01 · The bill
The most expensive health system in the world.
Health spending per person, 2024 (US$, PPP adjusted)
Source: Peterson-KFF Health System Tracker analysis of OECD and CMS dataHover a mark for details
$5.3 trillion
That is what the United States spent on health care in 2024: $15,474 for every person in the country and 18% of the entire economy.
CMS National Health Expenditure data, 2024
2× the peers
Eleven comparable wealthy nations spent an average of $7,860 per person. The U.S. spent $14,775 on the same basis, almost $5,000 more than Switzerland, the next highest.
Peterson-KFF, health consumption spending per capita, 2024
More money, shorter lives
Plot spending against life expectancy and the pattern breaks. Every peer country gets longer lives for less. The U.S. sits alone, far right and at the bottom.
Life expectancy at birth, 2024 · Peterson-KFF
−3.7 years
Americans can expect to live 79.0 years, against 82.7 in peer nations. In the Commonwealth Fund's 2024 comparison of 10 high-income countries, the U.S. health system ranked last overall, and last for health outcomes.
Commonwealth Fund, Mirror, Mirror 2024
02 · The uncovered
Tens of millions with no card at all.
100 million people · each dot is 100,000
26.7 million
People in the U.S. went the entire year without health insurance in 2025. That is more than everyone living in Florida.
U.S. Census Bureau, Health Insurance Coverage in the United States: 2025 (7.9% of the population)
85 million
Having a card does not mean you can afford to use it. Counting people whose deductibles and out-of-pocket costs are high relative to income, the sponsors of the Medicare for All Act put the total at 85 million uninsured or underinsured.
Medicare for All Act of 2025 introduction, citing Commonwealth Fund survey data
+14.2 million
The number is set to grow. The Congressional Budget Office projects the 2025 budget law will leave 10 million more people uninsured by 2034. Letting enhanced ACA subsidies expire adds an estimated 4.2 million more.
CBO, August 2025, via Center for American Progress
03 · The toll
Going without coverage costs lives.
Harvard Medical School researchers followed thousands of working-age adults and found that those without insurance had a 40% higher risk of death than those with private coverage, after accounting for income, smoking, health and other factors.
Wilper et al., American Journal of Public Health, 2009 · Harvard Gazette summary
Insurance on paper is not enough either. In a 2024 national survey, 57% of underinsured adults said they avoided needed care because of the cost. Two in five people who delayed care said a health problem got worse as a result.
Commonwealth Fund 2024 Biennial Health Insurance Survey
Each figure is 1,000 lives a year
04 · The debt
The bill follows you home.
In the U.S., getting sick is a financial event. Even people with good coverage pay more every year just to keep it.
Average annual premium, employer family coverage
KFF Employer Health Benefits Surveys, 2015–2026. Years 2016–2019 omitted (dashed).
Workers pay $7,471 of that directly out of their paychecks, up 9% in a single year. At small firms the worker share averages $9,687. And that is before a single deductible, copay or surprise bill.
KFF 2026 Employer Health Benefits Survey
05 · The paperwork
A third of the bill is bureaucracy.
Hundreds of insurers, thousands of plans, and a billing department in every clinic to fight them. In 2017, U.S. insurers and providers spent $812 billion on administration, 34.2% of all health spending.
Administrative cost per person, 2017
Himmelstein et al., Annals of Internal Medicine, 2020. Canada runs a single-payer system: 17.0% of its spending goes to administration.
Claim · in-network
- Plan
- HealthCare.gov marketplace
- Provider
- In network ✓
- Service
- Prescribed by your doctor
- Reason
- “Other”
Insurers listed “other” as the reason for 36% of denials and administrative reasons for 25%. Only 5% were denied for lack of medical necessity.
KFF, Claims Denials and Appeals in ACA Marketplace Plans in 2024
06 · The profit
Someone profits from the friction.
The seven biggest U.S. health insurance companies took in almost $1.7 trillion in revenue in 2025, $175 billion more than the year before and roughly 300% more than in 2015. Their operations earned more than $54 billion.
