The 10-for-10 Plan: How the Rich Paying Just 10% Could Give Every American Health Care – Medium

A Report on a Proposed Financial Framework for Universal Healthcare in the United States

Aligning National Health Policy with Sustainable Development Goals

This report outlines a proposal, termed the “10-for-10 Plan,” designed to finance universal healthcare coverage in the United States. The framework is analyzed through the lens of the United Nations Sustainable Development Goals (SDGs), with a particular focus on SDG 3 (Good Health and Well-being), SDG 1 (No Poverty), and SDG 10 (Reduced Inequalities). The proposal suggests that a 10% federal tax on the top 10% of income earners could serve as the primary funding mechanism to eliminate medical debt, guarantee healthcare access, and create a more equitable society.

The Systemic Challenge: Healthcare Expenditure and Inequity

The United States currently faces a significant challenge in providing equitable healthcare. This situation presents a direct obstacle to achieving SDG 3, which aims to ensure healthy lives and promote well-being for all at all ages. The core issues are:

• Annual national health expenditure exceeds $5.5 trillion, the highest globally.
• Despite this expenditure, millions of citizens remain uninsured or underinsured, creating profound inequalities in health outcomes, a direct contradiction of the principles of SDG 10.
• The financial burden of healthcare, including premiums, co-pays, and unexpected medical bills, is a leading cause of personal bankruptcy, undermining SDG 1 by pushing families into poverty.

The “10-for-10” Financial Concept

The proposed model is structured to generate sufficient revenue for a universal public health program by leveraging a progressive taxation strategy, which directly supports SDG 10 (Reduced Inequalities).

Revenue Projection Analysis

• The top 10% of U.S. earners generate approximately $13 trillion in annual income.
• A 10% federal tax on this income group would yield an estimated $1.3 trillion annually.
• This new revenue, combined with the approximately $2 trillion the federal government already allocates to healthcare (e.g., Medicare, Medicaid, VA), creates a substantial funding base for a universal system.

A Four-Pillar Funding Strategy

The plan is built upon a multi-faceted financial strategy to ensure its sustainability and efficacy.

1. 10-for-10 Tax on the Top 10% Earners: This pillar raises approximately $1.3 trillion annually, representing an equitable contribution from the highest beneficiaries of the national economy, thereby advancing SDG 10.
2. Employer Maintenance-of-Effort (MoE): This component would redirect approximately $350 billion. Employers would contribute amounts comparable to their current healthcare benefit expenditures into the universal fund instead of to private insurers.
3. Cost Controls and System Reform: An estimated $200 billion in annual savings could be realized through efficiency measures such as negotiating drug prices, capping hospital rates, and simplifying administrative processes. This promotes a sustainable model for SDG 3.
4. High-Earner Surtax on Passive Income: An additional $150–$200 billion could be generated via a modest surtax on high investment income, further reinforcing the progressive structure in line with SDG 10.

The combined total of over $2.0 trillion is projected to be sufficient to fund universal coverage while reducing overall national health spending through improved efficiency.

Integration of Public and Private Healthcare Systems

The proposal does not advocate for the elimination of private healthcare. Instead, it models a hybrid system common in other developed nations to ensure comprehensive coverage and choice.

• The Public System: Would provide universal access to essential health services, including hospital care, physician visits, prescriptions, and preventive care, fulfilling the core mandate of SDG 3.
• The Private System: Would offer supplemental insurance for non-essential services, such as private rooms or expedited elective procedures. This structure maintains innovation and reduces pressure on public resources.

Stakeholder Analysis and Counterarguments

Objections from High-Income Earners

The assertion that a 10% tax is confiscatory is countered by the fact that this demographic would retain 90% of their income. Historically, higher top marginal tax rates have coexisted with periods of strong economic growth and innovation.

Objections from Employers

The Maintenance-of-Effort contribution is not a new tax but a redirection of existing healthcare premium payments. This shift offers cost predictability and stability, contributing to a more stable economic environment supportive of SDG 8 (Decent Work and Economic Growth).

Objections from Healthcare and Pharmaceutical Industries

Concerns that price controls would lead to insolvency are mitigated by evidence from other OECD nations where rate-setting and value-based pricing have successfully controlled costs while ensuring the viability of health systems.

Objections from Fiscal Conservatives

The plan is designed to be budget-neutral by replacing inefficient private spending with efficient public administration. Revenue could be protected within a dedicated Health Trust Fund, similar to the Social Security model, to ensure fiscal responsibility.

Concerns from Middle-Class Families

This plan is structured to decrease the total household cost of healthcare by 15–25% by eliminating premiums, deductibles, and unexpected medical bills. This reduction in financial burden directly supports SDG 1 by preventing health-related poverty.

Implementation Framework

A phased and structured implementation is recommended to ensure a smooth transition.

1. Institute a three-year phase-in period to mitigate economic disruption.
2. Establish a Federal Health Trust Fund to manage all revenue streams transparently.
3. Launch pilot programs in select regions to refine cost-control models.
4. Brand the program as an extension of a trusted entity, such as “Medicare for All Americans.”
5. Guarantee the preservation of benefits for seniors while integrating other populations.
6. Regulate private supplemental insurance to prevent preferential access to essential care.

Conclusion: A Pathway to Achieving Sustainable Development Goals

The “10-for-10 Plan” presents a viable, data-driven financial model for achieving universal healthcare in the United States. Its implementation would represent a significant step toward fulfilling commitments to key Sustainable Development Goals.

• SDG 3 (Good Health and Well-being): By guaranteeing universal access to care.
• SDG 1 (No Poverty): By eliminating medical debt as a driver of poverty.
• SDG 10 (Reduced Inequalities): By creating an equitable system funded by a progressive tax structure.

