Universal health care would cost $70 Billion for 2009 if enacted using a market-based approach, but this cost will grow rapidly if overall health care inflation is not tamed.
How much would health coverage for all uninsured Americans really cost? Critics maintain that covering all Americans would break the US budget (which is already overstretched), while advocates maintain that covering all Americans can be done affordably. But how much would universal coverage really cost?
The Commonwealth Fund provides a great summary of the costs of proposals under consideration, including Medicare for all, a Building Blocks extension of the current system, and other proposals. Proponents of universal Medicare claim that it will save the US $58 Billion in 2010, since Medicare operates more efficiently than private insurers [1]. Providing universal coverage through incremental changes could cost anywhere between $48B and $120B, according to analyses by the Urban Institute and the Lewin Group, a private health care consultancy. And while Medicare for all would lower total health care spending, it would raise the Federal government’s share of spending by almost $200 Billion per year.
With numbers all over the map, is it possible to come up with a plausible estimate for comparison purposes? Sites like ehealthinsurance.com now make it much easier to get estimates for insurance coverage. Using this data, we can estimate how much basic health insurance coverage would cost for the 45 million uninsured Americans. The experience of Massachusetts, which has implemented universal health care, can also be used to project an estimate for the rest of the country. Since Massachusetts’ health care costs are above US average, this provides a high-side estimate.
Using market insurance quotes, the cost of providing a health insurance with a $1000 deductible and prescription coverage would amount to $2500 per person annually, or roughly $115B per year [2]. This calculation uses different insurance rates for different age groups among the uninsured, based on this demographic breakdown of the uninsured provided by the Kaiser Foundation. In Massachusetts’ experience, covering each uninsured individual costs roughly $3400 per year. Covering all 45 million uninsured Americans at this rate would cost $150 Billion per year.
The midpoint of these estimates is around $130 Billion per year. To get a final estimate, money currently spent on uncompensated care must be subtracted out, since there is no uncompensated care in a universal health care system. Approximately $58 Billion will be spent on uncompensated care in 2009 [3], and subtracting this figure out leaves roughly $70 Billion in annual expenditure required for universal health care.
While $70 Billion per year sounds like a lot of money, it’s actually less than many estimates. It looks increasingly likely that some kind of health care reform will be passed in 2009, and that money will be found to pay for it for the moment. The bigger question is, how will it be paid for tomorrow? Unless health care cost growth is pulled into line with inflation, no one has that answer.
[1] Medicare doesn’t have to perform medical underwriting, and it doesn’t have to spend money on advertising, sales, or shareholder dividends, so its overhead should be lower than private competitors, if it can maintain efficiency. Critics counter that Medicare suffers from high fraud rates precisely because it is a government bureaucracy without competition to force it to raise efficiency and tighten controls.
[2] Here is the rough cost estimate for each demographic group, taken from quotes on ehealthinsurance.com:
0-19: $100/month (20% of all uninsured)
20-29: $150/month (29% of all uninsured)
30-44: $200/month (27% of all uninsured)
45-64: $400/month (24% of all uninsured)
Using these numbers, we calculate a weighted average cost per person of $213 per month, or $2556 per year. That’s $115 Billion for 45 million people.
[3] In 2004, uncompensated care expense was estimated at $40.7 Billion. Since health care spending (in nominal dollars) has grown at 7.5% per year during this decade, the adjusted number for 2009 is approximately $58 Billion. This assumes that uncompensated care is growing in line with health care costs as a whole.
