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Elizabeth Warren Has a Plan, Oh My

Editorial Board Wall Street Journal
Date Posted:
December 27, 2019
Is Database:
Database

Elizabeth Warren’s comprehensive policy proposals reveal the American left’s ambitious agenda, aiming to transform government, business, and society. Her wealth tax targets net worths over $50m at 2% annually, with a 6% rate above $1bn, potentially raising $3.75tn over a decade.

Elizabeth Warren’s comprehensive policy proposals reveal the American left’s ambitious agenda, aiming to...
Elizabeth Warren's comprehensive policy proposals reveal the American left's ambitious agenda, aiming to transform government, business, and society. Her wealth tax targets net worths over $50m at 2% annually, with a 6% rate above $1bn, potentially raising $3.75tn over a decade, though many economists doubt its feasibility. Her Medicare for All plan, estimated at $20.5tn, mandates government coverage for all, including illegal immigrants, and phases out private plans. The global corporate tax proposes a 35% minimum rate on overseas earnings, expected to generate $1.65tn. Warren's Green New Deal allocates $3tn to achieve carbon neutrality by 2030. Her education reforms include $610bn for free college and $640bn for student-debt forgiveness. These initiatives, alongside others like a 7% corporate surtax and increased Social Security benefits, illustrate a significant expansion of government influence, reflecting the left's vision for systemic change in the U.S. economy.

“…She’s the candidate with a plan for everything: That’s Elizabeth Warren’s brand. But even that sells her ambitions short, as we discovered after a tour of her 60-some policy papers. Ms. Warren is proposing a transformation of American government, business and life that exceeds what the socialist dreamers of a century ago imagined. Her standing in the polls has fallen after missteps over Medicare, but she is still in the top candidate tier. Her ideas deserve to be taken seriously because they show where the American left wants to go…”

Editorial Board, "Elizabeth Warren Has a Plan, Oh My," Wall Street Journal, December 27, 2019, https://www.wsj.com/articles/elizabeth-warren-has-a-plan-oh-my-11577404548

Elizabeth Warren Has a Plan, Oh My

She’s the candidate with a plan for everything: That’s Elizabeth Warren’s brand. But even that sells her ambitions short, as we discovered after a tour of her 60-some policy papers. Ms. Warren is proposing a transformation of American government, business and life that exceeds what the socialist dreamers of a century ago imagined.

Her standing in the polls has fallen after missteps over Medicare, but she is still in the top candidate tier. Her ideas deserve to be taken seriously because they show where the American left wants to go:

***

• Wealth tax: Tax net worth over $50 million at 2% a year, and 6% above $1 billion. To prevent the rich from yachting off, add a 40% “exit tax” on assets over $50 million upon renouncing U.S. citizenship. Estimated revenue: $3.75 trillion over a decade from 75,000 households. Most economists, including many Democrats, call that number a fantasy. Courts might also find the tax unconstitutional.

• Medicare for All tax: Charge companies with at least 50 workers an “Employer Medicare Contribution,” equal to 98% of their recent outlays on health care, while adjusting for inflation and changes in staff size. These varying fees “would be gradually shifted to converge at the average health care cost-per-employee nationally.” Estimated revenue: $8.8 trillion over a decade. If receipts fall short, add a “supplemental” tax on “big companies with extremely high executive compensation and stock buyback rates.”

• Global corporate tax: Raise the top business rate to 35%. Apply this as a world-wide minimum on overseas earnings by U.S. companies. Businesses would “pay the difference between the minimum tax and the rate in the countries where they book their profits.” Apply a similar minimum tax to foreign companies, prorated by the share of their sales made in the U.S. Estimated revenue: $1.65 trillion over a decade.

• Corporate surtax: Tax profit over $100 million at a new 7% rate, without exemptions. This would go atop the regular corporate rate. Estimated revenue: $1 trillion over a decade from 1,200 public companies.

