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Editor’s note: This story was updated Jan. 18 at 5:20 p.m. to add information.

NBC news anchor Lester Holt began the Democratic debate Sunday night with a question that was hardly small: How would Bernie Sanders define his presidency?

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“How would you think big?” Holt asked.

“Well, that’s what our campaign is about. It is thinking big,” Sanders responded. “It is understanding that in the wealthiest country in the history of the world, we should have health care for every man, woman and child as a right.”

Universal health care is certainly a “big idea,” one that has long been on Bernie’s wish list. It’s a priority he speaks about frequently and passionately in campaign stops from Marshalltown, Iowa, to Manchester, New Hampshire.

On Sunday, after much prodding by Clinton, Sanders’ spokesman Michael Briggs blasted out details of the “Medicare-for-all plan” to reporters, just two hours before the debate started.

Among the highlights: The plan would be administered federally and paid for through income tax hikes on all earners. Sanders said it would save middle-class families thousands of dollars a year by replacing private health care expenditures.

Most middle-class Americans would pay a 2.2 percent health care premium tax; companies would contribute 6.2 percent in a payroll tax.

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People earning between $250,000 and $500,000 a year would pay an income tax rate of 37 percent, an increase of several points from today’s rate. Those bringing in $10 million or more a year would have a top rate of 52 percent, a steeper increase.

While the plan would be expensive ($1.38 trillion a year), the Sanders campaign says an analysis by Gerald Friedman, an economist at University of Massachusetts at Amherst,

shows it would cover 98 percent of all medical expenses and eventually save the system money.

Exactly how much? That’s $6 trillion over the next 10 years, they say.

A family earning $50,000 a year would save nearly $6,000 annually in health care costs, according to the campaign.

“The average working family now pays $4,955 in premiums for private insurance and spends another $1,318 on deductibles for care that isn’t covered,” Briggs said in the news release. “Under Sanders’ plan, a family of four earning $50,000 would pay just $466 per year to the Medicare-for-all program.”

The proposal Sanders outlined Sunday is similar to the American Health Security Act, a Senate bill he has repeatedly introduced.

The Supporters

Friedman, a Sanders ally who did the analysis free of charge, is a prominent proponent of universal health care.

He has drafted single-payer systems for Maryland, Massachusetts and the United States. He wrote his Harvard dissertation on the history of labor movements in the United States and France.

“I think that Sanders is absolutely right when he says that there is nothing else we can do,” Friedman said Monday in an interview. “There is no alternative to single-payer at this point.”

Friedman said he did some tax estimates and program cost estimations, but that most of work was done by Sanders’ staff on the Senate budget committee.

“Anybody who has any dealings with the health care system knows how terrible it is,” Friedman said. “People know the system’s broken, and I think Sanders can build on that.”

In a Facebook post Sunday, Robert Reich, a Sanders supporter who is an economist and was labor secretary under President Bill Clinton, called the plan “a huge advance of what we have now.”

“Bernie’s plan isn’t nearly as radical as it will be portrayed. It builds on the strengths of Medicare,” Reich wrote. “Like Medicare, it’s universal — separating health insurance from employment, and enabling people to choose a health care provider without worrying about whether that provider is in-network.”

Friedman said the plan was solid but acknowledged it would be a “tough sell” to Americans.

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“Clinton is taking a serious position, which is, ‘Politically we can’t do it,’” Friedman said. “But we’ve gone as far as we can within the current health care system. It’s broken and can’t be fixed.”

The Critics

While Clinton supports universal health care as a long-term goal, she sees Sanders’ single-player plan as a pie-in-the-sky idea.

“We finally have a path to universal health care. We’ve accomplished so much already,” Clinton said during the debate. “I do not want to see the Republicans repeal it, and I don’t want to see us start over again with a contentious debate.”

But while she criticized the Sanders plan, one of the sharpest attacks on single-payer came when one of the moderators, Andrea Mitchell, pointed to Vermont’s complicated history with its attempts at universal coverage financed through taxes and not premiums.

“Vermont walked away from this kind of idea,” Mitchell said. “Of — of Medicare for all, single-payer, because they concluded it would require major tax increases.”

Sanders’ response: “Let me just say that you might want to ask the governor of the state of Vermont why he could not do it.”

When Gov. Peter Shumlin was asked why he couldn’t implement Green Mountain Care in December 2014, he pointed to unbearable costs:

“If we pushed for single-payer financing when the timing isn’t right it would likely hurt our economy, and it is not good for Vermont, and it would not be good for health care reform,” Shumlin said.

The Vermont plan would have created an 11.5 percent payroll tax on employers and an income tax with a sliding scale from 0 percent to 9.5 percent, depending on income and family size.

Ultimately, the Shumlin administration estimated costs to be $2.6 billion, not the $1.6 billion it was hoping for.

Friedman, who did a bit of work around single-payer in Vermont, said its failure was a result of bad politics, not bad economics.

“It wasn’t too expensive. The governor’s own report projected that there would be net savings under the plan, that less would be spent on health care,” Friedman said.

The UMass economist said education is key to success on single-payer.

He said the income tax hikes instituted to pay for universal care should be portrayed as a cheaper alternative to the health insurance premiums Americans now pay to private providers.

He said Shumlin did a “totally inadequate job” of explaining the single-payer proposal in Vermont.

“The tax that the Green Mountain plan would have involved was less than most people are paying now for out-of-pocket health insurance costs now,” Friedman said, underlining what he said is a key point that is rarely mentioned.

Another Vermont critic of single-payer is former Gov. Howard Dean, who told MSNBC’s Chris Hayes last week that Sanders’ plan could create “chaos,” as “trying to implement it would in fact undo people’s health care.”

Dean, who called single-payer “by far the most economically efficient system” in 2009, appears to have shifted his position on the matter.

He has endorsed Clinton for president and, according to The Intercept, now works at Dentons, a lobbying firm with corporate health care clients.

Skepticism of the Sanders health plan has also surfaced from Paul Krugman and Ezra Klein, two well-respected economic wonks.

While Friedman said the details released Sunday were a good start, he acknowledged that many questions remained unanswered.

He said more in-depth economic analysis of the plan would be released in the next few weeks and that if Sanders becomes the Democratic nominee, a full bill would likely materialize.

“There is a lot more to be hashed out if this thing is going to happen,” Friedman said. “It doesn’t have to be 2,000 pages, but it needs to be more than what is out now.”

The full plan can be viewed here. A more complex breakdown of the numbers is here.

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