Universal Health Coverage Could Save $1T and 114k Lives a Year, Yale Study
Universal Health Coverage Could Save $1T and 114k Lives a Year, Yale Study
耶鲁大学研究：全民医保每年可节省 1 万亿美元并挽救 11.4 万条生命
A single-payer universal health care system could cover every American, save more than 100,000 lives a year, and still cost $1 trillion less than the system it would replace, according to a new preprint study led by researchers at the Yale School of Public Health.
根据耶鲁大学公共卫生学院研究人员领导的一项最新预印本研究，单一支付方的全民医疗保健系统可以覆盖每一位美国人，每年挽救超过 10 万人的生命，且成本比现行系统节省 1 万亿美元。
For the study, which has not yet been peer reviewed, the researchers modeled what would happen if the United States adopted a national public insurance program like the one proposed in the Medicare for All Act. Using 2024 spending, insurance coverage, and mortality data, they estimate that the universal coverage would reduce annual health expenditures by $1.04 trillion, or nearly 20% — even after accounting for the additional care that uninsured and underinsured people would receive.
这项尚未经过同行评审的研究模拟了如果美国采用类似于《全民医保法案》（Medicare for All Act）中提出的国家公共保险计划将会产生的结果。研究人员利用 2024 年的支出、保险覆盖范围和死亡率数据估算，全民医保将使年度医疗支出减少 1.04 万亿美元，降幅近 20%——这还是在计入了无保险和保险不足人群将获得的额外医疗护理成本之后得出的结论。
“Healthcare costs have been rising faster than inflation, and a staggering share of that spending is consumed by administrative middlemen, soaring drug prices, and emergency care for conditions that should have been treated earlier and for less,” said senior author Alison Galvani, the Burnett and Stender Families Professor of Epidemiology at YSPH and the director of the Yale Center for Infectious Disease Modeling and Analysis. “Medicare for All strips out those sources of waste while providing everyone with healthcare, saving over a trillion dollars and 114,000 lives every year.”
“医疗成本的上涨速度超过了通货膨胀，其中惊人比例的支出被行政中间商、飙升的药价以及本应更早、更低成本治疗的疾病的急诊护理所消耗，”资深作者、耶鲁大学公共卫生学院流行病学教授兼耶鲁传染病建模与分析中心主任 Alison Galvani 表示，“‘全民医保’剔除了这些浪费来源，同时为每个人提供医疗服务，每年可节省超过一万亿美元并挽救 11.4 万条生命。”
The model identified five major sources of savings: lower pharmaceutical prices, Medicare-level payments to providers, reduced administrative overhead, less fraudulent billing, and fewer avoidable emergency department visits and hospitalizations. Even under more conservative assumptions about drug prices and fraud reduction, the researchers projected that the savings would reach at least $663 billion a year. Both figures account for an estimated $304 billion in additional spending to meet unmet medical needs, reimburse care that now goes unpaid, and provide universal dental coverage.
该模型确定了五个主要的节省来源：更低的药品价格、向医疗服务提供者支付 Medicare 标准的费用、减少行政开支、减少欺诈性账单，以及减少可避免的急诊和住院。即使在对药价和欺诈减少采取更保守的假设下，研究人员预计每年节省的金额至少仍将达到 6630 亿美元。这两个数字都计入了约 3040 亿美元的额外支出，用于满足未被满足的医疗需求、补偿目前未支付的护理费用，以及提供全民牙科保险。
A universal healthcare policy would also save tens of thousands of lives, the researchers project. They estimate that adequate coverage for all could avert about 62,863 deaths annually — and that nearly half, or 29,631, would be among people who already hold insurance. These are the underinsured: the more than 45 million working-age adults whose deductibles and cost-sharing put care beyond financial reach anyway. Reversing coverage rollbacks and other health policies enacted since 2025 would avert a further 51,311 deaths each year, the researchers project, bringing the annual total to 114,174.
研究人员预计，全民医疗政策还将挽救数万人的生命。他们估计，为所有人提供充足的保险每年可避免约 62,863 人死亡，其中近一半（29,631 人）是已经拥有保险的人群。这些人属于“保险不足”群体：超过 4500 万劳动年龄人口，由于免赔额和共同负担比例，他们即便有保险也难以负担医疗费用。研究人员预计，扭转 2025 年以来的保险缩减和其他卫生政策，每年可额外避免 51,311 人死亡，使年度总挽救人数达到 114,174 人。
The study builds on findings Galvani, co-author Meagan Fitzpatrick, and other colleagues published in The Lancet in 2020, which projected that universal health care would save $450 billion and more than 68,000 lives annually. The larger estimates in the new study reflect ballooning health expenditures, a widening gap between commercial and Medicare payment rates, and new estimates on recent policy changes and the underinsured.
这项研究建立在 Galvani、合著者 Meagan Fitzpatrick 及其他同事 2020 年发表在《柳叶刀》上的研究成果之上，当时的研究预计全民医保每年可节省 4500 亿美元并挽救超过 6.8 万人的生命。新研究中更高的估算值反映了医疗支出的激增、商业保险与 Medicare 支付费率之间差距的扩大，以及对近期政策变化和保险不足人群的最新评估。
The authors caution that direct estimates of excess mortality among underinsured adults are unavailable, requiring them to model that risk. Their spending analysis also does not account for transition costs, administrative job losses, or how providers might respond to Medicare payment rates.
作者提醒称，目前尚无关于保险不足成年人超额死亡率的直接估算数据，因此需要对该风险进行建模。他们的支出分析也没有计入转型成本、行政岗位流失，或医疗服务提供者可能对 Medicare 支付费率作出的反应。
Even with those limitations, the researchers argue that the United States already spends enough to provide universal coverage. The problem, they conclude, is how that money is allocated.
尽管存在这些局限性，研究人员认为美国目前的支出已经足以提供全民覆盖。他们总结道，问题在于这些资金是如何分配的。
“A system that covers everyone, costs $1 trillion less, and averts more than 100,000 deaths annually requires no new discovery to implement, only enactment,” they wrote.
“一个覆盖所有人、成本降低 1 万亿美元且每年挽救超过 10 万人生命的系统，其实现并不需要任何新的发现，只需要立法实施，”他们写道。
The study’s other authors are Abhishek Pandey, senior research scientist in epidemiology (microbial diseases); Chad Wells, postdoctoral research associate; and Yang Ye, associate research scientist in epidemiology (microbial diseases), at YSPH.
该研究的其他作者包括耶鲁大学公共卫生学院的流行病学（微生物疾病）高级研究科学家 Abhishek Pandey、博士后研究助理 Chad Wells，以及流行病学（微生物疾病）副研究科学家 Yang Ye。