Will SAFECARE Pay For Itself?

SAFECARE is not a promise that health care will suddenly become cheap. It is a plan to fund the system Americans already pay for, but to fund it transparently and keep it solvent. In 2024, the U.S. spent about $5.3 trillion on health care. The question is whether the new structure can reliably collect enough revenue to cover costs and maintain a buffer without borrowing.

The core funding mechanism is simple and measurable. SAFECARE uses an 8.0% employer payroll contribution. On the individual side it uses a 3.5% base personal contribution on Modified Adjusted Gross Income, collected mostly through wage withholding with annual reconciliation, plus a personal high-income surtax that applies per individual, not by household, at 1.0% above 100,000 dollars, an additional 1.5% above 250,000 dollars, and an additional 2.0% above 500,000 dollars, reaching an 8.0% marginal rate above 500,000 dollars. Social Security benefits, VA-administered veterans benefits, and up to 100,000 dollars of retirement distributions are excluded from the contribution base, and the 199A qualified business income deduction is preserved. The Medicare Hospital Insurance payroll tax is replaced rather than stacked, and the Net Investment Income Tax is repealed on the main implementation date so investment income is not hit twice.

The second pillar is price discipline where the U.S. is uniquely overcharged. CMS reports retail prescription drug spending of $467.0 billion in 2024. SAFECARE’s formulary is tied to negotiated net prices with an international reference ceiling. The gap it targets is real. Published price comparisons show Ozempic at $936 per month in the U.S. versus far lower prices in peer countries. The basic logic is that America should not be the default profit sponge where the same drug is sold for a fraction abroad and marked up several times here.

The third pillar is the removal of duplicated administrative machinery that exists only because the U.S. runs hundreds of payers with different rules, codes, and denial tactics. Major reviews estimate total system waste in the high hundreds of billions annually, with administrative complexity as a large share. SAFECARE does not require perfect savings. It requires structural simplification, one claims pipeline, one rulebook, and real fraud enforcement at scale.

Finally, the bill has a financial governor. The Trust Fund must stay within a 5% to 10% reserve band. If the reserve slips, rates adjust automatically in small steps. On the same 2024 wage base, one stabilizer step of +0.30 percentage points total raises about $37 billion per year. That is what makes "no deficit" credible. Forecasts can be wrong. The system still stays solvent without hidden borrowing.