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How much would a single-payer universal health care system cost in the United States? You don’t need to do anything very complicated to get a ballpark figure. Here’s the arithmetic:

Total spending on health care in the US is $3.2 trillion

Of that, $1.5 trillion is already funded by federal and state programs. That leaves additional required spending of $1.7 trillion.

A universal system will still require some copays and other out-of pocket expenses. Figure $200 billion or so. That leaves $1.5 trillion

So that’s it. A universal health care system in the US would require about $1.5 trillion in additional government spending. If you want to make heroic assumptions about how much a single-payer would save, go ahead. But nobody serious is going to buy it. If we’re lucky, a good single-payer system would slow the growth of health care costs over the long term, but it’s vanishingly unlikely to actually cut current costs.

There was a lot of surprise today about an estimate that a single-payer plan for California would have a net additional cost of about $200 billion. But California has 12 percent of the nation’s population, and 12 percent of $1.5 trillion is $180 billion. So that estimate is right in the ballpark of what you should expect. Short of some kind of legislative miracle, there’s really no way around this. Health care is expensive.