As the readers of this blog well know, I am highly concerned about our rapidly growing national debt and how to fix it. I have stated many times that the only feasible way to do this is to get entitlement spending, and especially health care spending, under much better control.
The Committee for a Responsible Federal Budget has prepared a report, “Primary Care: Estimating Leading Democratic Candidates’ Health Plans” comparing the health care plans for Joe Biden, Pete Buttigieg, Bernie Sanders and Elizabeth Warren. Even though their plans are campaign oriented and not fully developed policy documents, they are still indicative in a general sense of the direction in which a future Democratic President would attempt to implement health care reform.
All four of these candidates would expand coverage by an additional 20 to 30 million people, thereby assuring nearly universal health insurance coverage. But there are still two huge problems remaining.
- First of all, it is too expensive overall, roughly double the cost as compared to other developed countries.
- Secondly, as mentioned above, it is the health care entitlement programs, i.e. Medicare and Medicaid, which are the fundamental drivers of our national debt.
How do the four leading Democratic Presidential candidates compare on addressing these two remaining fundamental problems?
On the first question, according to CRFB, their plans would have relatively minimal impact (see chart below). Total national healthcare expenditures would either slightly decrease (by 2%) or slightly increase (by 6%).
On the second question likewise, their plans would vary (see chart below) from having a minimal effect on the debt to making the debt substantially worse.
Conclusion. The healthcare plans of the top four Democratic Presidential candidates would have either a very small positive effect or a major negative effect on the two biggest problems of American health care, the cost issues. Basically their effect would be to significantly expand access to health care without addressing the cost problems or else making them worse.
It Does Not Add Up 
As demonstrated by the ACA 2010, any further expansion of entitlement commitments would be a major disaster. The current lack of an effective and efficient plan for healthcare reform is and will continue to represent an evolving disaster. The political climate this fall is likely to be characterized by major realignments. One could hope that common sense would be applied, even though that has not occurred within the last 10 years. Miracles happen, just not very often.
I support universal health care but we do have to pay for it. I also expect major political realignments to follow from the election in Fall 2020