Congress is back, the new majority has its marching orders, and Rep. Ro Khanna has posted the agenda in four lines: end the war in Iran, a $25 living wage, Medicare for All, and zero aid to Israel. “We need to be bold. We need to deliver.”

Fine. Let us price bold.

This post covers the two domestic items, because they are the ones with invoices attached. Every number below comes from a named source, most of them the government’s own scorekeepers. If you want to argue, argue with them.

Medicare for All: the federal bill

The current bill is S. 1506 in the Senate and H.R. 3069 in the House, reintroduced April 29, 2025. The House version carries 114 cosponsors, roughly 54 percent of House Democrats. The bill text sets no tax rates. It never has. So the cost has to come from the people who score these things, and they have, repeatedly:

• The Mercatus Center (Charles Blahous, 2018) estimated the Sanders plan would add $32.6 trillion in federal budget commitments over its first 10 years, 2022 to 2031, and called that figure a conservative lower bound. His sensitivity range runs to $38.8 trillion if the plan’s assumed drug savings and provider payment cuts to Medicare rates do not materialize. Blahous also wrote the sentence that should end every slogan version of this debate: “Doubling all currently projected federal individual and corporate income tax collections would be insufficient to finance the added federal costs.”
• The Urban Institute (2019) put its enhanced single-payer design, the one with no cost sharing and long-term care included, at $34.0 trillion in added federal spending over 2020 to 2029, and found total national health spending would rise about $7 trillion over the decade, not fall. Its stripped-down “lite” variant still cost $17.6 trillion federal.
• The Committee for a Responsible Federal Budget surveyed the field and landed on $25 trillion to $35 trillion over 10 years depending on design, with most estimates clustering between $30 trillion and $40 trillion.
• CBO has never scored the actual bill, because no Congress has ever asked it to. What CBO did do, in 2022, was model five single-payer designs of its own. For the single year 2030, federal health subsidies ran $1.5 trillion to $3.0 trillion higher than current law, total national spending moved between minus $0.7 trillion and plus $0.3 trillion, and under all five options CBO warned that “the increase in demand for personal health care would exceed the increase in supply, resulting in greater unmet demand than under current law.” Read that again. The government’s own analysts are telling you the queues are a feature of the arithmetic, not a talking point. CBO also estimated GDP would run roughly 1 to 10 percent lower by 2030 depending on the design and the tax used to pay for it.
• The freshest full score is the American Action Forum’s Center for Health and Economy (August 2026): the current Act, on a 2027 to 2036 window, carries a net budgetary cost of $47.4 trillion over 10 years absent new revenue.

Now scale it. The federal government collected $5.40 trillion in all of FY2026 and spent $7.40 trillion, running a deficit of about $2.0 trillion (CBO, Monthly Budget Review). Mercatus’s number works out to roughly $3.3 trillion a year, every year, on top of everything Washington already does. That is about 62 percent of every dollar the Treasury took in last year, added. National health spending in 2024 was $5.3 trillion, 18.0 percent of GDP (CMS). Medicare for All does not mostly find new money for new care. It moves the existing $5.3 trillion onto the federal ledger and then adds the uninsured, the benefit expansions, and the demand surge CBO describes.

The pay-for gap

Senator Sanders has a financing menu, published separately from the bill, and it deserves to be read the way an auditor reads it. The ten itemized options, at his office’s own estimates, sum to about $16.2 trillion over 10 years: a 7.5 percent employer payroll tax ($3.9 trillion), a 4 percent household premium ($3.5 trillion), eliminating health tax breaks ($4.2 trillion), higher income tax brackets topping out at 52 percent ($1.8 trillion), a wealth tax ($1.3 trillion), and the rest in smaller pieces.

Sixteen against thirty-three is not a plan. It is half a plan. Even crediting every dollar of the menu, the AAF re-score credits the Sanders pay-for framework with $17.2 trillion against a $36.1 trillion cost on its window, a $19.0 trillion shortfall.

CRFB did the exercise nobody on the podium wants to do and priced what actually closing the gap takes, picking any ONE of these for a $30 trillion bill: a 32 percent payroll tax on all wages, split between employer and employee; a 25 percent income surtax that takes the top rate to 62 percent; a 42 percent VAT; public premiums averaging $7,500 per person, about $20,000 per household; or doubling every income tax rate, which still comes up short at $22 to $27 trillion. CRFB also found that taxes on high earners, corporations, and the financial sector combined cover only about 35 percent of the cost. The money is in the middle class because that is where the money is. It always was.

For fairness, one counter-estimate exists and you will hear it quoted: a July 2026 Yale School of Public Health preprint claims the Act would cut national health spending by $1.04 trillion a year. It is a preprint, not peer-reviewed, and it measures total national spending, not the federal budget cost. Both things can be argued, but you cannot pay a $32 trillion federal invoice with a national-spending projection.

The $25 wage: a number nobody has scored

The $25 demand is not a stray tweet. It is a bill: the Living Wage for All Act, H.R. 8555 in the House (Rep. Delia Ramirez, introduced April 28, 2026, Khanna among the original cosponsors) and S. 4981 in the Senate (Sen. Chris Murphy). It phases the federal floor from $7.25 to $25, ends every subminimum wage including the $2.13 tipped rate, and then indexes the floor to two-thirds of the national median wage forever.