True Cost - Analyzing our economy, government policy, and society through the lens of cost-benefit 
In Ontario each person is covered by OHIP which is a provincial administered plan, funded by employer contributions and tax dollars. There are private insurance plans that cover costs not covered by OHIP. Many employers also provided catastrophic coverage. In reality OHIP provides adequate care in 99 percent of each doctors or hospital visit. The stories in the news about Ontarioans going to the US for care are largely those people unwilling to wait and able to pay for treatment they may have to wait for or is not available yet as the CMA and OHIP may not have adopted new procedures and experimental drugs. As the US medical system is a for profit system, and therefore will adopt new procedures quicker to build a competitive advantage, there are indeed good reasons to seek treatment in a US hospital or medical IF the person feels the Canadian system has or is failing this person in resolving his problem. While I have no statistics in general, my personal experiences indicate the system works well in 100 percent of my personal experience, including dialysis, kidney transplant, heart attack resolved by Stent, and 70 plus years of living. I was blessed with good health for 60 years and probably my employer overpaid “bigly” for all those years…. Even if I had paid those premiums myself, I would have happily paid them… Doing this allowed OHIP to provide care for those unfortunates who became sick and I really question those people who think so selfish and short sighted by complaining about paying for others who are sick. This is a morally indefensible attitude as eventually they become the sick ones…. sad…. US people historically value self reliance and will go to great lengths to protect their independence by buying enough guns and similar actions to insure this principle. Therefore the “socialist” concept that states that getting together in a large group to provide for the unfortunates in this group appears unpalatable…. Only unionists would recognize and understand. I sincerely hope the people in the US will eventually get a universal health system that takes care of all people irregardless of their ability to pay as that is the human and Christian thing to do…
Many Americans go abroad for medical care because it is much less expensive and just as good since many of the doctors trained in the United States. If you think Single Payer doesn’t work, you are wrong. Just ask anyone who has it if they would like to trade it in for our system. I have family that lives in Germany and they get excellent care including hearing, eyes and teeth (not to mention education through college) and child care at almost no cost! Not to mention, that all the wires are below ground, the roads are clearly marked.
Do not understand why you guys just don’t get your medical care from those other countries. …and why do so many foreigner s come here for medical care
There is a need to think outside the box. Government clinics and hospitals should be set up. Salaries are paid to doctors and nurses. Salaries are based on the fact that if they sign up at say $50,000 per year (doctors) their student loans are forgiven over a period of time while working at the government agency. There is no need for huge administrative costs as there will be no billing, no utilization reviews and no fraud. Just something to think about.
diane, who pays for the student loan forgiveness?
Ed,
Thanks for the insightful comment. One difference between my low-end estimate (achieved using public price quotes) and your numbers is that the plans I looked at would not meet HR3200 standards. HR3200 specifies coverage that is very comprehensive, whereas I was looking at plans with $1000 deductibles (per-person) and total out-of-pocket max for a family around $10,000.
I used that as the low-point estimate, and MA’s actual experience of $3400 per person as the high end estimate (MA has the most expensive health care in the country). So for my high end estimate I used $13,600 for a family of four, not dissimilar to the CBO number you mention.
The are also other estimates, as of August 30, 2009. The Lewin Group (subsidiary of UnitedHealth) estimates that pre-paid health care corresponding with the benefits required in Sec. 122 of HR 3200 would cost $12,000 per year IF a federal public plan is offered, or $16,000 per year if not.
The Congressional Budget Office estimates a typical family plan similar to the required benefits package would cost about $13,000 right now.
An actual price quote I obtained from the Massachussetts Health Connector came in at $17,000 for our family of four. (I do not live in MA but used their quote service to find a quote in a state with a similar requirement to HR 3200.)
Your estimate, therefore, seems quite low compared to the others.
I currently pay just over $500/month for the family. This coverage plan has high deductibles and no prescription coverage – except it does cover all meds if hospitalized. However, since it costs $6,000 per year, and the lowest estimate above is $12,000 per year, we could purchase a tremendous amount of prescription meds under our current plan, out of pocket, and still spend far less than $12,000 (or more likely about $16,000 per The Lewin Group).
https://truecostblog.com/2009/02/05/healthcare-bubble/
As I detailed in the healthcare bubble post, the US health care system is only a few years from going broke, and even a 20% reduction in Medicare payments won’t change that. Healthcare costs continue to grow at double the rate of inflation or more, and that simply cannot be sustained.
In my opinion, the government really should focus more on fixing Medicare, rather than on the private market. Why? Because Medicare/Medicaid are paid for by taxpayers. Medicare and Medicaid are going to have to move to a system of rationing, and if you don’t believe me – just wait a couple of years. They simply don’t have enough money to continue in a simple fee-for-service structure.
As for the private market – removing the tax deduction on health care would do wonders for reducing excess (subsidized) demand, while helping to plug the $1 Trillion deficit.
medicare could offer to pay 80% of what they do now, and they would tout they saved alot of money.
medicare sets its own payments, what you don’t realize is that medicares low payments force hospitals to apply upward pressure on prices to private insurers. what is going to happen is if you expand medicare to cover more than they already do the system will be in big trouble.