• Slower expensing: “Our current tax system lets companies deduct the cost of certain investments they make in assets faster than those assets actually lose value.” Closing this “loophole,” she says, would raise $1.25 trillion over a decade.

• Higher capital gains taxes: Tax the investment gains of the wealthiest 1% as ordinary income, meaning rates near 40% instead of today’s 23.8%. Apply the tax annually on gains via a “mark to market” system, even if the asset hasn’t been sold. Estimated revenue: $2 trillion over a decade.

• Finance taxes: Tax the sale of bonds, stocks and so forth at 0.1%. Estimated revenue: $800 billion over a decade. Charge big banks a systemic risk fee, raising $100 billion more.

• Individual tax increases: There’s no detailed proposal, but Ms. Warren’s clean-energy plan is “paid for by reversing Trump’s tax cuts for the wealthiest individuals and giant corporations.” She’s budgeted $1 trillion.

• Social Security: Increase benefits by $2,400 a year across the board. Raise them further “for lower-income families, women, people with disabilities, public-sector workers, and people of color” by changing “outdated” rules that Ms. Warren says disadvantage them.

Pay for this by lifting the 12.4% Social Security payroll tax, which today covers wages below $132,900, to 14.8% on wages above $250,000. Establish a matching 14.8% surcharge on net investment income, paid by those earning more than $250,000.

• Lobbying tax: Tax “excessive lobbying” over $500,000 a year at rates up to 75%. Ms. Warren says this would have raised $10 billion over the past decade, although it probably runs headlong into the First Amendment’s right to petition the government. Use the revenue for “a surge of resources to Congress and federal agencies.”

***

• Medicare for All: Mandate government coverage for everyone, including for illegal immigrants, with no copays or deductibles. Phase out the private plans of 170 million Americans. She says this would cost $20.5 trillion over a decade, which most economists say is $10 trillion short of reality. Keep the growth of health spending below 4% a year with tools like “population-based budgets” and “automatic rate reductions.” Pay doctors at “Medicare rates” and hospitals at 110% of that.

This means cutting payments 25% or more relative to private insurance, per the Mercatus Center’s Charles Blahous. Trim rates further on “overpaid specialties.” To save 70% on branded prescriptions, “negotiate” with drug makers by threatening excise taxes and “public manufacturing” after “overriding the patent.”

• Green New Deal: Spend $3 trillion, including $1.5 trillion on industrial mobilization, $400 billion on research, and $100 billion on a Marshall Plan. By 2030 hit 100% carbon-neutral power and 100% zero-emission new cars. Retrofit “4% of houses and buildings every year.” For “environmental justice,” put a third of the funds into “the most vulnerable communities.”

• An end to fossil fuels: Ban fracking. Halt new drilling leases on federal land. “Prohibit future fossil fuel exports.” Kill the Keystone XL and Dakota Access pipelines. “Subject each new infrastructure project to a climate test.” Give “workers transitioning into new industries” a “guaranteed wage and benefit parity” and “promised pensions and early retirement benefits.”

• K-12 education: Add $450 billion to Title I, $200 billion for students with disabilities, $100 billion for “excellence grants,” and $50 billion for school upgrades. “End federal funding for the expansion of charter schools.”

• A “right” to child care: Build a federal network of local providers, subject to national standards. Give free care to the “millions of children” whose households are under 200% of poverty, or $51,500 for a family of four. For everyone else, cap child-care spending at 7% of income. Estimated cost: $700 billion.

• Free college: “Give every American the opportunity to attend a two-year or four-year public college without paying a dime in tuition or fees.” Add $100 billion to Pell Grants and $50 billion for historically black colleges, tribal schools and more. Estimated cost: $610 billion.

• Student-debt forgiveness: Write off $50,000 for households with incomes under $100,000. This would phase out as income rises toward $250,000. Estimated cost: $640 billion.

