A new Yale analysis found that Bernie Sanders’ Medicare for All bill would save 114,000 American lives and cut national health spending by more than $1 trillion a year. Republicans responded by letting the ACA subsidies die, launching a president-branded drug website, and gutting Medicaid, Medicare, and SNAP. The evidence is now overwhelming — and the death toll is being counted in real time.
On Tuesday, a team of Yale University researchers led by epidemiologist Alison Galvani released a study concluding that a single-payer Medicare for All system — the framework long championed by Vermont Senator Bernie Sanders — would prevent more than 114,000 preventable American deaths every year while cutting national health spending by $1,041 billion annually, a reduction of roughly 20 percent off the current national bill. The study, currently posted as a preprint on medRxiv, updates a widely cited 2020 Lancet analysis from the same lead author, which found smaller but still enormous savings under the earlier version of the plan.
The moral math is now settled. What is not settled — what has, in fact, been actively sabotaged over the last nineteen months — is whether the country will allow itself to be governed by that math, or by the political interests of a president who has spent his second term liquidating the public-health infrastructure that keeps Americans alive.
Sanders, ranking member of the Senate Health, Education, Labor, and Pensions Committee, put the stakes plainly on the day of the release. In an official statement from his office, he cited the study’s finding that Medicare for All would deliver $377.5 billion in annual savings on prescription drugs alone by paying no more than other wealthy nations pay, plus $286.3 billion by eliminating the administrative bureaucracy of the private insurance industry. Those are not aspirational numbers. They are conservative estimates rooted in what other countries — Germany, France, Canada, the United Kingdom — already pay and already achieve.
“This study confirms what we have known for years: Medicare for All saves lives and saves money. In fact, guaranteeing healthcare as a human right through a Medicare for All, single-payer system would cost $1 trillion less than our current dysfunctional system. Do not tell me we cannot afford Medicare for All. What we cannot afford is a broken healthcare system based on greed.”
— Sen. Bernie Sanders (I-Vt.), August 11, 2026
I. The Evidence Republicans Refuse to Read
The Yale team, joined by researchers at the University of Maryland, identified the specific sources of savings that a public single-payer system would unlock. These are not ideological talking points; they are the arithmetic of a bloated middleman economy that no other developed country tolerates.
The findings echo an accumulating body of peer-reviewed literature. Galvani’s earlier Lancet paper found $450 billion in annual savings and 68,000 lives saved under the earlier bill; a subsequent Yale analysis found that more than 335,000 additional deaths could have been prevented during the pandemic if the United States had operated a universal system. Every credible model points in the same direction. The disagreement is not empirical. It is political.
II. How the GOP Killed the Coverage Millions Already Had
The strongest evidence that Republicans do not, in fact, believe their own claims about “market solutions” is what they have chosen to do with the market solution that already exists. The enhanced premium tax credits that made Affordable Care Act coverage affordable for tens of millions of Americans expired at midnight on December 31, 2025, after congressional Republicans refused to extend them. Democrats forced a 43-day government shutdown trying to save the credits. Four moderate House Republicans broke with Speaker Mike Johnson to force a January vote. Nothing was enough. The subsidies died on schedule.
The results were catastrophic and immediate. According to NPR’s analysis of federal data, five million fewer Americans are currently enrolled in ACA marketplace plans compared to the record high reached in 2025 — the largest single-year drop since the exchanges opened in 2014. Premium costs, on average, more than doubled between 2025 and 2026. The Urban Institute and the Commonwealth Fund projected 7.3 million people will leave the ACA marketplace this year, roughly 5 million of them going uninsured entirely.
The pain is not evenly distributed. KFF projected Arkansas would see benchmark Silver plan premiums rise 69 percent, Washington state 41 percent, Tennessee and Mississippi close behind. Some of the sharpest damage is falling on the exact red-state constituencies Republicans claim to represent. And as The Nation reported, the Trump administration has responded to the enrollment collapse by attempting to reframe it as a crackdown on fraud — a claim contradicted by every independent analyst.