Here is the problem, and it is a receipt problem. CBO has never estimated a $25 minimum wage. Its interactive model of minimum wage effects offers target options from $12 to $17. The proposal is literally off the government’s chart. What CBO has scored, twice, is smaller versions of the same idea:

• $15 by 2025 (scored February 2021): 17 million workers get raises, 10 million more likely see spillover raises, 900,000 people lifted out of poverty, and 1.4 million fewer jobs at CBO’s median estimate. Deficit up $54 billion over 10 years.
• $17 by 2029 (scored December 2023): 8.9 million workers directly affected, cumulative pay up $151 billion net, and 0.7 million more workers jobless. Deficit up $46 billion over 10 years, more than half of it from higher Medicare and Medicaid costs, because Washington is one of the employers paying the higher wage.

Now consider where $25 sits. The federal minimum has been $7.25 since July 24, 2009, the longest freeze since 1938, and only 843,000 workers, 1.0 percent of hourly workers, earn at or below it (BLS, 2024). The $25 proposal is not aimed at them. The Economic Policy Institute counts 14 million workers under $15 an hour and 42 million under $20. Nobody at BLS or EPI publishes a verified count under $25, and the roughly 67 million figure in the social media graphics traces to no primary source. I will not use it, and neither should anyone arguing the other side.

What we can verify is the shape of the wage distribution. A full-time $25 wage is $52,000 a year, and the median American worker earns $24.51 an hour, a median annual wage of $50,980 (BLS OEWS, May 2025). Sit with that for a second. The proposed floor for the least experienced worker in the country is higher than what the worker in the exact middle of the American labor market currently makes. Roughly half the workforce earns less than the proposed legal minimum. EPI’s own benchmark work (May 2026) puts two-thirds of the national median wage at about $17.70 today, reaching $25 only in 2038 on its projections. In other words, the bill’s permanent index, two-thirds of the median, is the standard economists use for the most aggressive wage floor a labor market can carry. The bill grabs the 2038 value now and locks the formula in behind it.

And a national floor does not land nationally. It lands locally. The median food preparation and serving worker earns $16.85 an hour (BLS, May 2025). The median healthcare support worker earns $18.43, and the median sales worker $18.52. Mississippi’s all-occupation median annual wage is about $40,120, roughly $19.29 an hour. A $25 floor in Mississippi is not a raise for the bottom of the distribution. It is a floor set above the state’s median wage, meaning more than half the jobs in the state are priced below the legal minimum on day one. Economists call the ratio of the floor to the median the Kaitz index, and no advanced economy on earth runs one at 1.3.

The precedents offered for $25 prove the narrowness of the thing. The highest general city minimum in America is Tukwila, Washington at $21.65. DC sits at $18.40 and Washington state at $17.13. The actual $25 floors in force are sector carve-outs: California hospital workers at large systems reached $25 on July 1, 2026 under SB 525, and Los Angeles hotel and airport workers phase to $25 in 2027. No study of the California law’s employment effects exists yet, which means the largest test of the idea is running right now with nobody measuring it. New York’s app delivery experiment is the cautionary version: the pay rate hit $22.13 in April 2026, the city credits the law with over $2 billion in added earnings, and analyses of the city’s own data show the tracked delivery workforce shrank roughly 29 to 32 percent while deliveries grew 31 percent. The workers who kept the work earn much more. There are just fewer of them, which is exactly the trade CBO keeps describing and exactly the trade the slogan version denies exists.

The total

Add the two demands the way a budget office would. Medicare for All: $25 to $35 trillion in new federal commitments over 10 years on the mainstream estimates, $47.4 trillion on the newest one, against a financing menu worth about $16 trillion. The $25 wage: no official score exists, its smaller siblings cost jobs in the high hundreds of thousands to 1.4 million range at $15 to $17, and its federal deficit effect at $17 was $46 billion before anyone models a floor above the median wage of a low-wage state.

Khanna is right about one thing. It is bold. The invoice is roughly $3 trillion a year in new federal spending, a payroll tax in the 30 percent range or its equivalent to pay it, and a wage floor set above what half the workers in the poorest state in the union currently earn. Deliver that, and let us see who is still applauding at the end of the first term.

Sources

• Charles Blahous, “The Costs of a National Single-Payer Healthcare System,” Mercatus Center, 2018; Blahous testimony, Senate Budget Committee, May 12, 2022
• Urban Institute, “From Incremental to Comprehensive Health Reform,” October 2019
• Committee for a Responsible Federal Budget, “Choices for Financing Medicare for All,” 2020
• CBO, “Exploring the Effects of Expanded Health Care Coverage” and related single-payer analyses, 2020 to 2022; testimony, May 12, 2022
• American Action Forum, Center for Health and Economy, “Medicare for All: An Updated Coverage and Budget Analysis,” August 2026
• Sen. Bernie Sanders, “Options to Finance Medicare for All,” options paper
• CBO, Monthly Budget Review: Summary for Fiscal Year 2026, November 2026
• CMS, National Health Expenditure Accounts, 2024
• Yale School of Public Health preprint on Medicare for All national spending, July 2026 (not peer-reviewed)
• Living Wage for All Act, H.R. 8555 (Ramirez) and S. 4981 (Murphy), 119th Congress
• CBO, “The Budgetary Effects of the Raise the Wage Act of 2021,” February 2021
• CBO, “The Budgetary and Economic Effects of S. 2488, the Raise the Wage Act of 2023,” December 2023
• Bureau of Labor Statistics, “Characteristics of Minimum Wage Workers, 2024,” Report 1115
• Bureau of Labor Statistics, Occupational Employment and Wage Statistics, May 2025 national estimates
• Bureau of Labor Statistics, Usual Weekly Earnings, Q2 2026
• Economic Policy Institute, “Setting High Standards for a Federal Minimum Wage,” May 2026; EPI Minimum Wage FAQ
• California Department of Industrial Relations, Health Care Worker Minimum Wage FAQ (SB 525)
• New York City Department of Consumer and Worker Protection, delivery worker pay reports, 2026