Physician & clinical services

Commercial physician prices average about 140% of Medicare (higher for specialists, near 120% for primary care). Medicaid's fee index is about 0.72× of Medicare. UHP pays an average of 112% of Medicare, weighted toward primary care (125%) and away from procedures (105%). Removing deductibles and copays and covering 28 million uninsured people raises visits by roughly 12%, consistent with RAND Health Insurance Experiment elasticities and Oregon Medicaid experiment results.

Result

$1.20T

$1.11T → $1.20T

Per resident, per year

$3,522

÷ 341.1M people

Per household

$9,087

÷ 132.2M households

Range

$1.11T–$1.39T

Lean and costly scenarios.

How it's calculated

#	Step	Arithmetic	Value
1	2024 spending on this service (CMS NHE Table 4) Sources: CMS Office of the Actuary (2025)		$1.11T
2	Private health insurance paid $505.1B at 1.40× the reference price → volume Sources: CMS Office of the Actuary (2025)	$505.1B ÷ 1.40×	$360.8B
3	Medicare paid $251.2B at 1.00× the reference price → volume Sources: CMS Office of the Actuary (2025)	$251.2B ÷ 1.00×	$251.2B
4	Medicaid paid $112.5B at 0.72× the reference price → volume Sources: CMS Office of the Actuary (2025)	$112.5B ÷ 0.72×	$156.3B
5	Out-of-pocket spending in 2024 Sources: CMS Office of the Actuary (2025)		$94.3B
6	Covered out-of-pocket converted to reference-price volume	$94.3B ÷ 1.30×	$72.5B
7	Care UHP takes over, valued at 2024 prices		$963.1B
8	Same care valued at the reference price (Medicare Physician Fee Schedule)		$840.8B
9	Re-priced at UHP rate 1.12×	$840.8B × 1.12×	$941.7B
10	Price effect (same care, new prices)	$941.7B − $963.1B	−$21.4B
11	Utilization multiplier 1.12×	$941.7B × 1.12×	$1.05T
12	Utilization effect (more care)	$1,054.7B − $941.7B	$113.0B
13	UHP spending on this service		$1.05T
14	Plus Other insurance programs (CHIP, DoD, VA) (continues unchanged)		$48.0B
15	Plus Other third-party payers & programs (continues unchanged)		$98.7B
16	Total national spending on this service under the plan	$1,054.7B + $0.0B + $146.7B	$1.20T
17	Change from 2024	$1,201.4B − $1,109.7B	$91.7B

Trade-off: Providers of this service receive $21.4B less for the same care; patients receive $113.0B more care.

Sources: CMS Office of the Actuary (2025); Medicare Payment Advisory Commission (2025); KFF (2019); RAND Corporation (1986); Finkelstein, Baicker et al., NEJM / QJE (2013)