By NextBestFitA costed plan · 2024 dollars
Universal health care for the United States, step by step and dollar by dollar.
The site has two parts. Part 1 lists every problem in the U.S. health system (and every problem universal systems elsewhere have run into) and every cost that makes up national health spending, down to the wages of each occupation. Part 2 lists every change needed, by phase, each with its trade-offs. Solutions are being decided problem by problem.
Ground rules
- 01Universal means everyone.Every resident, with no gaps, no churn, and no medical bills for covered care.
- 02Job losses and company closures are acceptable.They are counted, costed, and cushioned, but they don't veto the design.
- 03Higher cost is acceptable, if it is visible.Every dollar's move from one payer to another is shown, including increases.
- 04Every change has a trade-off, and every trade-off is listed.Each step and each cost item states its own.
- 05Apolitical.Legislative feasibility, filibusters, and court challenges are set aside; the question is what works.
- 06Experiments and transitions are fine.Changes can be piloted, phased, or run side by side before scaling up.
Draft model of the changes
What 2024 would have looked like with the draft changes in Part 2 fully in place (central estimate; the costly and lean cases bracket the uncertainty). These numbers will change as solutions are decided.
National health spending
$5.19T
−$84.8B vs $5.28T. Range −$425.2B to +$539.5B.
Uninsured people
0
From 28M in 2024.
Out-of-pocket spending
$197.3B
From $556.6B.
New general revenue needed
$97.2B
Costly: $842.8B; lean: $370.2B surplus.
Insurer & plan overhead removed
$238.2B
Net of $96.5B UHP administration.
Lower prices
−$208.0B
Hospitals, physicians, drugs.
More care used
+$349.6B
Newly insured, no cost sharing, new benefits.
Jobs displaced
975k
Insurers, billing, brokers, PBMs.
What the country buys
Each row links to its calculation.
| Line | 2024 | Under plan | Change |
|---|---|---|---|
| Hospital care | $1.63T | $1.62T | −$18.4B |
| Physician & clinical services | $1.11T | $1.20T | +$91.7B |
| Other professional services | $184.9B | $209.4B | +$24.5B |
| Dental services | $189.2B | $238.8B | +$49.6B |
| Other health, residential & personal care | $320.5B | $353.5B | +$33.0B |
| Home health care | $169.4B | $204.5B | +$35.1B |
| Nursing facilities & continuing-care communities | $219.9B | $225.7B | +$5.8B |
| Retail prescription drugs | $467.0B | $380.1B | −$86.9B |
| Durable medical equipment | $86.4B | $93.3B | +$6.9B |
| Other non-durable medical products | $128.7B | $128.7B | $0.0B |
| Public program administration | $66.1B | $107.5B | +$41.4B |
| Net cost of insurance (insurer overhead & profit) | $306.0B | $26.4B | −$279.6B |
| Government public health | $157.6B | $157.6B | $0.0B |
| Non-commercial research | $70.4B | $70.4B | $0.0B |
| Structures & equipment | $168.2B | $168.2B | $0.0B |
| Workforce capacity investment (new) | $0.0B | $12.0B | +$12.0B |
| Total national health expenditure | $5.28T | $5.19T | −$84.8B |
Who pays
Every 2024 payment stream and every new one. A decrease means that payer pays less. Each row links to its calculation.
One-time transition costs
Total $243.1B; temporary borrowing over the phase-in, including these, $882.2B (calculation).
How every number is produced
The baseline is the CMS 2024 National Health Expenditure tables ($5.28T). Every other input (rates, unit costs, counts) is defined once on the inputs page and reused everywhere. Sources always equal uses; anything the named taxes don't cover appears as its own general-revenue line.