The single-payer idea has enormous appeal: coverage for everyone, some effort to use the governments 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, Mr. Aaron said he believes that if Mr. Sanders were elected and fought for a single-payer plan, it would rapidly destroy his administration by using up every ounce of political capital hes got.
On his campaign website, Mr. 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 Mrs. Clinton suggested. But Kenneth E. Thorpe, a prominent health policy economist at Emory University who advised the Clintons in the 1990s, recently concluded that Mr. Sanderss health plan would actually cost $27 trillion, not $14 trillion, which would put total spending for all of Mr. Sanderss initiatives above $30 trillion through 2026.