Medicare will pay 80% of what THEY APPROVED, so lets say if a hospital charged an in patient hospital $22k, Medicare decided they are only going to approve $7k, if you haven’t met your deductible then part of 80% will deducted and goes toward deductible. You will have 20% of copay, plus the deductible from Medicare. They using payment system as “DRG” (Diagnosis Related Group) based on a patient conditions, and or added procedures, the system then grouped into how much Medicare will approve. This practice hurt many small independence own hospital for profit and many went out of business because of that especially if a patients very sick and couldn’t be discharge, but stay in the hospital for a long period of time, they loss a lot of $, because each DRG determine how many days patient stay in the hospital. Then the hospital can request for an outlier in order to get certain percent more per additional day. It’s a very complex system. Many hospitals relied on private insurance entities to help with the loss by having Medicare patients. So just think if they have Medicare for all, it’s not going to look pretty, ordinary people will have to wait for a very long time for any test and procedure or see the doctors. The rich and famous, don’t have to worry as they can pay for private doctors who will cater to them like concierge. Patient can be seen anytime. Then there are another group of people who could possibly afford for something they deemed important like catastrophic illness that can’t wail, they then have to go to another country (like many from Canada come to US for treatment). See Veteran Administration? Just think MEDICARE FOR ALL AMERICANS, and now they’re adding illegals who are not paying taxes. VA already have big problems of backlog and many veterans died waiting for treatment. Do we want this?
Insurance system actually pretty good before the 90’s. After Hilary tried the socialized medicine and failed, democrats loss in landslide during election. They start changing the way doctors and hospital treating patients. Before, when a woman goes into hospital and delivered baby, they stayed up to a week, C. Section may stay longer. After this new changes, women went in to delivery and going home within 2 days. There were comments amongst people that this is a “drive through delivery”. A family doctor would sat with patient for as long as it takes to work with patients depending on their conditions, given advices and so on. After the changes, the doctors have to document what all the treat the patient and how long, they were given definition of the time doctor spent with patient and pay accordingly. Doctors no longer have leisure time to work with patients, they have to spend that time to document as details as they can in case they get audited they may have to pay back what they were paid. From there if kept going down hill as doctors also had to meet quota, seeing how many patients per day.
Then comes Obamacare, purposely set up to fail although most people don’t know it. They expected Hilary to win, and then she will turn it into socialized medicine, just like what she had tried back in the 90’s. Now they even be more radical, Medicare For All, know what that means? MEDICARE FOR NONE! That’s right. Now poor seniors have to worry about other people competed with the system which already going broke. Where do you think money coming from to cover for all? Tax people to death, and they will have to keep going up and up until what we are now seeing in Venezuelan … The people who have money moved on, the ones who can’t afford to move, will eventually be made to work whether you want to or not. But this time, you don’t get to decide what to do with the supposed money you worked hard to earn. Because the government keep all the money and you will be provided with enough food and whatever they think necessary. Pretty soon, they confiscated all your guns, and you slowly afraid to say or protest, eventually your off sprints don’t know better, as they were never seen anything else. Slowly they totally control you. See North Korea? They are sneaky, insidious. You wont’ know what heat you. So please do your research very well before you fall for Medicare for all or socialized medicine. Or tax rich people who are rich up to 70%. A lot of these people are business owners, they create jobs. Once they’re done, what will you have left?
Sorry for a lot of misspell or typos.
The costs may be accurate, but what isn’t accounted for is access to care. Even if Medicare is more efficient (which seems possible in theory, although history tells us about the efficiency of bureaucracies), it also has terrible reimbursement rates to providers. This has led to a number of practices refusing to accept Medicare (see http://www.aapsonline.org/medicare/medrep.htm ). Single payer coverage works if the rest of the system accepts it, but given that there’s not enough capacity for existing Medicare patients, broader reform is likely required to make this work.
Until people have some incentive to monitor their own healthcare costs, throwing more money at the problem won’t make it go away.
@JL Given that it would be a federal crime not to accept Medicare, what you are suggesting is “it won’t work because most doctors would rather become criminals than work with a bureaucracy”. The fact of the matter is, if doctors don’t like it then they’re out of a job. In 2012, 15.7% of people were covered by Medicare and 16.4% by Medicaid, for a total “government bureaucracy” coverage of 32.1%, or about 1/3 of the population. I am incidentally one of those people as I presently have low income, and I have not had any problems getting care nor have I heard of any such problems from other low income, elderly, or disabled people. This argument by you simply does not bear out in reality, it’s just FUD without substance.