Fact check: Almost true. This Bloomberg review of the costs for Medicare for All still serves as a good reminder, as Laura Davison does some basic arithmetic. “There isn’t $30 trillion sitting around from high earners,” one source remarks, “it just doesn’t exist”:

Thirty trillion dollars, even in U.S. budget terms, is a lot of money.

That’s the rough estimate from some analysts of the 10-year cost of Senator Bernie Sanders’ “Medicare for All” plan, just one of many expensive social programs that some of the 21 Democrats seeking to replace President Donald Trump have proposed.

To pay for those programs, the candidates have focused on taxing the rich. But many of the plans they’ve put on the table would require across-the-board tax increases that would hit middle-earners as well as the wealthy, public policy analysts say. None more than Medicare For All.

Raising the more than $30 trillion needed to fund Sanders’s health plan over a decade would require doubling all personal and corporate income taxes or tripling payroll taxes, which are split between employees and employers, said Marc Goldwein, a senior vice president at the non-partisan Committee for a Responsible Federal Budget.

Not everyone sees Davison’s argument adding up, however:

“Shifting private premiums” means taxation, by the way. What precisely “etc” covers in shifts to government isn’t all that clear, but suffice it to say that still won’t be enough. It would cost $10,000 for every man, woman, and child over ten years to meet that cost, and that assumes that costs won’t be significantly higher in a single-payer system than the initial estimates. Current insurance premium payments might cover a good chunk of that. Maybe.

Per-person costs are only one part of the problem, though. Management of a single-payer system is another. Advocates claim that M4A isn’t single payer because providers won’t work directly for the government, but once M4A becomes the only third-party payer allowed, government will effectively control providers through reimbursement policies. The very wealthy will still afford to pay cash for whatever they want, but the rest of everyone else will have to settle for whatever the government will allow. As the costs climb far above the estimates, there will be all sorts of political pressure to ration care to contain them.

Insurance companies do that too, to some extent. However, government regulation and competition keeps those impulses in check to some extent, as do lawsuits brought by consumers. When government usurps all those roles, there will be no check or balance left in the system except for the mercy of bureaucrats. If one wonders how effective that might be, just take a look at decades of bureaucratic corruption and scandals at the Veterans Administration, or basically the entire failure of the Indian Health Service. Those are two single-payer government systems that progressives might want to spend some time fixing before forcing everyone into Medicare.

America can’t afford Medicare for All, and that’s not just because of its price tag.