Waldman dismisses any rational hesitation one may have for M4A with the same ideological bias that he accuses Bloomberg and conservatives having when they call it “unaffordable.” Entitlements can still bankrupt the country, even if the total cost for those entitlements are significantly lower than total costs paid to private, for-profit institutions. You can be a good, Rawlsian, “justice as fairness” liberal and still give pause on this issue.
Let’s grant the nontrivial assumption that total healthcare costs paid out via taxes in something like a single payer system would be significantly lower than total costs currently paid to privatized insurance companies. The $33T figure that Waldman cites over 10 years is not unreasonable. The problem is not just the cost, sadly, it is the source of the funds: our broken government and a sovereign debt crisis.
The national debt on publicly owned Treasury securities is right around $16T, with another $6T intragovernmental for a total of $21T comprising our US debt. A single payer system would require massive tax increases to cover the $33T, and the neo-conservatives/Tea-Party ideologies in congress, elected by their equally short-sided constituents, would never vote for the kind of tax increases required to cover that kind of cost (potentially doubling our TOTAL debt currently). Significant increases in Treasury securities and debt obligations are inevitable. As it is, our debt to GDP (currently > 107%) is consistently in the top 50 for all countries worldwide, and rising, sitting close to Spain, Italy, Greece, and Portugal. That’s not a defining metric for catastrophe by any sense, but it’s an indicator that international markets watch closely, and for good reason. Your debt to income ratio is a primary consideration for any bank when you apply for a mortgage. So too with international capital markets: if international investors fear that, for example, political idiocy coupled with rapid increases in US debt obligations pose serious issues to US credit-worthiness, they will sell off our Treasuries. THAT’S what Bloomberg worries would bankrupt our country. At a debt to GDP of 125% or so, on par with Greece/Italy/Portugal, US debt may lose it’s status as a “risk-free” investment, as international markets fear US insolvency and abandon fiduciary obligations. Further sell offs may result in US currency losing status as the international default currency, causing MAJOR crises like hyper-inflation. Iceland was not far past 100% when they went insolvent in 2008/9.
The point is just to emphasize that it’s not the cost alone that can bankrupt this country. It’s that we would need a functioning government to tax/fund it properly, without leading to a sovereign debt crisis and a politically generated economic disaster.