Policy brief · Health care
No. 01 · October 2026
Medicare for All
One public plan that covers everyone, for less than the country spends now.
The bottom line
- The United States spends about twice as much per person on health care as other wealthy nations and gets shorter lives in return.2,3
- 26.7 million people went all of 2025 without insurance, and lack of coverage is associated with about 45,000 deaths a year.5,8
- A third of health spending goes to administration. One public plan removes most of it.14
- Most independent cost studies find that covering everyone this way lowers total national health spending.19,21
- The Medicare for All Act of 2025 (H.R. 3069, S. 1506) is ready to cosponsor today.18
01The problem
The U.S. spent $5.3 trillion on health care in 2024, 18% of the economy.1 On a comparable basis that is $14,775 per person, against an average of $7,860 in eleven peer nations.2
The return is poor. Americans live 3.7 fewer years than people in those nations, and the Commonwealth Fund ranked the U.S. health system last of ten high-income countries in 2024, including last on access to care and on health outcomes.3,4
Coverage is thin and getting thinner. Counting people whose costs are high relative to income, sponsors of the Medicare for All Act put the number uninsured or underinsured at 85 million.6 The Congressional Budget Office projects the 2025 budget law will leave 10 million more people uninsured by 2034, and the expiration of enhanced ACA subsidies adds an estimated 4.2 million.7
Spending per person, 2024
Life expectancy at birth, years
Peterson-KFF Health System Tracker, OECD and CMS data, 2024. Spending is PPP-adjusted health consumption spending.2,3
02The evidence
Coverage saves lives. Harvard researchers found uninsured working-age adults had a 40% higher risk of death than privately insured adults after accounting for income, health and other factors, about 45,000 deaths a year.8 A 2026 Yale School of Public Health model estimates that universal coverage, together with reversing coverage cuts made since 2025, would avert 114,174 deaths a year; that study is a preprint. An earlier peer-reviewed estimate by the same team put lives saved at 68,531 a year.19,20
Cost keeps insured people from care, too. 57% of underinsured adults avoided needed care because of cost in 2024, and 28% of all adults skipped or postponed care in the past year.9,12 At least $220 billion in medical debt is owed by about 20 million adults, and two-thirds of bankruptcies are tied to illness or medical bills.10,11
The overhead is the system. Insurers and providers spent $812 billion on administration in 2017, 34.2% of health spending, against 17.0% in Canada's single-payer system.14 Insurers selling HealthCare.gov plans denied 85 million in-network claims in 2024, 19% of the total; just 5% of denials cited medical necessity.15
03The plan
The Medicare for All Act of 2025 was introduced on April 29, 2025 by Reps. Pramila Jayapal and Debbie Dingell (H.R. 3069) and Sen. Bernie Sanders (S. 1506), with 104 House and 16 Senate original cosponsors.6,18 Its core provisions:
| Provision | What it does | Section |
|---|---|---|
| Everyone is covered | Every U.S. resident is entitled to benefits, automatically, regardless of job or income. | Sec. 102 |
| Comprehensive benefits | Hospital, primary and specialist care; prescription drugs; mental health and substance use treatment; reproductive and maternity care; dental, vision and hearing; long-term care. | Secs. 201, 204 |
| No cost at the point of care | No premiums, deductibles, coinsurance or copays for covered benefits. | Sec. 202 |
| Any doctor, any hospital | Patients may see any qualified provider. No networks. | Sec. 103 |
| One payer for prices | Hospitals receive global budgets; the program negotiates drug prices directly with manufacturers. | Secs. 611, 617 |
| A two-year transition | Children and adults 55 and older enroll first, with a buy-in for others; full coverage two years after enactment. | Secs. 106, 1001 |
| Help for displaced workers | At least 1% of the budget for up to five years supports workers in insurance and billing jobs affected by the change. | Sec. 601 |
04The cost
Covering everyone adds use of care. Cutting administrative overhead, paying hospitals and doctors at Medicare-level rates, and negotiating drug prices save more than that costs in most analyses. Of 22 single-payer cost studies over 30 years, 19 projected savings in the first year and all 22 projected long-term savings.21 Private plans currently pay hospitals 254% of what Medicare pays for the same services.24
| Study | Estimated change in national health spending |
|---|---|
| Yale School of Public Health, 2026, preprint19 | −$0.66T to −$1.04T a year |
| Galvani et al., The Lancet, 202020 | −$458B a year (−13%) |
| Cai et al., PLOS Medicine, 2020, median of 22 studies21 | −3.5% in year one |
| Congressional Budget Office, 2020, five designs in 203022 | −$0.7T to +$0.3T |
| Mercatus Center (Blahous), 2018, for 2022 to 203123 | −$2.05T over ten years |
Yearly change in national health spending, US$ trillions
The Cai median is applied to 2024 spending (about −$0.18T a year) and the Mercatus ten-year total is shown as its yearly average (about −$0.21T); both conversions are ours. The CBO result depends on payment rates and design.