This proposal reframes the universal healthcare debate from one of affordability to one of political will, arguing that a fair and efficient system is not only possible but is a critical investment in the nation’s long-term health, stability, and economic prosperity.

1. Which SDGs are addressed or connected to the issues highlighted in the article?

SDG 3: Good Health and Well-being

• The article’s central theme is the establishment of universal health care in the United States. It directly addresses the question, “how do we guarantee health care for everyone?” This aligns with SDG 3’s mission to ensure healthy lives and promote well-being for all at all ages. The proposal aims to cover every American, eliminating the problem of millions being “uninsured or underinsured.”

SDG 10: Reduced Inequalities

• The article’s proposed funding mechanism, the “10-for-10 plan,” is a fiscal policy designed to reduce economic inequality. It suggests a “10% tax on the top 10% of U.S. income earners,” who the article notes are “taking home roughly half of all national income.” This directly tackles the disparity in wealth and income by requiring “a fair contribution from those who’ve gained the most from our economy” to fund a universal social service.

SDG 1: No Poverty

• The article highlights the severe financial burden of healthcare, mentioning “premiums, copays, and surprise bills” and the goal to “end medical debt.” One of the plan’s stated outcomes is that “No one goes broke because they got sick.” This connects to SDG 1 by aiming to prevent households from falling into poverty due to catastrophic health expenditures and by providing a social protection system that mitigates financial shocks related to health crises.

SDG 16: Peace, Justice and Strong Institutions

• The article proposes institutional reforms to make healthcare financing more efficient and transparent. It suggests creating a “Federal Health Trust Fund to hold and protect all revenue streams,” which relates to building effective and accountable institutions. The plan emphasizes replacing “private spending with public efficiency” and implementing “cost controls and reform” to “eliminate waste,” which speaks to improving the governance and efficiency of public expenditure.

2. What specific targets under those SDGs can be identified based on the article’s content?

SDG 3: Good Health and Well-being

• Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.
  
  The article is entirely focused on this target. The “10-for-10 plan” is designed to “fully fund universal health coverage for everyone in the United States.” It explicitly aims to provide financial risk protection by ensuring “no one goes broke because they got sick” and eliminating “premiums, deductibles, and surprise bills.” The public system would cover “hospital, doctor, prescriptions, preventive care,” which are essential health-care services.

SDG 10: Reduced Inequalities

• Target 10.4: Adopt policies, especially fiscal, wage and social protection policies, and progressively achieve greater equality.
  
  The proposal of a “10% federal tax on the top 10%” and a “High-Earner Surtax on Passive Income” is a direct fiscal policy aimed at redistribution to fund a universal social protection program (health care). This is intended to create a more equitable system where the wealthiest contribute more to a public good, thereby promoting greater equality.

SDG 1: No Poverty

• Target 1.3: Implement nationally appropriate social protection systems and measures for all, including floors, and by 2030 achieve substantial coverage of the poor and the vulnerable.
  
  Universal health care, as proposed in the article, is a fundamental component of a national social protection system. The plan aims to create a system where “everyone gets covered,” providing a safety net that protects all citizens, especially the vulnerable, from the financial consequences of illness.

SDG 16: Peace, Justice and Strong Institutions

• Target 16.6: Develop effective, accountable and transparent institutions at all levels.
  
  The article’s proposal to “Create a Federal Health Trust Fund to hold and protect all revenue streams” is a mechanism for creating a transparent and accountable institution. The emphasis on “simplified billing, unified rates, and negotiated drug prices” aims to make the healthcare financing system more effective and less wasteful, aligning with the goal of institutional reform and efficiency.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

For Target 3.8 (Universal Health Coverage)

• Indicator 3.8.1 (Coverage of essential health services): The article implies this indicator by stating the goal is to ensure “everyone gets covered” and that the current system “leaves millions uninsured or underinsured.” Progress would be measured by the increase in the percentage of the population with access to essential health services.
• Indicator 3.8.2 (Proportion of population with large household expenditures on health): The article directly addresses this by aiming to “end medical debt” and eliminate “premiums, deductibles, and surprise bills.” It predicts that for middle-class families, the “total household health cost goes down 15–25%.” This reduction in out-of-pocket spending is a direct measure of this indicator.

For Target 10.4 (Fiscal and social protection policies for equality)

• Indicator 10.4.1 (Labour share of GDP, comprising wages and social protection transfers): The article’s plan to raise “$1.3 trillion annually” from the top 10% and redirect it into a universal health fund is a massive increase in social protection transfers. The success of this fiscal policy could be measured by analyzing the redistribution of national income towards social benefits. The article notes the top 10% earn “$13 trillion a year,” providing a baseline for measuring the impact of the proposed tax.

For Target 1.3 (Social protection systems coverage)

• Indicator 1.3.1 (Proportion of population covered by social protection floors/systems): The primary goal of the plan is to move from a system where “millions” are uncovered to one where “everyone gets covered.” The key metric for this indicator would be the percentage of the U.S. population covered by the new universal health program, aiming for 100% coverage.

For Target 16.6 (Effective, accountable, transparent institutions)

• Implied Indicator: Government spending efficiency and budget transparency. The article claims the plan will cut “overall national spending by hundreds of billions through efficiency” by implementing “cost controls and reform” that save “$200 billion annually.” Progress could be measured by tracking the total national health expenditure as a percentage of GDP, with the goal of reducing it while expanding coverage, and by auditing the proposed “Federal Health Trust Fund” for transparency.

4. SDGs, Targets, and Indicators Table

Source: dowhatmatters.medium.com