag and the amount of disruption and redistribution was just so enormous,” Thorpe said of Shumlin’s efforts, “that he just had to drop it.”