Wendell Potter, Health Care Un-covered, February 2026, from company filings
Net income, 2025 (billions of US$)
Becker's Payer Issues, from Q4 2025 earnings reports. Net income is after taxes, one-time charges and losses in other business lines; Centene posted a loss.
How long would you work to earn their 2025 pay?
Total 2025 compensation from proxy filings, reported by Becker's. $60,000 is an example; enter your own pay.
UnitedHealth's CEO earned 748 times the company's median employee in 2025, most of it from a one-time $60 million option award. Across the industry, insurer chiefs earned at least 206 times their median worker.
Becker's, payers ranked by CEO-to-worker pay ratios, 2025
07 · The lobby
And they pay to keep it this way.
Health care is the biggest lobbying force in Washington. Insurers, drugmakers, hospital chains and other health interests reported $743.9 million in federal lobbying in 2024, more than any other sector.
If 2024 health lobbying were split across all 535 members of Congress
OpenSecrets, federal lobbying by sector, 2024. Per-member and per-day figures are this page's arithmetic.
The spending has not slowed. Health interests reported $460.8 million in lobbying so far in 2026, according to OpenSecrets.
In 2018, as Medicare for All gained support, industry groups formed the Partnership for America's Health Care Future to fight it. The coalition opposed single-payer, a public option and a Medicare buy-in alike.
BenefitsPRO and Becker's Hospital Review, 2019 reporting on the coalition
The turn
A different diagnosis.
Every other country in the comparison at the top of this story guarantees health coverage to its people. They spend less and live longer. Medicare for All is the American version: one public plan for everyone, built on the program seniors already rely on.
08 · The plan
One card. Everyone covered.
The Medicare for All Act of 2025 (H.R. 3069) was introduced on April 29, 2025 by Reps. Pramila Jayapal and Debbie Dingell, with Sen. Bernie Sanders leading in the Senate. It launched with 104 House and 16 Senate original cosponsors.
- Everyone is covered, automatically, for life. Losing a job no longer means losing care.
- No premiums, deductibles or copays. The plan is publicly financed instead of billed at the point of care.
- Any doctor, any hospital. No networks, so no surprise out-of-network bills.
- Benefits Medicare lacks today, including dental, vision, hearing and long-term care.
- One payer negotiates drug prices and replaces thousands of billing rules with one.
Congress.gov, H.R.3069 · Sponsors' introduction release, April 29, 2025
09 · The savings
Covering everyone can cost less.
It sounds backwards, but study after study finds the same thing. Cutting administrative waste and paying fair prices saves more than covering everyone costs. Select a study to see its estimate.
Estimated change in yearly national health spending (US$ trillions)
Where the savings come from
- 1Lower prescription drug prices through national negotiation
- 2Paying hospitals and doctors at Medicare-level rates
- 3Far less administrative overhead and billing work
- 4Less fraudulent billing
- 5Fewer avoidable emergency visits and hospital stays, because people get care earlier
Savings sources modeled by Yale School of Public Health, 2026
Of 22 single-payer cost analyses over 30 years
19 predicted savings in the very first year, and all 22 predicted long-term savings once spending growth was controlled.
Cai et al., PLOS Medicine, 2020
10 · The lives
The number that matters most.
That includes 62,863 lives from giving everyone adequate coverage, nearly half of them people who already have insurance today, and 51,311 from reversing the recent cuts. The study is a preprint and has not yet been peer reviewed.
An earlier peer-reviewed Lancet study by the same team estimated 68,531 lives saved each year. Their pandemic analysis found single-payer care could have saved about 338,000 lives during COVID-19, plus $105.6 billion in hospital costs.
Galvani et al.: Yale SPH, 2026 · The Lancet, 2020 · PNAS, 2022
Each figure is 1,000 lives a year
11 · The mandate
Most Americans already agree.
Gallup, November 2025
The money already exists. The U.S. spends nearly twice what peer nations spend. The question is whether it keeps paying for denials, paperwork and profits, or pays for care. Your representatives decide that, and they hear from the insurance lobby every day.