• Housing: Spend $500 billion “to build, preserve, and rehab” millions of affordable-housing units. Condition such funding “on repealing state laws that prohibit local rent control.” Paid for by lowering the death-tax exemption to $7 million from $22 million per couple. At the same time, “raise the tax rates above that threshold.”

***

• Unions: Overturn “so-called ‘right to work’ laws” in 27 states. Guarantee public employees an ability to “bargain collectively in every state.” Amend labor law to aid “sectoral bargaining.” Give the National Labor Relations Board “much stronger” powers, such as “to impose compensatory and punitive damages.”

• Corporate governance: Make companies with revenue over $1 billion obtain a new federal charter—separate from the current state charter system—that requires them to “consider the interests of all corporate stakeholders.” Give workers 40% of board seats, and put CEOs under “a new criminal negligence standard.”

• Industrial policy: Manage the dollar’s value “more actively” to “promote exports and domestic manufacturing.” Create a Department of Economic Development, and have it write a National Jobs Strategy. Expand the Export-Import Bank. Impose a “border carbon adjustment” fee—that is, new tariffs—on imports from countries that don’t align with U.S. climate policies.

• Antitrust: Break up Amazon, Facebook and Google. “Unwind” their mergers with Whole Foods, Instagram, DoubleClick and more. Regulate as a “platform utility” any online marketplace with global revenue of $25 billion. Reverse agriculture consolidation, “including the recent Bayer-Monsanto merger,” and create a “supply management program” to “guarantee farmers a price at their cost of production.”

• Banking: Pass “a 21st Century Glass-Steagall Act that breaks up the big banks.” Let the U.S. Postal Service “partner with local community banks” to provide “basic banking services like checking and savings accounts.”

***

• Gun control: Create a “federal licensing system for the purchase of any type of firearm or ammunition.” Raise taxes to 30% on guns and 50% on ammo. Ban sales of “assault weapons,” and make current owners “register them under the National Firearms Act.” Pass a law to let shooting victims “hold the manufacturer of the weapon that harmed them strictly liable.”

• Centralized elections: Use federal money to “replace every voting machine in the country.” For federal elections, mandate early voting and same-day registration. If state elections follow the same rules, they can be “fully funded by the federal government,” with “a bonus for achieving high voter turnout.” Estimated cost: $20 billion, paid by “closing loopholes” in the death tax.

• Miscellaneous: Spend $100 billion “to end the opioid crisis,” $85 billion “to massively expand broadband access,” $25 billion on “health professional shortage areas,” and $7 billion “to close the gap in startup capital for entrepreneurs of color.” Double the foreign service and the Peace Corps.

Give congressional staff “competitive salaries.” Recruit 10,000 people to “a 21st Century Civilian Conservation Corps.” End entry fees at national parks. Buy flood-prone houses “for low-income homeowners at a value that will allow them to relocate.” Plus much more.

***

All of this adds up to such an expansion of government that the temptation is to dismiss it as fanciful. But Ms. Warren is a shrewd and disciplined politician who isn’t supporting these ideas on an ideological whim. She believes they have enough political support to help her win the Democratic nomination and then the White House against a vulnerable Donald Trump.

Her only real policy difference with Bernie Sanders is that she has the courage to offer more details. As for getting it all enacted, she has a plan for that, too: Kill the legislative filibuster, so she can pass her agenda with a simple Senate majority.

The question for Democrats: Is this the agenda they want to put forward in 2020? Or will Ms. Warren’s radical plans scare voters into resorting to Mr. Trump again?

  • Government Spending
  • Fiscal Policy
    • Taxation
  • Politics
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Showing 193 database articles primarily about Government Spending

The Fairest Way to Reform Social Security May Also Be the Worst Way to Grow the Economy

AI Summary. Raising payroll taxes to fix Social Security's funding gap preserves earned benefits but reduces take-home pay without added compensation, shrinking labor supply and slowing economic growth.

