Improving the prognosis of health care in the USA
Open accessAbstract
Although health care expenditure per capita is higher in the USA than in any other country, more than 37 million Americans do not have health insurance, and 41 million more have inadequate access to care. Efforts are ongoing to repeal the Affordable Care Act which would exacerbate health-care inequities. By contrast, a universal system, such as that proposed in the Medicare for All Act, has the potential to transform the availability and efficiency of American health-care services. Taking into account both the costs of coverage expansion and the savings that would be achieved through the Medicare for All Act, we calculate that a single-payer, universal health-care system is likely to lead to a 13% savings in national health-care expenditure, equivalent to more than US$450 billion annually (based on the value of the US$ in 2017). The entire system could be funded with less financial outlay than is incurred by employers and households paying for health-care premiums combined with existing government allocations. This shift to single-payer health care would provide the greatest relief to lower-income households. Furthermore, we estimate that ensuring health-care access for all Americans would save more than 68 000 lives and 1·73 million life-years every year compared with the status quo.
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Oral health remains one of the most inequitable areas within healthcare.
“yet it remains one of the most inequitable areas within healthcare (3, 4)”
From Access to oral health care and its social determinants across the lifespan in the United States (2025) · cites this paper as [3]
The Expansion of coverage and services section discusses unequal healthcare access for uninsured and underinsured people, but does not address oral health or compare inequities across areas of healthcare. Searches for “oral,” “dental,” and the claim’s distinctive wording found no passage supporting the attributed point; page numbers were not available in our copy. (LLM, conf=0.75)
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Pyrz, K. H., Hargreaves, M. D., Wood, A. S., Girardi, A., McGwin, G., Kirk, J., Patton, B., Casp, A., & Momaya, A. M. (2024) · Southern Medical Journal · doi:10.14423/smj.0000000000001707 · Cited by 7 · see citing works
Virk, A., Alasmari, S., Patel, D., & Allison, K. (2025) · Cureus · doi:10.7759/cureus.80676 · Cited by 14 · see citing works
“Nevertheless, consolidation and collaboration to some degree in health insurance will benefit through sharing information about both cybersecurity and healthcare indicators, which will allow for more innovation and advancement of the industry [53,54].”
InfluentialQuality of gastrointestinal surgical oncology care according to insurance status
Butensky, S. D., Kerekes, D. M., Bakkila, B. F., Billingsley, K. G., Ahuja, N., Johnson, C. H., & Khan, S. A. (2025) · Journal of Gastrointestinal Surgery · doi:10.1016/j.gassur.2025.101961 · Cited by 6 · see citing works
Reinhart, E. (2025) · Social Science & Medicine · doi:10.1016/j.socscimed.2025.118428 · Cited by 6 · see citing works
Prabhudesai, D., Chen, J. J., & Lim, E. (2022) · Journal of Racial and Ethnic Health Disparities · doi:10.1007/s40615-022-01304-8 · Cited by 6 · see citing works
“Americans who do not have health insurance are reported at more than 37 million, and those with inadequate access to care are at 41 million [10].”
BackgroundStoffel, M., Beal, S. G., Ibrahim, K. A., Rummel, M., & Greene, D. N. (2023) · Critical Reviews in Clinical Laboratory Sciences · doi:10.1080/10408363.2023.2258973 · Cited by 6 · see citing works
Healthcare Cost Burden and Self-Reported Frequency of Depressive/Anxious Feelings in Older Adults
Choi, N. G., Marti, C. N., Choi, B. Y., & Kunik, M. E. (2024) · Journal of Gerontological Social Work · doi:10.1080/01634372.2024.2326683 · Cited by 6 · see citing works
“According to a study by Galvani et al. (2020), a single-payer, universal healthcare system is likely to lead to a 13% savings in national health-care expenditure, equivalent to more than US $450 billion annually (based on the value of the US$ in 2017).”
