HEALTH5 is a proposal, not current law. This site makes the case for Congress to enact it. What lawmakers would vote on.
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The math, done in public

The proposal aims to move national health spending from about $5.3 trillion to no more than its $3.395 trillion ceiling. Here is exactly what that requires.

The test every budget must pass

$832 × covered member months = claims + administration + reserves

Per person per year, that means:

$9,984 = medical + dental + vision + hearing + prescriptions + extended care + administration + reserves

If the equation doesn’t balance, the analysis has to name the cause: a benefit category, a utilization assumption, a provider price or an administrative cost. Savings are shown with data. They are never assumed just to make the budget balance.

Try the reconciliation yourself

Each row is a 2024 national spending category from CMS national health expenditure data, as listed in the UR2Big reconciliation workbook. Set the reduction you think is realistic for each one and see whether you reach the target.

Category
2024
Your reduction
Modeled
$0Striped band: up to the $3.395T ceiling$5.4T
Modeled national spending
Total reduction
Compared with $3.395T at $832 a month

The workbook’s category figures add to $5,278.8 billion, slightly above CMS’s headline $5,263.3 billion, so the final model must reconcile that difference too. Public health and research spending sit outside the core HEALTH5 benefit and would continue in some form. The tool starts every category at 0% on purpose: no reduction is pre-filled because none has been proven yet.

Where savings have to come from

Cutting insurance overhead alone can’t close a $2 trillion gap. Nonmedical insurance costs were $306 billion in 2024 (CMS). Hospitals were $1.6 trillion, physician and clinical services more than $1.1 trillion, and retail prescriptions about $467 billion (CMS fact sheet; Medical Economics). HEALTH5 would restructure national spending, not just insurance.

For every category, the model must show the 2024 spending, the proposed HEALTH5 spending, the dollar and percentage reduction, the mechanism behind it, the supporting evidence, and the risk of carrying it out.

If the categories add up to $3.395 trillion or less with adequate provider pay, capacity and quality, the $832 ceiling has real support. If they don’t, the model should show the funding level actually required, rather than forcing the numbers under $832.

Stress tests before launch

Universal coverage means people who put off dental work, hearing aids, medications and procedures will finally get them. That’s the point, and it’s also a cost. The $832 model has to survive:

  • A base case with expected use and medical inflation
  • A high-utilization case
  • An aging population
  • A drug-price shock
  • A recession
  • Provider shortages
  • A pandemic or other catastrophe

Extraordinary events would be handled through reserves or explicit government catastrophe funding, not built permanently into everyone’s contribution.

What still has to be proven

Before HEALTH5 is presented as a validated fiscal plan, the research must:

  1. Independently verify CMS spending categories and population
  2. Build claims and utilization estimates for each service
  3. Define benchmark provider payment, including rural exceptions
  4. Model age, dependent and risk adjustments
  5. Test who really bears the employer and government costs, and the legal path to implement them
  6. Measure administrative savings without counting any twice
  7. Stress-test the transition and provider capacity
  8. Reconcile every modeled reduction against the 2024 baseline

We publish this list because a reform this large should be judged on evidence before anyone votes on it. Supporting HEALTH5 today means supporting a serious, public test of whether it would work, followed by a vote in Congress.

Sources for this page

  1. CMS, National Health Expenditure historical dataDetailed 2024 spending by category used in the reconciliation tool.
  2. CMS, National Health Expenditure Fact Sheet (2024 data)Total 2024 spending of $5.3 trillion and $15,474 per person; hospital, physician and drug spending; Medicare, Medicaid and private insurance totals; sponsor shares.
  3. Medical Economics, Health care spending reaches $5.3 trillion, or 18% of U.S. economy, in 2024 (Jan. 14, 2026)Health spending at 18% of GDP; hospitals $1.6 trillion, physician and clinical $1.1 trillion, drugs $467 billion.

Policy design details come from the UR2Big HEALTH5 Comprehensive Research and Policy Proposal (November 2026). See all sources.

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