From Swords to Stethoscopes: How We Could End Medical Debt — and Afford Universal Care — Without Spending More
Every year, the United States spends close to $5 trillion on health care — roughly 18 percent of GDP — yet tens of millions of Americans carry medical debt.
The Kaiser Family Foundation estimates that about 100 million people owe medical or dental bills, with total household medical debt near $200 billion. That’s more than the GDP of Greece — owed mostly because someone got sick.
The paradox is simple: we spend more on health care than anyone in the world, and still can’t protect people from the bills.
🏦 The Big Picture: High Spending, Low Security
The U.S. doesn’t under-invest in health care. It spends twice as much per person as most wealthy nations — but spends it through a maze of insurers, billing systems, and profit centers that turn care into paperwork.
The federal government already spends around $1.9 trillion a year on health programs (Medicare, Medicaid, ACA subsidies, CHIP, veterans’ care).
That’s about twice the Pentagon’s budget of ~$850 billion.
Yet we still leave millions uninsured and tens of millions underinsured.
We are, effectively, already paying for universal coverage — we just don’t get it.
💰 Corporate Profit ≈ Public Suffering
Across the U.S. health sector — insurers, drug companies, hospitals, and device manufacturers — combined profits typically range from $250 billion to $350 billion a year.
That’s roughly the same amount as all household medical debt in the country.
So even at a very rough level:
one year of health-industry profit equals every unpaid hospital bill in America.
That doesn’t mean eliminating profit would instantly erase debt — but it shows how much money sloshes through the system without healing a single person.
⚙️ The Hidden Machinery of Waste
Profits are only part of the story. The U.S. health system’s administrative complexity burns enormous resources.
Analyses from JAMA, the Commonwealth Fund, and others suggest 25–30 percent of total health spending — about $1 trillion to $1.5 trillion — goes to administrative overhead, redundant billing, marketing, and price inflation.
Even modest simplification, like what single-payer countries achieve, could free up hundreds of billions each year.
That’s more than enough to cancel medical debt several times over — or to cover the uninsured outright.
🍔 Illness We Manufacture
The CDC estimates physical inactivity alone costs about $117 billion a year in medical bills.
Poor diet and obesity add hundreds of billions more — perhaps 10–20 percent of all health spending, depending on what’s included.
These aren’t unavoidable expenses; they’re the downstream price of food policy, city design, and chronic stress. Prevention and healthier infrastructure could save lives and money — genuine “plowshare” investments.
🌎 The Environmental Tab
Air pollution, unsafe water, and heat waves quietly drive disease and cost.
Conservative estimates tie 5–10 percent of U.S. health spending — roughly $250–500 billion annually — to environmental harms.
Even partial improvements in air quality and climate resilience would save tens of billions in hospitalizations and chronic-disease treatment. Cleaner air and water are, quite literally, cheaper medicine.
🏛️ The Federal Role: Halfway There
The government already funds nearly half of all health spending, directly or indirectly.
To move to a full single-payer model, it would need to assume another $2.5–3 trillion — but Americans already pay that much privately through insurance premiums, employer contributions, and out-of-pocket costs.
So the total doesn’t have to rise; it just has to flow through a simpler, fairer channel.
We wouldn’t be spending more — just spending better.
⚔️ Beating Swords Into Plowshares
America’s defense budget — about $850 billion — is roughly four times the total medical debt burden of U.S. households.
Even a quarter of one year’s defense spending could eliminate every dollar of that debt.
Redirecting a fraction of what we spend preparing for war toward keeping people alive would defend Americans in the most literal sense.
Defense cuts alone wouldn’t fund single payer, but they highlight what’s possible when priorities shift from protection through force to protection through care.
⚖️ What’s Truly Unavoidable
No system can or should eliminate all health spending.
People age, technology advances, and good care costs money.
If we pared away the excess profit, waste, and preventable illness, the U.S. would likely spend around $2.5 trillion a year — about 10 percent of GDP — which is what most other rich nations spend for universal coverage.
In other words: we could cover everyone and cut total costs roughly in half, simply by running the system efficiently.
💳 The Moral Weight of Medical Debt
Medical debt isn’t a sign that care is expensive — it’s a sign that the financing is broken.
It punishes people for getting sick, traps families in poverty, and disproportionately affects Black, Latino, and low-income households.
A single-payer system would largely erase this form of suffering.
No one would face collection calls because they had appendicitis. No one would have to crowdfund an ICU stay.
That alone would make the system morally coherent.
🕊️ A Real “Defense” of the People
We spend nearly a trillion dollars each year defending our borders, yet far more Americans die from preventable disease, pollution, and unaffordable care than from foreign threats.
Imagine if even part of that budget funded:
universal clean-air and water programs,
healthy-school meals nationwide,
interest-free medical-debt forgiveness, and
community health clinics in every county.
That would be a true national defense — one that guards our health, not just our territory.
🧮 The Back-of-the-Napkin Ledger
These are broad strokes, not precise accounting — but even conservative assumptions show hundreds of billions in recoverable value each year.
🌱 The Moral Ledger
We already spend enough to insure everyone twice over.
We just pay the wrong intermediaries, for the wrong reasons.
A single-payer system, coupled with serious prevention and environmental reform, could replace medical debt with health security — without raising total spending.
We don’t need new money.
We need new priorities.
Healing, after all, is the highest form of defense.
Author’s Note
This is a back-of-the-napkin argument, not a budget proposal.
The goal isn’t to claim perfect precision, but to show that America already has the money to end medical debt and guarantee care. The question isn’t whether we can afford it — it’s whether we choose to.