A single-payer universal health care system could cover every American, save more than 100,000 lives a year, and still cost $1 trillion less than the system it would replace, according to a new preprint study led by researchers at the Yale School of Public Health
For the study, which has not yet been peer reviewed, the researchers modeled what would happen if the United States adopted a national public insurance program like the one proposed in the Medicare for All Act. Using 2024 spending, insurance coverage, and mortality data, they estimate that the universal coverage would reduce annual health expenditures by $1.04 trillion, or nearly 20% — even after accounting for the additional care that uninsured and underinsured people would receive
Healthcare costs have been rising faster than inflation, and a staggering share of that spending is consumed by administrative middlemen, soaring drug prices, and emergency care for conditions that should have been treated earlier and for less
“Healthcare costs have been rising faster than inflation, and a staggering share of that spending is consumed by administrative middlemen, soaring drug prices, and emergency care for conditions that should have been treated earlier and for less,” said senior author Alison Galvani, the Burnett and Stender Families Professor of Epidemiology at YSPH and the director of the Yale Center for Infectious Disease Modeling and Analysis. “Medicare for All strips out those sources of waste while providing everyone with healthcare, saving over a trillion dollars and 114,000 lives every year.”
The model identified five major sources of savings: lower pharmaceutical prices, Medicare-level payments to providers, reduced administrative overhead, less fraudulent billing, and fewer avoidable emergency department visits and hospitalizations. Even under more conservative assumptions about drug prices and fraud reduction, the researchers projected that the savings would reach at least $663 billion a year. Both figures account for an estimated $304 billion in additional spending to meet unmet medical needs, reimburse care that now goes unpaid, and provide universal dental coverage.
A universal healthcare policy would also save tens of thousands of lives, the researchers project. They estimate that adequate coverage for all could avert about 62,863 deaths annually — and that nearly half, or 29,631, would be among people who already hold insurance. These are the underinsured: the more than 45 million working-age adults whose deductibles and cost-sharing put care beyond financial reach anyway. Reversing coverage rollbacks and other health policies enacted since 2025 would avert a further 51,311 deaths each year, the researchers project, bringing the annual total to 114,174.
The study builds on findings Galvani, co-author Meagan Fitzpatrick, and other colleagues published in The Lancetin 2020, which projected that universal health care would save $450 billion and more than 68,000 lives annually. The larger estimates in the new study reflect ballooning health expenditures, a widening gap between commercial and Medicare payment rates, and new estimates on recent policy changes and the underinsured
The authors caution that direct estimates of excess mortality among underinsured adults are unavailable, requiring them to model that risk. Their spending analysis also does not account for transition costs, administrative job losses, or how providers might respond to Medicare payment rates
A system that covers everyone, costs $1 trillion less, and averts more than 100,000 deaths annually requires no new discovery to implement, only enactment
Even with those limitations, the researchers argue that the United States already spends enough to provide universal coverage. The problem, they conclude, is how that money is allocated
“A system that covers everyone, costs $1 trillion less, and averts more than 100,000 deaths annually requires no new discovery to implement, only enactment,” they wrote
The study’s other authors are Abhishek Pandey, senior research scientist in epidemiology (microbial diseases); Chad Wells, postdoctoral research associate; and Yang Ye, associate research scientist in epidemiology (microbial diseases), at YSPH