Andrew Biggs American Enterprise Institute
Date Posted:
May 28, 2026
Is Database:
Database
Is Important:
Important

Biggs argues that “fair” approaches to restoring Social Security solvency – those that do not cut already accrued benefits – are less effective than “unfair” ones that do, because the latter incentivize increased work effort, raising growth and revenue.

Biggs argues that “fair” approaches to restoring Social Security solvency – those that do not cut already accrued...

Does preserving Social Security benefits require sacrificing economic growth?

Core argument: A 5.2 pts payroll tax increase to 17.6% drives reduced labor supply and slower economic growth vs. the status quo.

Imagine that Social Security reform follows the fairness model, in which accrued benefits are paid in full but the rate at which future benefits are earned is reduced. A simple way to do this is to increase the payroll tax rate To keep Social Security permanently solvent, meaning through 75 years and beyond, would require an immediate and permanent increase in the payroll tax rate [from] 12.4% to 17.6%. The higher rate would decrease labor supply and reduce economic growth. [Consider] an alternate reform, which looks clearly unfair: fix Social Security’s funding gap entirely by reducing accrued benefits that Americans already have earned. As of 2025, Americans had accrued $54 trillion in Social Security benefits. Social Security’s unfunded obligation as of 2025 was $26 trillion. So, roughly, this means cutting Americans’ “earned benefits” in half. [Analyzing the 1977 reform that undid the notorious 1972 “double-indexing” of benefits, a group of economists], using SSA earnings data, found that, for every dollar of lost benefits, the affected Americans increased their earnings by 61 cents. Moreover, these additional earnings would be taxed by Social Security, further strengthening the program’s finances. In effect, this makes cutting benefits a “cheaper” way to fix Social Security than raising taxes, because people respond in ways that also increase tax revenues.

Takeaways by Macro Roundup® AI

  1. A 5.2 pts payroll tax increase to 17.6% drives reduced labor supply and slower economic growth vs. the status quo.
  2. $54 trillion in accrued Social Security benefits vs. the unfunded obligation reveals that benefit cuts would reduce growth drag but.

Related Articles:

  • Social Security and Trends in Wealth Inequality — .@sc_cath @mjmill611 and @NatashaRSarin calculate that the market value of future Social Security benefits represented 49% of the wealth of the bottom 90% in…
  • How Federal Spending is Distributed by Age — Retirees receive 62 cents of every age-assignable federal dollar, driven primarily by Social Security and Medicare, which together account for 80% of all federal spending directed at adults over 65.
  • The Great “Transfer”-mation — Transfer payments made up 18% of all US personal income in 2022, up from 8% in 1970. Social Security/Medicare made up 56% of the increase from 1970 to 2022…
  • Government Spending
  • Fiscal Policy
    • Fiscal Deficits
    • Taxation

The World’s Most Surprising Capitalist Makeover Is Under Way in Sweden

AI Summary. Sweden has privatized nearly half of primary healthcare and one in three public high schools, shrinking public social spending to 24% of GDP — comparable to the U.S. and well below France and Italy — while projecting ~2% annual growth through 2030, double the rate of France and Germany.

Tom Fairless Wall Street Journal
Date Posted:
May 12, 2026
Is Database:
Database

Swedish public social spending is now 23.7% of GDP, just 1pp above that of the US and well under France’s 31.6%. Market-based reforms in the 1990s brought overall government spending down from 69.4% to 49.3% in 2024.

How is Sweden's shift to privatization impacting its economic growth?

Core argument: Sweden’s public social spending fell to 24% of GDP, matching the U.S. and 6+ pts below France/Italy, driving lower taxes.

