Every actuarial estimate predicts savings during the first year of transition and in every year following. The math is somewhat simple every claim dollar has almost 33% eaten by administrative costs, medicare does it for only 3%. That is the savings along with less time wasted on writing referrals and getting approvals. I've survived serious hospitalizations on both sides of the Atlantic, Europe had a much better ER scene and their care while more spartan it was 100 times cheaper. I spent 17 days in severe ICU on a ventilator and the whole bill for 35 days in the hospital wasn't even 20K euros. Yes some specialized care might get backed up. I'd guess we could get some Physician Assistants up and practicing fairly quickly. Yes the longstanding shortage caused by the medical cartel keeping the seats in medical schools below population growth is part of this mess. But having less time wasted checking coverage for things would speed up care, saving everyone's time including the Doctors themselves. Will our system be at its best the first 5 years, no it will take time for the staffing to reorganize and scale up to what is truly needed. We all all at risk as long as this dimwitted and inefficient system is still in place. This system leads to overcrowded emergency rooms which pose a risk to us all, no matter how healthy and far from medical need we are right now. It only takes a drunk driver to send you into the ER and as long as that is our medical safety net we are all at risk. This is how single payer has to be sold, we can save money right away, it will make even the rich better off once the strain on our ER system is relived and over 5-10 years we will get the gains from preventative medicine.