Where America's health care money goes
An illustration of how the money moves in the US system today, what a single public payer would change, and what the numbers do and don't show.
Seven steps. Use Next, the arrow keys, or the bars below. Every figure carries its source; Checked = read in the original source, Reported = credible secondary source.
Share of the whole economy spent on health
US: CMS National Health Expenditure Fact Sheet, 2024 Checked · UK: ONS UK Health Accounts 2024 and 2025 (29 Apr 2026; a broader definition than NHS spending) Checked. Each country's own national accounts; definitions are close but not identical.
Who funds the US bill today
Source: CMS NHE Fact Sheet, 2024, spending by sponsor Checked. Shares are rounded, so they add to 99%.
From the people who pay to the people who treat
Diagram is illustrative, not to scale. Red dashed lines = money spent on billing and administration.
Shares of spending: private insurance 31%, Medicare 21%, Medicaid 18%, paid out of pocket 11% · CMS NHE Fact Sheet, 2024 Checked.
Administration cost per person, 2017
Insurers' overhead alone: $844 per person in the US against $146 in Canada.
Source: Himmelstein, Campbell & Woolhandler, Annals of Internal Medicine, 7 Jan 2020 (2017 data) Checked. The authors founded Physicians for a National Health Program, which campaigns for single payer: attribute by name.
Congressional Budget Office: change in total US health spending, 2030
Five single-payer designs, all based on Medicare. The answer depends on the design.
Pushes spending down
- Paying hospitals and doctors at lower rates
- Less spent on insurers' administration
Pushes spending up
- People using more care once it's covered
Also in CBO's analysis
- Coverage nearly universal
- Federal health spending up $1.5–3.0tn in 2030
- More delays where pay rates are lowest
Source: CBO Working Paper 2020-08, Dec 2020 (cbo.gov/publication/56811) Checked. Other estimates: The Lancet (Galvani et al., 2020) about 13% saved, over $450bn a year Reported; Mercatus (2018, libertarian) main scenario $2.05tn saved over 10 years, alternative $3.25tn more Reported. Different methods and units: not plotted together.
Results for the money
Peterson-KFF Health System Tracker, 31 Mar 2026 Checked
Census Bureau, P60-288, Sep 2025 Checked
Top three, as the report lists them: Australia, the Netherlands, the UK. US last overall, last on health outcomes and on equity. UK virtually tied with Australia for best on administrative efficiency.
Commonwealth Fund, Mirror, Mirror 2024 Checked
What the other side will say, on the facts
Taxes go up
Federal health spending rises by $1.5–3.0 trillion in 2030, even as premiums and out-of-pocket costs fall.
CBO 2020 Checked
Savings rest on paying providers less
The biggest saving is lower payment rates; Medicare pays well below private insurers (Mercatus assumed about 40% less).
CBO 2020 Checked · Mercatus via PolitiFact Reported
Waits could grow
CBO expects more congestion, meaning delays and care going without, where payment rates and cost-sharing are lowest.
CBO 2020 Checked
"Look at the NHS"
About 7.1 million on the NHS England waiting list (July 2026); the 18-week standard not met since 2016.
House of Commons Library, 2 Oct 2026 Checked
"Cheaper" isn't guaranteed
One of CBO's five designs raises total spending. The case is that it can cost less, as it does elsewhere; the design decides.
CBO 2020 Checked