For decades, Sweden was shorthand for the brand of high-tax, high-spend government that managed people’s lives from cradle to grave through state-run hospitals, schools and care homes. No longer. With little fanfare, this Nordic country of 11 million has embraced capitalism. Today, nearly half of primary healthcare clinics are privately owned, many by private-equity firms. One in three public high schools is privately run, up from 20% in 2011. School operators are listed on the stock exchange. The capitalist makeover has allowed Sweden to do what few industrialized countries have managed in recent years: shrink the size of the state. That has enabled the government to sharply lower taxes and, economists say, sparked a surge in entrepreneurship and economic growth. Its total public social spending bill—which includes healthcare, education and all welfare payments—has fallen to 24% of gross domestic product, similar to the U.S. and well below the over 30% for nations like France and Italy. Sweden’s economy is expected to grow by around 2% a year through 2030, roughly the same pace as the U.S. and double the growth rates of France and Germany, according to an April forecast by the International Monetary Fund.

Takeaways by Macro Roundup® AI

  1. Sweden’s public social spending fell to 24% of GDP, matching the U.S. and 6+ pts below France/Italy, driving lower taxes.
  2. Privately-run primary healthcare clinics reached nearly 50% of the market vs. 20% for high schools in 2011, demonstrating accelerating privatization.
  3. Sweden’s projected 2% annual GDP growth through 2030 doubles France and Germany’s rates, resulting from state downsizing and capitalist sector.

Related Articles:

  • How Sweden Overcame Socialism — Sweden’s market reforms: Govt spend cut 70% to <50% GDP, debt 80% to 41%, corp tax -6pts to 22%. Results: Growth +1pt vs EU since 1995, GDP/capita now at…
  • Reforming the Welfare State: Recovery and Beyond in Sweden — Sweden’s structural reforms, initiated in response to the 1990s crisis, included adopting flexible exchange rates & inflation targeting, leading to…
  • The US Has One of the Highest Fertility Rates Among Peer Countries — As of 2022, the US had a “tempo fertility rate,” which is adjusted for life-cycle effects, of 1.82 – among the highest of advanced economies, and ~ on…
  • Government Spending
  • Fiscal Policy
    • Fiscal Deficits
  • Politics

How Policy and Demographics Are Reshaping SNAP: From Families with Children to Older Adults

AI Summary. SNAP enrollment has doubled from 6% to 12% of the U.S. population since 2000, with real costs per capita rising 179% to $279 annually, driven by policy expansions and benefit increases that prevent costs from fully retreating after economic downturns.

Angela Rachidi American Enterprise Institute
Date Posted:
May 1, 2026
Is Database:
Database

About 40mm Americans, 12% of the population, receive SNAP benefits, up from 6% in 2000. In 2023, only 34% of these households included children, down from 49% in 2010, while 36% contained an elderly person, up from 16% in FY2010.

How Are Policy Changes and Demographic Shifts Impacting SNAP Enrollment?

Core argument: SNAP participation doubled from 6% to 12% of the population between FY2000–FY2025, driven by policy expansions and demographic shifts outpacing.

Comparing FY2000 with FY2025, the share of the population receiving SNAP doubled from 6% to 12%, while real SNAP costs per capita increased by 179%—from roughly $100 per year to $279 (in 2024 dollars). Despite this growth, per capita participation and costs in FY2025 remained below their pre-pandemic peak in 2013, which coincided with the aftermath of the Great Recession and changes in eligibility and other policies stemming from the 2008 Farm Bill. SNAP is countercyclical, meaning that all else equal, the number of people receiving SNAP should rise during recessions because of increased unemployment and decline as the economy recovers, [though] overall SNAP participation has grown faster than changes in the unemployment rate alone would predict. Over the long run, and especially since FY2020 (due to the Thrifty Food Plan’s increase in the maximum SNAP benefit), costs per capita have not returned to prerecession levels after a period of high unemployment. In FY2023, the share of SNAP households containing an elderly person (36%) exceeded the share containing a child (34%) for the first time. This was a sharp departure from the early 2000s, when more than half of SNAP households contained a child and less than 20% included an elderly person (Figure 2).

Takeaways by Macro Roundup® AI

  1. SNAP participation doubled from 6% to 12% of the population between FY2000–FY2025, driven by policy expansions and demographic shifts outpacing.
  2. Real per capita SNAP costs rose 179% from $100 to $279 (2024 dollars) over 25 years, with the Thrifty Food.
  3. FY2025 SNAP enrollment remains 8–12% below the FY2013 peak despite 25-year growth, indicating countercyclical policy design successfully targets recession-driven need.

