Projected Costs of Single-Payer Healthcare Financing in the United States: A Systematic Review of Economic Analyses - Cai et al. (2020)

Cai et al. (2020) conduct a systematic review of 22 economic studies evaluating the cost of implementing a single-payer healthcare system in the United States.

The authors find strong consensus across models that single-payer is financially feasible, with 86% of studies projecting net savings in the first year and nearly all predicting long-term savings.

Increased costs from higher healthcare utilization are consistently offset by savings from simplified administration, lower drug prices, and reduced inefficiencies.

The median estimated savings is about 3.5% of total healthcare spending. The study concludes that cost outcomes depend on policy design, but overall evidence supports single-payer as economically viable.

1. There is broad economic consensus that single-payer is financially feasible

2. Most models predict net savings, even in the first year

3. Increased utilization raises costs—but not enough to outweigh savings

4. Administrative simplification is the largest source of savings

5. Lower drug prices are a key driver of savings

6. U.S. healthcare is expensive mainly due to prices and inefficiency—not usage

7. Savings grow over time under single-payer

8. Policy design determines whether savings are achieved

9. Evidence supports the key assumptions behind savings

10. The main barrier is political, not economics

⭐ Star Facts

• The study reviewed 22 economic analyses of single-payer healthcare over ~30 years.
• 86% of studies (19/22) predicted net savings in the first year of implementation.
• 91% of studies predicted long-term savings under single-payer.
• Median estimated savings: ~3.5% of total healthcare spending in year one.