Meanwhile, House Democratic Leader Hakeem Jeffries and Senator Angela Alsobrooks of Maryland have been unsparing. Alsobrooks, in a May 2025 floor statement, called the underlying reconciliation package “the largest cuts to Medicaid and SNAP in American history” and “a predatory scam on the American people designed to pay for billionaire tax cuts.” She was, if anything, understating the case.
III. Still Waiting on Those “Concepts of a Plan”
Two years ago, in the September 10, 2024 presidential debate, moderator Linsey Davis pressed Donald Trump for a specific replacement for the Affordable Care Act. His answer became instantly infamous. He had, he said, “concepts of a plan.” He would release “concepts and options” in “the not-too-distant future.” STAT News’ post-debate analysis was blunt: after eight years of promising to repeal and replace the ACA, Trump still hadn’t decided how he wanted to do it.
Two years, one election, and full Republican control of Washington later, the concepts remain concepts. What was floated in January 2026 as “The Great Healthcare Plan” is, by any honest reading, a marketing wrapper for what Trump’s 2020 budget already proposed: block-granting Medicaid to the states and killing the ACA’s premium subsidies — the exact policy path the country has now been forced onto by legislative inaction. KFF’s analysis of the underlying “concept” makes this explicit. It is not a replacement plan. It is a demolition plan with a bow on it.
Larry Levitt, executive vice president of health policy at KFF, put it simply to NBC News: “Any ACA replacement plan would involve trade-offs and winners and losers, and you can bet that the losers would scream loudly.” That is why the concepts have never become a plan. To write it down is to name the losers. And the losers, under every scenario Republicans have privately favored, are working-class Americans, older adults, and the chronically ill.
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IV. America Is Sicker Than It Was Two Years Ago
The most damning fact is not any single policy. It is the aggregate. On the health measures that matter, the United States is now further behind its peers than it was when a Democrat last occupied the White House.
Life expectancy at birth in the United States reached 79.0 years in 2024 — a modest recovery from pandemic lows, but still 3.7 years below the average of comparable wealthy countries, according to the Peterson-KFF Health System Tracker. The Institute for Health Metrics and Evaluation, in a peer-reviewed Lancet analysis, forecasts that the U.S. global ranking on life expectancy will drop from 49th in 2022 to 66th by 2050 on current trajectory. On “healthy life expectancy” — years of life free from disability — the forecast is worse: from 80th globally to 108th.
On maternal mortality, the United States has the highest rate of any high-income nation, with 17.9 deaths per 100,000 live births in 2024 per CDC’s National Center for Health Statistics. Black women die at a rate of 50.3 per 100,000 — more than triple the rate for white women. The Commonwealth Fund, in its 2025 State Health System Performance Scorecard, found that America remains the only wealthy country that guarantees neither paid parental leave nor postpartum home visits.
On infant mortality, the U.S. rate of 5.34 per 1,000 live births in 2024 exceeds that of virtually every peer nation. Black infants die at more than twice the rate of white infants. And the child mortality rate for Black children under 5 stands at 13.4 per 1,000 — a number more associated with middle-income countries than with the wealthiest nation on Earth. Every one of these gaps is expected to widen as Medicaid coverage contracts under the terms of the Big Beautiful Bill.
V. The Grift Behind the Curtain
What has the Trump administration done with the crisis it manufactured? It launched a presidential brand.
TrumpRx.gov went live on February 5, 2026. The website — hosted on the .gov domain, built with government resources, and named after the sitting president — is not a pharmacy. It is a referral hub that points cash-paying consumers to drug-manufacturer direct-to-consumer discount sites. That is the entire product.
House and Senate Democratic health-committee leaders — including Frank Pallone and Richard Neal — wrote formally to the administration demanding transparency about the site’s ties to the president’s family and donors. A February 2026 Joint Economic Committee analysis found that TrumpRx frequently steers consumers toward brand-name drugs when significantly cheaper generic alternatives exist, and that families using it could end up paying substantially more than they would through independent tools like GoodRx.
At the same time — and this is the fact that ties the entire indictment together — the administration has been actively working to weaken the Medicare drug-price negotiation program established by the Inflation Reduction Act, the single most consequential drug-pricing reform in a generation. According to the Center for American Progress, carve-outs slipped into the Big Beautiful Bill shield billions of dollars’ worth of drugs from negotiation, reducing the projected savings Medicare beneficiaries would have received. The administration is claiming credit for the IRA prices taking effect this year while simultaneously ensuring that the next rounds of negotiation will deliver less relief.