BackgroundInfluentialUniversal health care needed to end HIV epidemic in the USA
Goedel, W. C., Marshall, B. D. L., & Galvani, A. P. (2020) · The Lancet HIV · doi:10.1016/s2352-3018(20)30342-8 · Cited by 6 · see citing works
Self-citationJimenez, T., Helm, P. J., & Arndt, J. (2020) · Group Processes & Intergroup Relations · doi:10.1177/1368430220920375 · Cited by 6 · see citing works
Crowdfunding in urology: Canadian perspective
Carlo, A. D., Leveridge, M., & McGregor, T. B. (2020) · Canadian Urological Association Journal · doi:10.5489/cuaj.6572 · Cited by 6 · see citing works
The COVID-19 Pandemic and Ethical Challenges Posed by Neoliberal Healthcare
Ahlbach, C., King, T., & Dzeng, E. W. (2020) · Journal of General Internal Medicine · doi:10.1007/s11606-020-06316-w · Cited by 6 · see citing works
Are new pediatric trauma centers located close to the high-risk populations? A geolocation study
Williams, K. M., Scholtz, N., Plagens, C. J., Tubbs, D., & Ehrlich, P. F. (2024) · The Journal of Trauma: Injury, Infection, and Critical Care · doi:10.1097/ta.0000000000004452 · Cited by 5 · see citing works
Medicare for All: Considerations for Neuroradiologists
Nguyen, T. H., Milburn, J. M., Duszak, R., Savoie, J., Horný, M., & Hirsch, J. A. (2020) · American Journal of Neuroradiology · doi:10.3174/ajnr.a6524 · Cited by 5 · see citing works
Hospitalization Trends of Fractures Presenting to the Emergency Room From 2009 to 2021
Albers, J. R., Brown, J. B., Dolorit, M., Ladehoff, L. C., Kumar, A., & Wessel, R. P. (2023) · Journal of Orthopaedic Business · doi:10.55576/job.v3i4.46 · Cited by 4 · see citing works
“There are widespread growing concerns regarding the affordability and sustainability of the USA Healthcare System.”
BackgroundBulaj, G. W., Coleman, M., Johansen, B., Kraft, S., Lam, W., Phillips, K., & Rohaj, A. (2024) · Pharmacy · doi:10.3390/pharmacy12040107 · Cited by 4 · see citing works
“Some challenges associated with reducing chronic disease prevalence and burden are healthcare affordability, accessibility, and inequality [6,7].”
BackgroundKassam, H. F., Khan, A. Z., & Ramirez, M. (2024) · Journal of Shoulder and Elbow Surgery · doi:10.1016/j.jse.2024.08.004 · Cited by 4 · see citing works
Cost-effectiveness of transitional US plans for universal health care
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Self-citationThe Need for Specialized Oncology Training for Clinical Ethicists
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“The US healthcare system, with its mix of public and private providers and insurers, has long been recognized as the costliest system in the world despite producing less favorable health outcomes (Galvani et al., 2020).”
Healthcare Disparities in Cardiovascular Medicine
Fishkin, T., Wang, A. Y.-D., Frishman, W. H., & Aronow, W. S. (2022) · Cardiology in Review · doi:10.1097/crd.0000000000000507 · Cited by 4 · see citing works
Yingling, M. E. (2020) · Journal of Human Rights and Social Work · doi:10.1007/s41134-020-00143-z · Cited by 3 · see citing works
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Ischemic stroke pathophysiology: A bibliometric and visualization analysis from 1990 to 2022
Bao, Y., Hu, Q., Wang, D., Ding, M., Li, W., Li, C., Lei, Z., Yang, R., & Zeng, N. (2024) · Heliyon · doi:10.1016/j.heliyon.2024.e28597 · Cited by 3 · see citing works
“Furthermore, the healthcare system of the USA is well-developed, with higher healthcare expenditure per person ($59,900 per patient per year) than any other country [32,33].”
BackgroundPandey, A., Fitzpatrick, M. C., Singer, B. H., & Galvani, A. P. (2024) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.2321494121 · Cited by 3 · see citing works
Self-citationA non-parametric mathematical model to investigate the dynamic of a pandemicPreprint
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Cyrus, E., Villalba, K., Jean-Gilles, M. M., Rosenberg, R., Ichite, A., Ullah, E., Lovera, E., Lester, A. O. S., Neptune, S., Wilson, H., et al. (2023) · medRxiv · doi:10.1101/2023.05.23.23290385 · Cited by 3 · see citing works
Patwary, M. M., Bardhan, M., Browning, M. H. E. M., Astell‐Burt, T., van den Bosch, M. A., Dong, J., Dzhambov, A. M., Dadvand, P., Fasolino, T. K., Markevych, I., et al. (2023) · doi:10.32942/x2h60b · Cited by 3 · see citing works
Eficiencia del Gasto Público en la salud
Cano, M., Llauce, C. T. D. J. C., & León, M. F. C. (2025) · Podium · doi:10.31095/podium.2024.46.5 · Cited by 2 · see citing works
Daghaghele, E., Angali, K. A., Kamyari, N., & Seyedtabib, M. (2025) · Scientific Reports · doi:10.1038/s41598-025-91309-0 · Cited by 2 · see citing works
Shen, Q., Kang, L., Ye, D., Li, Y., & Zhang, K. (2025) · Frontiers in Public Health · doi:10.3389/fpubh.2025.1616534 · Cited by 2 · see citing works
“In response to the growing burden of healthcare costs, governments and health organizations worldwide have implemented various strategies to control healthcare costs, including measures to manage drug expenditure (5–7).”