Related Articles:

  • The Great “Transfer”-mation — Transfer payments made up 18% of all US personal income in 2022, up from 8% in 1970. Social Security/Medicare made up 56% of the increase from 1970 to 2022…
  • Poverty and Dependency in the United States, 1939–2023 — Btw 1939 and 1963, the % of Americans below LBJ’s absolute poverty line (3× the cost of a minimal meal plan), fell from 48.5 to 19.5, driven by rising market…
  • Government Benefit Programs Already Do A Lot To Help Low Income Families — A 2-adult, 3-child US family with $20,000 of market income receives at least $61,000 in annual benefits and has $79,000 of disposable income. That same family…
  • Government Spending
  • Fiscal Policy
  • Workforce
    • Poverty/Crime

Washington’s Growing Portfolio: Tracking U.S. Government Investments

AI Summary. The U.S. government has deployed $20.9bn across 16 direct equity deals, expanding beyond grants, loans, and tax incentives into direct ownership stakes. This approach has mobilized an additional $4.75bn in private co-investment alongside the government's positions.

Jonathan Hillman Council On Foreign Relations
Date Posted:
April 23, 2026
Is Database:
Database

Since January 2025, the USG has taken equity stakes totaling $20.9B in 16 American businesses. $8.6B, ~41% of the total, was invested in critical mineral miners and processors, while $8.9B, ~43% of the total, funded the government’s 10% stake in Intel.

Core argument: The U.S. government deployed $20.9bn in direct equity investments since January 2025, expanding beyond traditional grants and loans to drive.

Since January 2025, the U.S. government has invested $20.9 billion across sixteen deals involving direct ownership, broadening a toolkit that has traditionally focused on grants, loans, and tax incentives. The Department of Commerce has participated in six such deals, including taking a 10% stake in Intel. The Development Finance Corporation, the United States’ development bank, has executed three equity transactions in critical minerals, healthcare, and infrastructure. The Department of Defense leads the way with seven such deals. The U.S. government is also working with a range of partners and has mobilized an additional $4.75 billion in investment. Private co-investors include J.P. Morgan, Goldman Sachs, and others.

Takeaways by Macro Roundup® AI

  1. The U.S. government deployed $20.9bn in direct equity investments since January 2025, expanding beyond traditional grants and loans to drive.
  2. The Department of Defense leads with seven equity deals of the sixteen total, establishing direct ownership as a core national.
  3. Commerce Department’s 10% Intel stake exemplifies government equity participation in critical infrastructure, mobilizing private capital alongside public investment to strengthen.

Related Articles:

  • Industrial Policy and Economic Security — Chris Miller asks, “How much inefficiency should we swallow in exchange for the security of self-sufficiency?” He argues it’s “a tricky…
  • The Cold War and the U.S. Labor Market — Defense spending played a major role in sustaining tight labor markets for low-skill workers following the Second World War. Drops in procurement spending…
  • Capital Is Making a Comeback — Btw 1985-2021 the capital intensity of the American economy was relatively flat as a rise in intangible investment was offset by a decline in tangible…
  • Government Spending
  • Fiscal Policy
  • Politics
  • Productivity
    • Investment
  • Security

How Federal Spending is Distributed by Age

AI Summary. Retirees receive 62 cents of every age-assignable federal dollar, driven primarily by Social Security and Medicare, which together account for 80% of all federal spending directed at adults over 65.

Kent Smetters University of Pennsylvania
Date Posted:
April 2, 2026
Is Database:
Database
Is Important:
Important

In 2025, of the 62.5% of Federal spending that is age-assignable on a per-capita basis, US retirees aged 65+ were given $43,700, working-age adults 26–64 got $7,300, and children and young adults got $4,300.