The pattern is unmistakable: the public negotiation program that would lower drug prices for everyone is being quietly dismantled, while the president-branded website is being aggressively promoted. One serves the country. The other serves the brand.
VI. What Has Been Taken, and From Whom
The cumulative damage is now measurable across every major program Americans rely on to stay alive and fed:
“Americans are needlessly losing lives and money. Medicare for All would be both an economic stimulus and life-saving transformation of our health care system.”
— Prof. Alison P. Galvani, Yale School of Public Health, lead author
When policy failure becomes a fitness question: a serious constitutional argument, honestly assessed.
The 25th Amendment was ratified in 1967 in the aftermath of the Kennedy assassination. Its most contested provision, Section 4, permits the vice president together with a majority of the Cabinet — or such other body as Congress may by law provide — to declare the president “unable to discharge the powers and duties of his office,” transferring authority to the vice president pending congressional review. It has never been formally invoked to remove a sitting president.
The Legislators Making the Argument
In April 2026, Rep. Jamie Raskin (D-Md.), the ranking member of the House Judiciary Committee and a constitutional law scholar, introduced legislation with 50 co-sponsors to create the exact “other body” the amendment contemplates: a 17-member independent Commission on Presidential Capacity composed of physicians, psychiatrists, and former senior executive-branch officials. Rep. Raja Krishnamoorthi (D-Ill.) directly called on Vice President Vance and the Cabinet to invoke the amendment. Raskin framed the case in explicitly national-security terms.
The Constitutional Argument
The traditional reading of Section 4 focuses on acute physical or cognitive incapacity — a stroke, a coma, dementia. But the amendment’s text is broader: it addresses inability “to discharge the powers and duties” of the presidency. Progressives making the fitness argument now point to a pattern the healthcare record makes uniquely visible: a president who two years ago said he had only “concepts of a plan” to replace the ACA, who has still produced no coherent replacement, who has permitted policies that will kill tens of thousands of Americans according to peer-reviewed research, and who has simultaneously stood up a federal website carrying his own name — while Yale University has just published, on the record, that a different policy would save 114,000 lives a year. The claim is not that policy disagreement equals incapacity. The claim is that the systematic pursuit of personal branding at the demonstrable cost of American lives is itself evidence a president cannot discharge the duties of his office as they were understood by every president before him.
The Honest Barriers
Any serious progressive analysis has to acknowledge what stands in the way. Section 4 requires the vice president to initiate the process. Vice President JD Vance will not. It also requires a majority of the Cabinet — a Cabinet the president himself selected and can dismiss. Raskin’s commission bill, even if it passed a Republican-controlled Congress (it will not), would be vetoed. And the Supreme Court would almost certainly be called upon to define what “unable to discharge the powers and duties” means in a fitness-of-office rather than medical-incapacity context, on a legal question with essentially no precedent.
Why the Barriers Don’t Negate the Case
None of that changes what the record shows. The point of Raskin’s bill, and of the broader progressive argument, is not to pretend removal is imminent. It is to establish, publicly and on the congressional record, that the framers of the 25th Amendment envisioned a democracy capable of examining its own leadership when the evidence demands it — and that a body of evidence now exists which, in a healthier constitutional culture, would demand it. The Yale study is one entry in that record. The 5 million Americans dropped from ACA rolls are another. So are the 3.5 million dropped from SNAP, the maternal mortality figures, the plummeting global rankings, and the president-branded pharmacy site running on the .gov domain. The moral and constitutional case for accountability does not require a successful removal vote to be a real case. The record will outlast this administration. History will decide what to do with it.
VII. The Choice, Named Plainly
Every credible piece of academic research on American healthcare — from Yale, from the Commonwealth Fund, from the Congressional Budget Office, from the Institute for Health Metrics and Evaluation — points in the same direction. A universal, negotiated, public system saves money and saves lives. A privatized, fragmented, middleman-driven system costs more and kills more. This is not a matter of ideology. It is a matter of arithmetic that the rest of the developed world settled decades ago.
