RESEARCH: Committee for a Responsible Federal Budget: Choices for Financing Medicare for All: A Preliminary Analysis

Proposals to adopt single-payer health care in the United States have grown in popularity in recent years, as numerous lawmakers and presidential candidates have embraced Medicare for All. However, few have grappled with how to finance the new costs imposed on the federal government. By most estimates, Medicare for All would cost the federal government about $30 trillion over the next decade. How this cost is financed would have considerable distributional, economic, and policy implications.

In the coming months, the Committee for a Responsible Federal Budget will publish a detailed analysis describing numerous ways to finance Medicare for All and the consequences and trade-offs associated with each choice. This paper provides our preliminary estimates of the magnitude of each potential change and a brief discussion of the types of trade-offs policymakers will need to consider.

We find that Medicare for All could be financed with:

• A 32 percent payroll tax
• A 25 percent income surtax
• A 42 percent value-added tax (VAT)
• A mandatory public premium averaging $7,500 per capita – the equivalent of $12,000 per individual not otherwise on public insurance
• More than doubling all individual and corporate income tax rates
• An 80 percent reduction in non-health federal spending
• A 108 percent of Gross Domestic Product (GDP) increase in the national debt
• Impossibly high taxes on high earners, corporations, and the financial sector
• A combination of approaches

Each of these choices would have consequences for the distribution of income, growth in the economy, and ability to raise new revenue. Some of these consequences could be balanced against each other by adopting a combination approach that includes smaller versions of several of the options as well as additional policies.