Yale Preprint: Single-Payer Coverage Would Cut $1T in Annual Spending

Researchers at the Yale School of Public Health have released a preprint modeling what would happen if the US adopted a national public insurance program along the lines of the Medicare for All Act. Using 2024 spending, coverage, and mortality data, they estimate annual health expenditures would fall by $1.04 trillion — close to 20% — while covering everyone, and that 114,174 deaths a year would be averted.

The savings come from five modeled sources: lower pharmaceutical prices, Medicare-level provider payments, less administrative overhead, less fraudulent billing, and fewer avoidable emergency visits and hospitalizations. Under more conservative assumptions about drug prices and fraud, savings drop to at least $663 billion. Both figures already subtract an estimated $304 billion in new spending to cover unmet needs, reimburse currently unpaid care, and add universal dental coverage.

The mortality figure has two components. About 62,863 averted deaths come from adequate coverage for all — and nearly half of those, 29,631, are among people who already have insurance, the underinsured whose deductibles and cost-sharing keep care out of reach. Reversing coverage rollbacks and other policies enacted since 2025 accounts for a further 51,311.

The caveats are the authors' own. The study has not been peer reviewed. Direct estimates of excess mortality among underinsured adults do not exist, so that risk had to be modeled. The spending analysis excludes transition costs, administrative job losses, and how providers might react to Medicare payment rates — three of the biggest practical unknowns in any such transition.

The work extends a 2020 Lancet paper by some of the same authors, which projected $450 billion and more than 68,000 lives; the larger numbers reflect rising expenditures and a widening commercial-to-Medicare payment gap.