America’s healthcare systems seems absurd. It could surely be done better. What do you think about a base level of socialized medicine for all American citizens akin to what England and Australia have along with private options for those willing to pay? I suspect Trump would be down for this if he could get it passed.
For years, I bought into Dennis Prager’s nonsense about the bigger the government, the smaller the citizen. Now I don’t see a correlation.
Short answer
- Federal “sticker price”: roughly $18T–$34T over 10 years depending on design. Urban Institute’s bookends: “single-payer lite” (covers legal residents with some cost sharing) adds about $17.6T to federal outlays; an expansive version with richer benefits/no cost sharing adds about $34.0T. Urban PDF • Urban explainer
- Mercatus estimate for the Sanders-style bill: +$32.6T federal over 10 years. Mercatus working paper • Time summary
- Total national health spending (not just federal) could fall a bit or rise a bit. Urban shows national spending down under “lite” but up under the expansive version; CBO says it depends on benefits, payment rates, and admin savings. Commonwealth brief on Urban modeling • CBO single-payer design report
What that implies for taxes
To finance on the order of ~$30T, credible menus include: ~32% payroll tax, or ~25% income surtax, or ~42% VAT, or some mix—remember these replace most premiums and out-of-pocket costs. Clean summary: CRFB overview and the detailed PDF here.
Would quality of life improve?
- Medical debt and bill anxiety: Americans owe an estimated ~$220B in medical debt. Eliminating premiums/deductibles (as in most M4A designs) directly attacks this. KFF/Health System Tracker
- Financial stress and mental health: The randomized Oregon Medicaid experiment found coverage virtually eliminated catastrophic out-of-pocket costs and reduced depression and financial strain. NBER summary • NEJM paper
- Access and affordability vs peers: The U.S. ranks last among high-income countries on overall health system performance, with especially poor affordability; universal systems have far fewer cost-related access problems. Commonwealth Fund report (PDF here)
- Mortality: Coverage expansions like Medicaid are associated with fewer deaths; scaling to universal coverage points in the same direction. Sommers et al., NEJM 2012 • Lee et al., Lancet Public Health 2022
The tradeoffs (no sugar-coating)
- Utilization will jump when prices and cost sharing fall. Without added capacity, some waits lengthen. CBO: demand would likely rise faster than supply if payment rates drop and cost sharing goes to zero. CBO 2022 illustrative options • CBO 2019 design report
- Savings assumptions are make-or-break. Big system savings require: provider prices nearer Medicare than today’s private rates, drug price negotiation, and real admin simplification. Urban’s “lite vs enhanced” shows how these knobs flip total spending. Urban/CF brief
- Who pays changes. Households/employers likely pay far less in premiums and out-of-pocket, offset by broader taxes. Distribution hinges on the financing mix you pick. CRFB • PWBM scenarios here.
Context to keep in mind
The U.S. already spends a lot: $4.9T in 2023 (17.6% of GDP). M4A mostly shifts who writes the check, not whether the nation spends on health care. CMS NHE fact sheet • Health Affairs 2025
Bottom line
- Federal ledger impact for a true “Medicare for All”: roughly $25T–$35T over 10 years depending on scope and payment rates. Benchmarks: Urban “lite” +$17.6T; Urban “enhanced” +$34.0T; Mercatus +$32.6T. Urban • Mercatus
- Systemwide spending could be a bit lower or a bit higher than status quo depending on the knobs (prices, benefits, admin). PWBM shows initial national spending drops of 8–16% in scenarios with lower provider prices/overhead; Urban shows national spending goes down under “lite,” up under “enhanced.” PWBM PDF • Urban/CF brief
- Quality-of-life upside is real: far less financial fear, fewer people skipping care, and likely better population health—if capacity and implementation are handled. Medical debt data • Oregon experiment • Commonwealth Fund