Chaudhari, A. J., & Mahajan, S. (2023) · Journal of Pure and Applied Microbiology · doi:10.22207/jpam.17.2.56 · Cited by 2 · see citing works
“14 The use of implantable foreign bodies and advanced immunosuppressive or immunomodulatory treatment regimens in oncology are growing.”
BackgroundFrom sea to shining IV: the current state of OPAT in the United States
Larnard, J., Swords, K. E., Taupin, D., & Padival, S. (2023) · Therapeutic Advances in Infectious Disease · doi:10.1177/20499361231181486 · Cited by 2 · see citing works
Utami, F., Rajaguru, V., Jang, J., Han, W. M., Roh, J., & Shin, J. (2023) · Journal of International Development Cooperation · doi:10.34225/jidc.2023.18.2.29 · Cited by 2 · see citing works
A bibliometric analysis of ovarian cancer care from 2000 to 2023 via CiteSpace
Xiong, A., & Guo, X. (2025) · Women and Children Nursing · doi:10.1016/j.wcn.2025.05.003 · Cited by 2 · see citing works
Structural medicine: towards an economy of care
Reinhart, E., Dawes, D., & Maybank, A. (2021) · The Lancet · doi:10.1016/s0140-6736(21)00937-5 · Cited by 2 · see citing works
Analytic Marxism and Economic Feasibility. A Defense of Central PlanningPreprint
Jeuk, A. A., & Spang, F. (2022) · doi:10.31219/osf.io/uygvw · Cited by 2 · see citing works
Quantifying the Mortality and Morbidity Impact of Medicaid RetractionsPreprint
Pandey, A., Ye, Y., & Galvani, A. P. (2025) · medRxiv · doi:10.1101/2025.05.19.25327564 · Cited by 2 · see citing works
“While intended to reduce federal spending, these changes would come at a steep human cost and may, in fact, have counterproductive economic repercussions (14).”
Self-citationAbubakar, I., Nwoko, M., Umar, S. S., Iyoha, E. A., & Maduako, K. T. (2023) · Corporate Governance and Organizational Behavior Review · doi:10.22495/cgobrv7i2sip2 · Cited by 1 · see citing works
“To explore how to improve the prognosis of healthcare in the United States, the study by Galvani et al. (2020) discovered that a shift to single-payer healthcare would be able to provide great relief to lower-income households.”
BackgroundResisting State Capture as a Democratic Ideal
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Maryland's Global Budget Revenue Program and Equitable Access to Esophagectomy for Esophageal Cancer
Yang, V., Rando, H. J., Menta, A. K., Zhao, X., Blum, J., Battafarano, R. J., Broderick, S., Yang, S. C., & Ha, J. S. (2024) · Journal of Surgical Research · doi:10.1016/j.jss.2024.07.073 · Cited by 1 · see citing works
Chowdhury, D., Das, A., Mishra, M., Khutere, T., Jayashree, Manna, R., & Bodakhe, S. H. (2026) · Vacunas · doi:10.1016/j.vacun.2026.500650 · Cited by 1 · see citing works
Mental Health Among LGBTQ+ Communities in the Context of COVID-19
Phillips, G., Felt, D., Ruprecht, M. M., & Beach, L. B. (2023) · Emerald Group Publishing Limited eBooks · doi:10.1108/978-1-80262-115-020231005 · Cited by 1 · see citing works
Bagg, S. E. (2024) · doi:10.1093/oso/9780192848826.003.0010 · Cited by 1 · see citing works
Bagg, S. E. (2024) · doi:10.1093/oso/9780192848826.003.0005 · Cited by 1 · see citing works
Niehus, H. D., Gunesch, A. N., Rodriguez, N., Khoury, J., Ma, A., Gu, N., Cao, T., Muller, M., Moriates, C. P., Linker, A. S., et al. (2024) · Journal of General Internal Medicine · doi:10.1007/s11606-024-08783-x · Cited by 1 · see citing works
C. Everett Koop Healthcare System for Biosecurity and Defense
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Alva, D. P., Andrews, T. M., & Delton, A. W. (2024) · Political Psychology · doi:10.1111/pops.13060 · Cited by 1 · see citing works
“And lacking healthcare can be fatal: In the United States, some have estimated that universal healthcare would prevent 68,000 annual deaths whereas repealing the ACA would result in 38,500 annual deaths (Galvani et al., 2020).”
