By NextBestFitWhy universal health care
Some benefits come from covering everyone, whatever the design. Others depend on which paths are chosen. Each reason links to the evidence behind it, and the costs and risks are at the end so the case can be weighed, not just read.
Why cover everyone
These follow from universal coverage itself, whichever payer structure delivers it.
1. Everyone is covered, and coverage saves lives
Tens of millions of people have no coverage. People without coverage skip care until it becomes an emergency. When coverage has expanded, death rates have fallen.
- 28M uninsured in 2024; insured share fell from 92.5% (2023) to 91.8%.Sources: CMS Office of the Actuary (2025)
- Three-quarters of uninsured adults skipped or postponed needed care because of cost.Sources: KFF (2025)
- After the ACA's Medicaid expansion, deaths among adults aged 20 to 64 fell by 3.6% in expansion states over its first four years.
2. More people start businesses, and small firms can hire the talent they need
When health insurance comes with a job, leaving that job is risky. Would-be founders stay put to keep coverage for their families, and small firms, which offer coverage far less often than large ones, struggle to hire people who would otherwise join them. Coverage that doesn't depend on an employer removes that barrier.
- 178.6M people in employer-sponsored insurance (2024).Sources: CMS Office of the Actuary (2025)
- Business ownership among male workers jumps from 24.6% just before age 65 to 28% just after, when Medicare starts. No such jump appears at other ages.
- Only 51% of firms with 10 to 24 workers offer health benefits, against 97% of firms with 200 or more. A worker with a family to insure has a reason to pick the large firm.Sources: KFF (2026)
- Job lock cut voluntary job changes by people with employer coverage by 25% in a classic study.
- The evidence isn't one-sided: when the ACA let young adults stay on a parent's plan, overall self-employment and job mobility among young adults did not measurably rise, though self-employment rose among young adults with disabilities.
3. Coverage stays put when life changes
Today people lose or switch coverage when they change jobs, earn a little more or less, move, marry, age off a parent's plan, or age into Medicare. Each switch can mean new doctors, new rules, or a gap. Coverage that belongs to the person, not the job or the income bracket, doesn't break.
- Medicaid enrollment fell from 92.2M to 84.3M in 2024 as eligibility checks resumed.Sources: CMS Office of the Actuary (2025)
What it can also bring, depending on the paths
Universal coverage makes these possible, but they only happen if the matching paths are chosen. Each lists example paths; open one for its trade-offs.
Example: the same coverage, two price choices
Both cases cover everyone through a single payer with no point-of-care charges. The second adds all-payer rate setting, national negotiation for all drugs, one claims system and standard rules, and public administration with a cost target. Without them, the cost model uses its high-price and high-admin cases.
| National health spending | Per year | Change |
|---|---|---|
| Today | $5.28T | — |
| Single payer, no price paths | $5.62T | +$337.0B (+6.4%) |
| Single payer with the price paths | $5.19T | −$84.8B (−1.6%) |
From the site's cost model; see the method for its assumptions, or mix your own paths in Build your plan.
1. Illness stops causing debt and surprise bills
Getting sick can mean bills a family can't pay, and people with medical debt put off further care. Bills from providers a patient never chose to see add to it. How far debt falls depends on what patients still pay at the point of care.
- About 100 million adults have medical or dental debt; 79% of them skipped or delayed care because of cost.Sources: KFF / KHN / NPR (2022)
- 1.42M IDR disputes in 2024, over 99% initiated by providers; at least $5B in total process costs through 2024.
- ACA out-of-pocket maximum $9,200 single / $18,400 family (2025).
- 36% of adults skipped or postponed care because of cost in the past year.Sources: KFF (2025)
2. Less money goes to paperwork
Hundreds of payers, each with its own rules, forms, networks, and approvals, make U.S. health care costly to administer. The savings depend on how far billing is simplified: one claims system saves the most, common standards across many payers less.
- About $950B a year in administration; about $265B could be removed with existing interventions.
- Administrative complexity wastes about $266B a year.
- Hospitals spent about $43B trying to collect payment from insurers.Sources: American Hospital Association (2025)
- Health insurer net earnings were about $25B in 2023 and $9B in 2024 (margins of 2.2% and 0.8%).Sources: NAIC (2024)
3. Prices come down toward what other countries pay
The U.S. uses about as much care as peer countries but pays far more per service. Covering everyone doesn't lower prices by itself; a payer or rate-setter that covers everyone can bargain for everyone.
- Private hospital prices average 254% of Medicare.Sources: RAND Corporation (2024)
- U.S. drug prices average 278% of 33 OECD countries; brand-name drugs 422%.Sources: RAND Corporation (2024)
- Pricing failure wastes an estimated $231–241B a year.
- Estimated insulin production cost about $2–6 per vial; a profitable price would be $48–133 per person per year.
- U.S. brand-name prices average 422% of other OECD countries.Sources: RAND Corporation (2024)
4. Workers keep more of their pay
Employer premiums come mostly out of wages. A family premium costs the same for a cashier as for an executive, so it takes the biggest bite from modest pay. Who comes out ahead depends on how the replacement is funded.
- Family premium $26,993; worker share $6,850.Sources: KFF (2025)
5. Better results for the money
The U.S. spends the most of any country on health care and gets shorter lives and worse outcomes than its peers. Coverage helps, but results depend on where the money goes.
- U.S. last among 10 high-income countries.Sources: The Commonwealth Fund (2024)
What it costs, and what could go wrong
Universal coverage has real costs. Each page below gives the case that it is a serious cost and the case that it isn't, with sources.
- Replacing premiums with taxes
- Longer waits if demand grows faster than capacity
- Transition disruption: jobs, companies, and familiar coverage
- Losing the choice of health plan and insurer competition
For the full price tag, see the cost ledger, and to weigh the options yourself, try Build your plan.