Nearly Two Hundred Million Forgotten Americans

Ed Minnock

July 4, 2025

Nearly 200 million Americans are living paycheck to paycheck.[i] People living paycheck to paycheck are at risk of not being able to pay bills if they miss a single payday. These are people who don’t enough savings to cover one large unexpected expense, such as a hospital bill.

The problem: for decades, the cost of living has increased faster than wages. In 2023, the inflation-adjusted per-capita cost of healthcare was 6.4 times what it was in 1971.[ii] But the $7.25 federal minimum wage adjusted for inflation is just 57 percent of what it was in 1971. The median house price has increased more than four times faster than the median income. From 1971 to 2023, the median price of an American home increased from $25,200 to $428,700, a seventeen-fold increase. During the same period, the median salary increased from $10,622 to $44,225, a fourfold increase.[iii] 

Because the cost of living has increased faster than wages, a 2020 study of 163 countries revealed that the U.S was one of only three countries whose quality of life declined during the previous decade, and the U.S declined the most.[iv]

Fortunately, there are steps that can be taken to significantly relieve the hardship:

1.       Reduce and limit healthcare costs (as every other developed democracy does).

2.       Increase the supply of affordable houses and apartments

3.       Raise the minimum wage

Voters overwhelmingly want these policies implemented.

Reduce Healthcare Cost

In 2023, America spent $4.9 trillion on healthcare, or $14,570 per person.[v] In 2024, the federal government spent $1.9 trillion on healthcare and services, or more than twice what was spent on defense.[vi]

Healthcare has become so expensive that by 2022, employers paid more for healthcare as a percent of total employee compensation (7.9 percent) than they did for Social Security, Medicare, unemployment insurance, and worker's compensation benefits combined (7.2 percent).[vii] To reduce cost, employers have increased the share of premiums that employees pay and increased deductibles. A 2021 poll revealed that voters’ number one priority was reducing healthcare costs.[viii] 

In 2022, U.S. prescription drug prices were, on average, 2.78 times higher than the average prices in thirty-three other developed countries.[ix] The Inflation Reduction Act of 2022 was the first law that began to reduce prescription drug prices. The law requires the Secretary of HHS to negotiate prices with drug companies for a small number of single-source brand-name drugs or biologics without generic or biosimilar competitors covered under Medicare Part D (prescription drugs) and Part B.[x]

Accelerating the number of drugs negotiated from fifteen to thirty beginning in 2027 and extending negotiated drug prices to Medicaid and private insurance plans could bring annual savings to $100 million.[xi] 

Eighty-three percent of Americans want the government to lower the prices of prescription drugs.[xii]

In 2022, spending on hospital services accounted for 42 percent of total healthcare spending among the 160 million Americans with private insurance.[xiii] The price paid to hospitals for privately insured individuals was, on average, 2.54 times what Medicare would have paid. Hospital costs are the primary reason healthcare costs cause financial distress and bankruptcy. Limiting what hospitals can charge to what Medicare would pay would reduce healthcare costs by roughly $800 billion annually. Seventy-eight percent of Americans support limiting hospitals’ costs.[xiv]

Medicare and Medicaid fraud are estimated to exceed $100 billion per year. There are two primary types of Medicare and Medicaid fraud. First is making claims for services not rendered. All it takes is a street address, patient information, doctors’ signatures, and the government-issued Medicare and Medicaid handbooks that explain how to charge the government for services rendered or, in this case, not rendered.[xv] The second is insurance provider overbilling. The Centers for Medicare & Medicaid Services allows private insurance providers to add diagnoses to patients’ records and receive larger payouts from Medicare. For instance, Medicare pays private insurers an annual base rate of $3,735 for a healthy person. But if someone is diagnosed with morbid obesity, Medicare adds $2,370 for a total of $6,105.[xvi]

It should be easy to stop Medicare Advantage insurance providers from adding false maladies to patients’ records. This book predicts that Republicans would join Democrats to pass a law prohibiting insurance providers from adding maladies to patients’ records. If Medicare Advantage insurance providers believe patients have additional maladies, they should contact the patients. This could save up to $25 billion per year. This book predicts the Supreme Court will let this law stand.

Stopping false Medicare claims is much harder. There are 450 federal agents assigned to Medicare and Medicaid fraud, but they can’t begin to keep up.[xvii] Having more agents would

Accelerating the number of drugs negotiated and extending negotiated drug prices to Medicaid and private insurance plans, limiting hospital costs to what Medicare would pay, and reducing fraud would reduce the cost of healthcare by nearly one trillion dollars per year. The burden of large medical bills would be greatly reduced, resulting in fewer healthcare bankruptcies. Employer healthcare and Medicare, Medicaid, and other government-funded healthcare costs would also be significantly reduced.