Core argument: Federal spending heavily favors retirees, who receive 38.6 percent of total outlays through Social Security, Medicare, and related programs.

We trace spending items within 52 general spending categories, totalling $7T for the 2025 Fiscal Year. We are able to classify a total of $4.4T across three broad age categories and assign the remaining $2.6T to an all-ages residual. Retirees (adults age 65 and older) receive $2.7T, equal to 38.6% of total federal outlays and 61.9% of age-assignable spending. Working-age adults (ages 26-64) receive $1.2T (27.9% of age-assignable), and children and young adults (under age 26) receive $449B (10.3%). The dominance of the retiree category reflects two programs above all others: Social Security and Medicare. Social Security directs $1.3T to retirees, and Medicare sends $835B. Together, they account for 80% of all age-assignable spending on older adults. But the retiree total extends beyond these two entitlements. Federal employee retirement benefits ($169B), housing assistance for older households, Medicaid long-term-care spending, and VA medical care all contribute, making the federal budget more retiree-focused than a Social Security–only lens would suggest.

Takeaways by Macro Roundup® AI

  1. Federal spending heavily favors retirees, who receive 38.6 percent of total outlays through Social Security, Medicare, and related programs.
  2. Working-age adults and children combined receive less than half the spending directed to retirees despite representing larger population segments.
  3. Social Security and Medicare alone account for 80 percent of all federal spending on older Americans, dominating the retiree budget.

Related Articles:

  • The Great “Transfer”-mation — Transfer payments made up 18% of all US personal income in 2022, up from 8% in 1970. Social Security/Medicare made up 56% of the increase from 1970 to 2022…
  • France and Britain Are In Thrall To Pensioners — Since 1970, cumulative real income growth for pensioners in France and the UK has outpaced that of the workers who support them. French pensioners over the age…
  • The Budgetary Impact of the Abandonment of Federalism — John Cogan finds federal budget deficits are driven by items “originally considered to be the responsibility of state and local governments or private-sector…
  • Government Spending
  • Fiscal Policy
    • Fiscal Deficits
  • Healthcare/Seniors
  • Workforce
    • Poverty/Crime

Has the United States Bent the Health Care Cost Curve?

David Cutler and Lev Klarnet Brookings Papers On Economic Activity
Date Posted:
March 30, 2026
Is Database:
Database
Is Important:
Important

In 2024, medical spending as a share of GDP was just above its 2010 level and 15% ($977B) below its 2010 forecast; 21% of the gap was due to technology, 24% to price reductions, and 11–27% to reforms such as prior authorization and higher deductibles.

Five factors are important in the slowdown in spending [Figure 16]. The first is technology-associated changes in health and site of care. These correspond to the subsequent innovations in our model. Together, technologies along these lines account for 21% of the overall cost slowdown and double that in Medicare. Second, long-run supply is more elastic than short-run supply, which lowers spending over time. This is particularly apparent in the impact of patent expiration for pharmaceuticals and in relative declines in imaging reimbursement. We estimate that greater long-run supply explains 6% of the spending slowdown. Third, a variety of market changes contribute to reduced and more elastic demand, including increased cost sharing paid by consumers, physicians not paid as much for using technologies, and insurers imposing restrictions on technology use - a rough guess is that these account for 11 to 27% of the spending slowdown. Fourth, the population is healthier in ways that reduce spending. This includes fewer hospitalizations for smoking-related conditions and reduced need for formal home health care. The birth rate has fallen as well, which reduces the need for care. We estimate improved population health explains 7% of the spending slowdown. A major component is slower price growth. Net of upcoding, we estimate lower price growth explains 24% of the spending slowdown.

Related Articles:

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  • The Great “Transfer”-mation — Transfer payments made up 18% of all US personal income in 2022, up from 8% in 1970. Social Security/Medicare made up 56% of the increase from 1970 to 2022…
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    • Fiscal Deficits
  • Healthcare/Seniors
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