Under the existing health care system, Americans can expect to pay$11.7 trillion between out-of-pocket costs — the copays,deductibles and uncovered medical expenses — and premiums over thenext decade. (Photo: Shutterstock)

Promoting her much-discussed plan to create a single-payer "Medicare for All" health system, Sen. ElizabethWarren emphasized a striking figure.

"If we make no changes over the next 10 years, Americans willreach into their pockets and pay out about $11 trillion oninsurance premiums, copays, deductibles and uncovered medicalexpenses," the Democratic presidential candidate said in anInstagram video posted Monday.

The Democratic health care debate has been full of competinganalyses and estimates about what Medicare for All might cost, whatit might save and who would bear the brunt of paying for it. Butthis precise number was new to Kaiser Health News.

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If true, it would be a figure both staggering and significant tothe unfolding debate, as Americans try to understand how Warren'sbrand of a single-payer health system could affect theirpocketbooks. So we decided to dig in.

A reasonable estimate

We contacted the Warren campaign, which redirected us to areport from the Urban Institute, a Washington think tank, as wellas to federal estimates of household out-of-pocket expenses andpremium costs over the next decade.

The Urban report doesn't include the $11 trillion figure. Buteconomist Linda Blumberg, who authored the paper, told us the statistic is "perfectlyconsistent" with the analysis.

If anything, she said, the number is a lowball figure. WhenBlumberg and her team crunched the numbers, they found that, underthe existing health care system, Americans can expect to pay $11.7trillion between out-of-pocket costs — the copays, deductibles anduncovered medical expenses — and premiums over the next decade.That calculation comes from Urban's model for projecting whatindividual households might expect to spend, factoring ininflation, on these types of health costs.

"Talking about the amount of money we expect households to bespending over time is a very important part of trying to educatepeople on what single-payer would do, and what the tradeoffs arefor them," said Blumberg, who previously advised the Clinton WhiteHouse on health policy. On the numbers, "they're roughly in theright neighborhood," she added.

We consulted other analysts, too, and as far as we can tell, noone else has done a similar calculation.

Experts told us that Urban's estimate — and the Warrencampaign's use of it — checks out, based on what we know aboutAmerican health care spending.

Cynthia Cox, a vice president at the Kaiser Family Foundationand expert on the Affordable Care Act, pointed to what a typical American family currently spends on health care: about$5,000 per year, when you look at out-of-pocket costs and premiumscombined. Extrapolating from there, she said, Warren's claim seemsreasonable. (Kaiser Health News is an editorially independentprogram of the foundation.)

"Over the course of 10 years, when you add it up — that soundsabout right," Cox said. "The reality is, people do spend a lot onhealth care out of their pockets, and there's a lot spent on theirbehalf by employers or taxpayer-funded programs that they neversee."

Under Warren's health care plan, Americans would pay nothingdirectly out-of-pocket — no premiums, copays or deductibles — forhealth care. So that $11 trillion would disappear from the costside of the ledger.

The figure Warren sited also tracks with national healthexpenditure projections for out-of-pocket health costs and health premiumgrowth.

The bigger picture

Still, there are serious questions about the financing such ashift would require.

And Warren's Medicare for All plan has been under intensescrutiny since she unveiled it earlier this month, with manycritics suggesting it's too optimistic in its estimates of how muchmoney a single-payer system would cost.

Warren suggests the federal government would need to come upwith $20.5 trillion — well below Urban's estimate of $34 trillion.The difference comes largely from assumptions about how much thegovernment could save, as well as decisions about how much to paydoctors and hospitals.

Warren's financing structure includes cracking down on taxevasion, new taxes on financial institutions and the wealthiestAmericans, and maintaining what many employers currently pay intothe system. Critics say that could yield its owninefficiencies.

For instance, the way employer payments are structured coulddisproportionately harm small businesses, or lower-wage workers,noted Paul Ginsburg, who directs the USC-Brookings SchaefferInitiative for Health Policy. He also argued that doctors andhospitals —represented by powerful lobbying organizations inWashington — could successfully battle any effort to pay them less,driving up what the government needs to spend.

Still, those disputes are separate from the question of thisparticular statistic. Here, Warren's on firm ground.

Analysts also said the $11 trillion number gets at a largerpoint. Americans currently pay a lot out-of-pocket on health care.Certainly, some might see a tax hike under Warren's proposedreform, or see downward pressure on their salaries.

Still, others could experience major pocketbook relief.

To be sure, Medicare for All is not the only approach toameliorating what families pay for health care. Other, moreincremental proposals — such as building on the ACA's coverageexpansions or pursuing a "Medicare for all who want it" approachtouted by former Vice President Joe Biden and Pete Buttigieg, theSouth Bend, Ind., mayor — would cut into the $11 trillion as well,Cox said.

While it wouldn't eliminate that household cost burden, it wouldrequire less in taxes to finance.

"There's a lot of ways to bring down what people spend on healthcare," Cox said. "Any expansion of the role of public programs islikely to bring down individuals' costs. It's just a question ofhow much taxes have to go up to pay for that."

Our rating

In her explanation of how she would structure and financeMedicare for All, Warren highlighted what Americans currently payfor "insurance premiums, copays, deductibles and uncovered medicalexpenses."

The $11 trillion figure is staggering — and it checks out.Whether and how to address that issue is fiercely controversial,but on this particular stat, Warren's statement is accurate. Werate it True.

Kaiser HealthNews (KHN) is a national health policy news service. It is aneditorially independent program of the Henry J. Kaiser Family Foundation whichis not affiliated with Kaiser Permanente.

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