The United States spends trillions of dollars on health care each year, more than any other country, yet millions of people still struggle to afford the care they need. It doesn’t have to be that way.
A recently released Yale study led by Abhishek Pandey now estimates that a national single-payer health care system could cut U.S. health care spending by about $1.04 trillion a year. These findings update those from a previous Yale study on the topic published in The Lancet in 2020.
The researchers also project that a single-payer system, combined with the reversal of recent health policy changes that have increased the number of uninsured and underinsured, could prevent 114,000 deaths per year.
What Did the Yale Study Look At?
The authors modeled a national public health insurance program similar to that proposed in the Medicare for All Act, one method of providing universal coverage in the U.S.
They used 2024 data on health care spending, insurance coverage, and deaths, during which U.S. health care spending was about $5.3 trillion.
The findings project that a single-payer system could lower total health care spending by about 20%. This figure includes the added cost of providing more care to people who are uninsured or who currently cannot afford the care they need.
Where Could the Savings Come From?
The researchers at Yale noted several areas where spending could fall. These included reduced spending on billing and administrative costs, less fraudulent billing, lower prescription drug prices, setting provider reimbursement at Medicare rates, and fewer emergency room visits and hospital stays that would be avoided as a result of earlier access to care.
Covering everyone would also increase spending in some areas. The researchers included about $304 billion in added costs for more health care use, covering the cost of necessary care for which hospitals and other providers currently receive no payment from patients, insurers, or other sources, and providing dental coverage for everyone.
Even with those added costs, the model was able to show about $1.04 trillion in yearly savings. Under more conservative assumptions, the model still projected at least $663 billion in savings each year.
Having Health Insurance Is Not Always Enough
As The Asclepius Initiative and others have shown, simply having health insurance does not always mean a person can afford to get the care they need.
The study estimates that more than 45 million working-age adults in the U.S. (23%) are underinsured. These are people who have health care coverage but still face out-of-pocket costs that make care unaffordable.
Deductibles, copays, coinsurance, and other out-of-pocket costs can cause people to delay or skip doctor visits, tests, treatments, or medications even when they have health insurance.
Universal Health Care Could Save Lives
The Yale study looked at how access to affordable health care could prevent loss of life.
The model estimates that adequate health care coverage for everyone could save about 62,863 deaths each year compared with the current system. Nearly half, or 30,000 of those deaths, would be among people who already have health insurance.
The researchers also looked beyond people who are currently uninsured or underinsured to consider health policy changes made in 2025 that are expected to further reduce coverage or access to care. They estimate that reversing those changes could prevent another 51,311 deaths each year.
Taken together, the authors estimate that universal coverage plus reversing the 2025 policy changes could prevent more than 114,000 deaths each year.
The Yale Study Has Important Limits
While well-reasoned, the findings of the Yale study are based on projections for the future, not absolutes or guarantees.
The work has not yet been peer-reviewed. Peer review allows other experts to examine a study’s methods, analysis, and conclusions before it is formally published in a scientific journal.
The researchers identify several limitations of their model. For example, there are no direct estimates of how much underinsurance increases the risk of death, so the researchers estimated that effect.
The projected savings estimate also does not include the cost of changing from the current system to a new one, possible job losses in insurance administration, or how hospitals and other health care providers might respond to changes in payment rates.
On the other hand, the study may underestimate some savings. These could result from less paperwork for health care providers, more use of preventive care and earlier treatment, and claims records that are easier to see and follow once people no longer move between different sources of coverage.
These points are important when interpreting the study’s conclusions. Additional research and peer review could lead to changes in the findings.
What Could This Mean for U.S. Health Care?
The United States already spends more on health care than any other country, while millions of people remain uninsured or underinsured. The Yale study challenges the assumption that covering everyone would require the United States to spend more on health care.
The calculations by Pandey and his colleagues suggest that changing how health care coverage is financed and distributed could allow everyone to have coverage while simultaneously lowering total health care spending.
The Asclepius Initiative supports adoption of a health care system in which everyone has affordable, high-quality, continuous coverage from birth until death. This study adds to growing evidence that the U.S. could spend less and improve health outcomes by providing universal coverage.
We must ask ourselves: If the United States could cover everyone, spend less, and prevent thousands of deaths, what is stopping us, and how can we overcome those obstacles?
Health care is a right, not a luxury.