Association Between Medical Debt and Vaccine Uptake in the USA, 2021–2022
Himmelstein, K. E. W., & Mohareb, A. M. (2024) · Journal of General Internal Medicine · doi:10.1007/s11606-024-09183-x · Cited by 1 · see citing works
“43 Unlike other social determinants of health, medical debt results directly from the billing and collection practices of healthcare institutions (i.e., clinics, hospitals, corporate health systems, pharmacies, and insurance companies).”
Chow, K., Zenone, M. A., Kenworthy, N., Merid, B., & Maani, N. (2025) · PLOS Global Public Health · doi:10.1371/journal.pgph.0003244 · Cited by 1 · see citing works
“Despite estimates that implementation of UHC would reduce national health care spending by 13.1% annually [2], like other large industries, for-profit health care providers are resisting interventions that would constrain their profits.”
InfluentialRidwan, A., & Rikmadani, R. Y. A. (2022) · Eduvest - Journal Of Universal Studies · doi:10.36418/edv.v2i2.371 · Cited by 1 · see citing works
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The effect of Medicare for All on rural hospitals – Authors' reply
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The effect of Medicare for All on rural hospitals
Agarwal, A., & Royce, T. J. (2020) · The Lancet · doi:10.1016/s0140-6736(20)32210-8
Reintegration in the Red: Navigating Child Support Arrears After Prison
Spencer-Suarez, K. (2021) · doi:10.7916/d8-0ng4-0b97
17. Economic Issues in Healthy Aging
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The Role of the Fragmented United States Healthcare System in Exacerbating COVID-19 MortalityPreprint
Campbell, T., Galvani, A. P., Fitzpatrick, M. C., & Friedman, G. C. (2022) · SSRN Electronic Journal · doi:10.2139/ssrn.4001496
Self-citationRisky Business: Health Care Before and After Trump
Gordon, C. (2022) · Emerald Group Publishing Limited eBooks · doi:10.1108/s0198-871920220000039007
The Role of Government in National Healthcare Systems
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Crummett, D. (2023) · Ergo an Open Access Journal of Philosophy · doi:10.3998/ergo.2270
“Some estimates suggest that implementing universal health care in the US might save 68,000 lives annually (Galvani, Parpia, Foster, Singer, & Fitzpatrick 2020), and that there are perhaps as many as 155,000 deaths attributable to pollution per year (Sifferlin 2017).”
Welch, S. B., Navrange, N., Wetoska, N., & Capan, S. (2024) · Research Square · doi:10.21203/rs.3.rs-3832873/v1
- Authors
- Galvani, A. P., Parpia, A. S., Foster, E. M., Singer, B. H., & Fitzpatrick, M. C.
- Affiliations
- Yale University (US)
- University of Florida (US)
- University of Maryland, Baltimore (US)
- Corresponding author
- Galvani, Alison P
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2020-02
- Volume
- 395
- Issue
- 10223
- Pages
- 524-533
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- PMC
- PMC8572548
- OpenAlex
- W3006668752
- Cited by
- 138
- References
- 53
- Citations by year
- 2026: 10 · 2025: 25 · 2024: 43 · 2023: 17 · 2022: 11 · 2021: 15 · 2020: 17
- FWCI
- 2.36
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Allergy and Infectious Diseases (K01AI141576)
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Social Sciences › Economics, Econometrics and Finance › Finance › Healthcare Systems and Reforms
- Health Sciences › Health Professions › General Health Professions › Healthcare Systems and Practices
- Keywords
- single-payer health care, Medicare for All, universal health care, health care expenditure, Affordable Care Act repeal, health insurance coverage, health care access, health care inequities, cost reduction, life-years gained, health policy, United States
- MeSH terms
- Universal Health Care, Delivery of Health Care, Health Expenditures, Medicare, Health Services Accessibility, Humans, Prognosis, United States, Drug Costs, Cost Savings, Patient Protection and Affordable Care Act
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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