Universal healthcare in the United States would likely shift who pays rather than simply add new costs, with most credible estimates showing large new federal spending (tens of trillions over 10 years) but little or no increase in total national health spending, and possibly net savings.
Big-picture numbers
- Analyses of “Medicare for All”–style universal systems generally estimate new federal spending of about 24–36 trillion dollars over 10 years, depending on how generous the benefits are and how providers are paid.
- Those trillions largely replace what employers, households, and states already pay in premiums, out‑of‑pocket costs, and other health spending, so total national health spending may stay similar or even fall.
Net cost vs. savings
- A peer‑reviewed modeling study in a major medical journal estimated that a U.S. single‑payer universal system could reduce total national health expenditure by about 13%, roughly 450 billion dollars in annual savings on a 2017 spending base.
- Another analysis of a Medicare‑for‑All–type plan projected annual savings on the order of 400+ billion dollars, driven by lower administrative costs, negotiated prices, and more preventive care.
Federal budget impact
- Because government would take over most payments currently made by private insurers and employers, federal outlays would rise sharply, on the order of 2.4–2.8 trillion dollars per year under some single‑payer estimates.
- Proposals typically finance this with new taxes (for example payroll and income surtaxes), though external budget groups argue that some published tax packages would not fully cover the most generous versions and might leave annual federal deficits 1–2 trillion dollars higher without additional offsets.
Why estimates differ
- Costs depend heavily on design choices: how broad the benefits are (e.g., whether they include dental, vision, and long‑term care), whether there are any copays or deductibles, and how much provider payment rates are reduced relative to today’s private insurance rates.
- Assumptions about administrative savings, drug price negotiation, and changes in use of services can swing results from modest net savings to modest net increases in total spending, even when the headline federal price tag looks similar.
