THE STICKING POINTS

How many trillion???

Mr. Biden, deploying one of his favorite rhetorical weapons against Medicare for All, said Tuesday night that the plan would cost $30 trillion, or roughly 278 Jeff Bezoses, over the next 10 years. But Mr. Sanders has pointed out that that figure is much less than what the current system is projected to cost.

The truth is that no one knows for certain whether the country’s health care costs — which in total and per person far exceed those of any other industrialized country — would go up or down under Medicare for All. Ezekiel J. Emanuel and Victor R. Fuchs explain in The Times:

Medicare for All would move money from one column (private health insurance spending) to another (federal health spending); it does not automatically increase total costs. … We have our doubts about Medicare for All. But unaffordability is not a reason to oppose it.

“In some estimates, the country would not pay more for health care,” a Times analysis of five studies found. Rather, there would be “a drastic shift in who is doing the paying.” For that reason, it is more accurate to think of Mr. Sanders’s plan not as an outlay of (imaginary) money but as a redistribution of it away from insurers, drug companies, health care providers and higher-income people.

About those taxes …

Ms. Warren has drawn criticism for her continued unwillingness during debates to say whether Medicare for All would cause taxes to go up for middle-class families. Mr. Sanders admits they would, but Ms. Warren has refused the premise of the question, emphasizing the money most taxpayers would save overall after premiums (which come out of many people’s paychecks like taxes), deductibles, co-pays and coverage gaps are eliminated.

Middle-class people would “save a lot of money on health care,” the Kaiser Family Foundation’s Larry Levitt told NPR in July. Yet how exactly their net costs would change depends on the particulars of Medicare for All’s funding plans, which neither Mr. Sanders nor Ms. Warren has fully outlined. The Times wrote in a fact check:

Mr. Sanders has suggested various possible tax increases that could pay for this expansion, including a payroll tax that would affect workers across the economic spectrum. He has not provided enough details about the mix and magnitude of taxes for economists to measure what sorts of families would be better or worse off under Medicare for all.

Why not a public option?

Americans should be allowed to keep their private health insurance, Mr. Buttigieg has argued.

“The problem, Senator Sanders, with that damn bill that you wrote, and that Senator Warren backs is that it doesn’t trust the American people,” Mr. Buttigieg said during September’s debate. “I trust you to choose what makes the most sense for you, not my way or the highway.” He elaborated on his own health care plan, which he calls “Medicare for all who want it,” in an earlier debate:

You take something like Medicare, a flavor of that, you make it available on the exchanges, people can buy in. And then if people like us are right, that that will be not only a more inclusive plan, but a more efficient plan than any of the corporate answers out there, then it will be a very natural glide path to the single-payer environment.

Critics of public option proposals point out that the path may not actually be so glide-y. That’s because the price of health care services — not insurance or pharmaceutical profits — is the primary driver of America’s ballooning health care spending. Only a single-payer system can restrain those costs, Benjamin Studebaker and Nathan J. Robinson argue in the left-wing magazine Current Affairs, because it gives the government a monopoly on access to patients. “If instead there are a large number of insurance companies, providers can play those insurance companies off each other,” they write.