The Republican Party has, in nineteen months of unified control, chosen the more expensive and more lethal option. It let the ACA subsidies die. It cut $1 trillion from Medicaid. It cut $186 billion from SNAP. It weakened Medicare drug negotiation. It launched a president-branded referral site instead of policy. It has produced concepts, not plans; grievances, not proposals; branding, not care.
The bill for those choices is now being paid by American families, one hospital visit and one skipped prescription at a time. And the receipt is $1 trillion a year, plus 114,000 preventable deaths, that would not exist under the alternative Yale University just laid out in black and white.
Editorial Conclusion
The evidence is not close, and neither is the moral question. A peer-reviewed research consensus, spanning half a decade and multiple institutions, has now established that a public single-payer system would save Americans a trillion dollars and more than a hundred thousand lives every year the country continues without it.
The Republican Party knows this. Donald Trump knows this. They have chosen private enrichment, presidential branding, and the systematic dismantling of the imperfect coverage millions of Americans already had — over the health, the solvency, and the survival of the country they were elected to serve.
The 25th Amendment was written for moments when a president can no longer discharge the duties of the office. Producing a website with your name on it while 5 million Americans lose insurance and 3.5 million lose food is not the discharge of those duties. It is their abandonment. The constitutional record now exists. The country’s obligation is to demand that its representatives — every one of them — read it.
Sources & References
- Office of Sen. Bernie SandersNew Study Confirms Medicare for All Would Save 114,000 Lives and More Than $1 Trillion a Year (Aug. 11, 2026)
- Common DreamsYale Study: Medicare for All Would Save Over 114,000 Lives and $1 Trillion a Year
- TruthoutStudy: Medicare for All Would Save 114k Lives Yearly — And Save $1T in Costs
- The LancetGalvani et al., “Improving the prognosis of health care in the USA” (2020)
- Yale School of MedicineMore Than 335,000 Lives Could Have Been Saved During Pandemic Under Universal Care
- STAT NewsPresidential Debate: Trump Still Has No ACA Replacement Plan (Sept. 11, 2024)
- KFFThe “Concept of a Plan” President Trump Proposed to Replace the ACA
- NPR5 Million Have Dropped ACA Insurance After Trump and the GOP Let Prices Skyrocket
- The NationRepublicans Blocked Healthcare Subsidies — and Now More Americans Are Going Uninsured
- WHYY / Associated PressACA Health Subsidies Expire, Launching Millions Into 2026 With Steep Hikes
- CNBCMillions May Drop ACA Coverage — and Raise Health Insurance Costs for Everyone Else
- CNBCAt Least 3.5 Million Have Lost Food Stamp Access as Trump’s “Big Beautiful Bill” Cuts Take Effect
- Washington PostTrump’s “One Big Beautiful Bill” Has Cut Food Assistance for Millions
- Center for American ProgressMedicare Negotiation Is Working, But Trump Rollbacks Diminish Potential Savings
- Joint Economic Committee (Senate Minority)TrumpRx Could Cost Families Thousands in Higher Drug Costs (Feb. 2026 analysis)
- CNBCWhite House Launches Direct-to-Consumer Drug Site TrumpRx
- House Energy and Commerce Committee DemocratsDemocratic Health Committee Leaders Blast TrumpRx for Ties to Donors and Family
- Peterson-KFF Health System TrackerHow Does U.S. Life Expectancy Compare to Other Countries?
- Institute for Health Metrics and EvaluationU.S. Life Expectancy Global Ranking Forecast to Drop From 49th to 66th by 2050
- Commonwealth FundMaternal Mortality in the United States, 2025
- CDC / National Center for Health StatisticsMaternal Mortality Rates in the United States, 2024
- Office of Rep. Raja KrishnamoorthiKrishnamoorthi Calls for President Trump’s Removal Under 25th Amendment
- Fox NewsRep. Jamie Raskin Introduces Bill to Assess Trump’s Fitness for Office
- Office of Sen. Angela AlsobrooksAlsobrooks: “GOP Scam Bill — the Poor Get Poorer and the Rich Get Richer”
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