05Who benefits and who pays
Who benefits
- Families stop paying premiums, deductibles and copays. Today a family plan through work averages $28,303 a year, $7,471 of it from the worker's paycheck.13
- Lower-income households gain the most; the Lancet analysis finds savings concentrated among them.20
- Workers can change jobs, start a business or retire early without losing care.
- Employers no longer buy and manage health plans.
- Doctors and hospitals bill one payer under one set of rules.
Who pays
- The public, through the Medicare for All Trust Fund, which pools existing federal health spending, including Medicare, Medicaid and federal employee coverage (Sec. 701). Congress sets the additional revenue.18
- In place of what families pay now. Premiums, deductibles and copays end, so the comparison is total cost, not taxes alone.
- Private insurers lose the business of selling coverage that duplicates the program (Sec. 107). The seven largest took in almost $1.7 trillion in revenue in 2025.16
- Profit leaves the payments. The bill bars program payments from being used to increase a provider's profit.18
06What lawmakers can do
- Cosponsor H.R. 3069 or S. 1506 and say so publicly.
- Refuse health industry money. Health interests reported $743.9 million in federal lobbying in 2024, more than any other sector.17
- Protect coverage now. Oppose cuts to Medicaid and ACA subsidies while the larger fight continues.7
- Move first steps that point the same way: add dental, vision and hearing to Medicare, lower the eligibility age, and expand drug price negotiation.
- Use the toolkit for model language, a local resolution and answers to the industry's talking points.
Notes
- CMS, National Health Expenditure fact sheet, 2024 data
- Peterson-KFF Health System Tracker, health spending in the U.S. and other countries
- Peterson-KFF Health System Tracker, life expectancy in the U.S. and other countries
- Commonwealth Fund, Mirror, Mirror 2024
- U.S. Census Bureau, Health Insurance Coverage in the United States: 2025
- Reps. Dingell and Jayapal and Sen. Sanders introduce the Medicare for All Act, April 29, 2025
- Center for American Progress, citing CBO projections, 2025
- Wilper et al., American Journal of Public Health, 2009 (Harvard Gazette)
- Commonwealth Fund, 2024 Biennial Health Insurance Survey
- Peterson-KFF, the burden of medical debt in the United States
- Himmelstein et al., medical bankruptcy, American Journal of Public Health, 2019
- KFF, Americans' challenges with health care costs
- KFF, 2026 Employer Health Benefits Survey
- Himmelstein et al., administrative costs in the U.S. and Canada, Annals of Internal Medicine, 2020
- KFF, claims denials and appeals in ACA Marketplace plans, 2024
- Wendell Potter, Health Care Un-covered, Big Insurance's $1.7 trillion year, 2026
- OpenSecrets, federal lobbying set a new record in 2024
- H.R. 3069, Medicare for All Act of 2025, as introduced (GovInfo)
- Yale School of Public Health, universal coverage could save $1 trillion and 114,000 lives a year, 2026 (preprint)
- Galvani et al., The Lancet, 2020
- Cai et al., PLOS Medicine, 2020
- Congressional Budget Office, how CBO analyzes the costs of single-payer proposals, 2020
- People's Policy Project on the Mercatus Center's 2018 study by Charles Blahous
- RAND, prices paid to hospitals by private health plans, 2024 (2022 data)
- Gallup, November 2025