AMERICA DENIEDA Plan for Universal Essential Healthcare within a Budget
AMERICA DENIED

A Plan for Universal Essential Healthcare within a Budget.

America spends more on healthcare than any peer nation. We can provide essential healthcare to every American—and do it within a budget.

DONATE $6
18%of U.S. GDP
spent on healthcare
“
Healthcare is the tapeworm of America and American competitiveness…and the tapeworm has won.”

WARREN BUFFETT

WHY AMERICA DENIED?

Why America needs both cost and coverage reform.

Stephen Lehner introduces America Denied and the case for Universal Essential Healthcare within a Budget.

THE PROBLEM

America spends more.
Patients get less.

73%

of Americans believe healthcare affordability is a very big problem.

18%

of GDP goes to U.S. healthcare versus roughly 9–12% in many OECD peers.

$5.7T

in annual U.S. healthcare spending.

High prices + administrative inefficiency
are principal drivers of high costs.

Patients bear hidden costs
through networks, surprise bills, deductibles, prior authorization and complexity.

Health data remains fragmented
causing duplication, poor continuity and administrative waste.

Employers pay too
as healthcare costs consume compensation and reduce competitiveness.

SPENDING

The U.S. leads the world in healthcare spending.

18%of U.S. GDP
in 2024
0%5%10%15%20%United States18.0%Germany12.3%France11.5%United Kingdom11.1%Australia10.3%OECD average9.3%

Sources: CMS National Health Expenditure Accounts (2024) and OECD Health at a Glance 2025. CMS reports 18.0% including investment; OECD reports 17.2% current health expenditure.

PROCEDURE PRICES

Americans pay far more for the same procedures.

2–4×U.S. private insurance
vs. peers
1–2×U.S. Medicare
vs. peers

Sources: iFHP/HCCI International Healthcare Cost Comparison Report 2024; CMS FY2022 IPPS; Peterson-KFF Health System Tracker. “Peers” = simple average of Australia, Germany and UK.

DRUG PRICES

Prescription drugs can cost 4–10× more in America.

Sources: iFHP/HCCI (2022); CMS; Australian PBS; UK NHS/BNF/NICE. Medicare net prices are estimates where shown.

WASTE

About one quarter of U.S. healthcare spending may be waste.

$1.4T2025-dollar
illustrative estimate
0%8%15%22%30%Administrative complexity28.4%Pricing failure25.7%Overtreatment / low-value10.8%Fraud and abuse9.0%Care coordination failure8.4%Care delivery failure17.7%

Source: Shrank et al., JAMA 2019. Upper estimates, inflation-restated; not guaranteed recoverable savings.

INFLUENCE

The Healthcare Industrial Complex spends about $1.8 billion a year influencing the system.

$750M

Federal healthcare lobbying in 2024.

~$1.0B

Estimated additional state lobbying, advocacy, public relations, think tanks, revolving-door activity and other influence spending.

~$1.8B

Total estimated annual influence spending — about $6 for each of 300 million Americans.

$6per American
to match $1.8B
~50%Pharma / health products share of federal healthcare lobbying~18%Hospitals / nursing homes share+26%Federal healthcare lobbying growth, 2019–2024
$0m$200m$400m$600m$800m201920202021202220232024
Pharma / Health ProductsHospitals / Nursing HomesHealth Services / HMOsHealth ProfessionalsMisc. Health

Sources: OpenSecrets; JAMA. Federal lobbying totaled approximately $750M in 2024. America Denied estimates roughly another $1B annually across state lobbying, advocacy, public relations, think tanks, revolving-door activity and other influence spending. The ~$1.8B total and ~$6 per American are illustrative estimates.

WHY AMERICA DENIED?

What are Americans being denied?

Affordable healthcare.

Continuous coverage.

Clear prices.

Ownership of our healthcare data.

Affordable drugs.

Job mobility and rising real wages.

We are denied humanity and compassion by an extractive industry that pursues volumes and high prices over care.
THE COST OF THE STATUS QUO

What if healthcare spending had been limited to 12% of GDP?

≈$8Tlower federal debt
by 2024
$0T$10T$20T$30T$40T2000200420082012201620202024■ Actual federal debt━ Est. debt at 12% healthcare

Illustrative estimate based on CMS NHE and Treasury/FRED data. Assumes healthcare spending limited to 12% of GDP beginning in 2000 and federal savings reduce borrowing. Not a CBO estimate.

WHO WOULD HAVE SAVED?

The savings would belong to Americans.

$22.8Tcumulative estimated savings
2000–2024
$136,100total non-federal savings per average household equivalent*

* Per-household equivalents based on approximately 119 million average U.S. households, 2000–2024.

“Revolution is impossible
until it is inevitable.”
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