Reduce Housing Cost

The financial crisis took a toll on homeowners. By 2011, 4.7 million American households had lost their homes. For real estate investment firms, the extraordinary supply of cheap homes in good neighborhoods was a once-in-a-lifetime opportunity. Private equity firms took the lead. Blackstone, the world’s largest private equity company, amassed 82,500 homes.[xviii]

As the economy recovered, housing prices skyrocketed partly because so many homes had been taken off the market. Because private equity firms aim to maximize profit, rent prices were increased, fees were added, maintenance was delayed, and renters who fell behind were quickly evicted.[xix]

In 2022, large institutional investors (companies that own over 100 single-family homes) owned 574,000 single-family homes, including 29 percent of single-family-rental homes in Atlanta, 24 percent in Jacksonville, Florida, and 20 percent in Charlotte, North Carolina.[xx]

Today, housing costs eat up most of the budget for most Americans. Nearly 30 percent of American homeowners are “house poor,” meaning they spend 30 or more percent of their income on housing. Forty percent of renters spend over 30 percent of their income on housing.[xxi] 

Congress should pass a bill that requires corporations that own more than fifty homes to sell their homes within three years.

Seventy-eight percent want Congress to address high housing costs.[xxii]

America needs to build more houses. America has roughly 425 dwellings (houses, condominiums, and apartments, etc.) per thousand people. Italy, France, Portugal, and Finland have between 580 and 600 dwellings per thousand people. The average in the European Union is about 520.[xxiii]

The shortage of houses and apartments, combined with zoning restrictions, burdensome permitting processes, and stagnant wages have caused housing prices to increase more than four times faster than wages, as noted. States should reform their laws and regulations to allow faster permitting and construction of affordable houses and apartments

Raise Minimum Wage

Today, the minimum wage in twenty states the same as the federal minimum wage: $7.25. In all those states, $7.25 per hour falls far short of a living wage without government programs. [xxiv] 

Seventy-four percent of Americans believe the federal minimum wage, currently $7.25, should be raised to $20 per hour.[xxv] A raise to $20 per hour would provide raises to over 40 million Americans. A $15 minimum wage would provide raises to over 30 million Americans.

According to Matthew Desmond, author of, Poverty in America, a higher minimum wage eases the “grind of poverty.” It reduces stress-related health problems, teen births, child neglect, smoking, and alcohol consumption.[xxvi]

Alleviate the Burden of Living Paycheck to Paycheck

Relieving the hardship of nearly 200 hundred million people should be a top priority for lawmakers. Three actions that will help: reduce and limit healthcare costs (as every other developed democracy does), raise the minimum wage, and increase the supply of affordable houses and apartments.

[i]       Clara Haverstic, “57% of Americans Live Paycheck to Paycheck in 2025, MarketWatch, May 14, 2025, https://www.marketwatch.com/financial-guides/banking/paycheck-to-paycheck-statistics/.

[ii]     Matthew McGough, Emma Wager, Aubrey Winger, Nirmita Pancal, and Lynne Cotter, “How Has U.S. Spending on Healthcare Changed Over Time?,” Peterson-KFF Health System Tracker, December 20, 2024, https://www.healthsystemtracker.org/chart-collection/u-s-spending-healthcare-changed-time/#Total%20national%20health%20expenditures,%201970-2023

[iii]     How Long Does It Take to Save for a House,” WTF Happened in 1971, accessed April 5, 2025,  https://www.youtube.com/watch?app=desktop&v=auV3099wmPI.

[iv]    Devon Haynie, “Report: American Quality of Life Declines Over Past Decade,” USNews, September 11, 2020,  https://www.usnews.com/news/best-countries/articles/2020-09-11/a-global-anomaly-the-us-declines-in-annual-quality-of-life-report

[v]       Matthew McGough, Emma Wager, Aubrey Winger, Nirmita Pancal, and Lynne Cotter, “How Has U.S. Spending on Healthcare Changed Over Time?,” Peterson-KFF Health System Tracker, December 20, 2024, https://www.healthsystemtracker.org/chart-collection/u-s-spending-healthcare-changed-time/#Total%20national%20health%20expenditures,%201970-2023

[vi]      Juliette Cubanski, Alice Burns, and Cynthia Cox, “What Does the Federal Government Spend on Health Care?,” KFF, February 24, 2025, https://www.kff.org/medicaid/issue-brief/what-does-the-federal-government-spend-on-health-care/.

[vii]   Sam Hughes, Emily Gee, and Nicole Rapfogel, “Health Insurance Costs Are Squeezing Workers and Employers,” The Center for American Progress, November 29, 2022, https://www.americanprogress.org/article/health-insurance-costs-are-squeezing-workers-and-employers/.

[viii]     Erica Socker, “New Poll: Majority of Voters Want Congress to Take Action to Lower Health Care Prices,” Arnold Ventures, June 30, 2021, https://www.arnoldventures.org/stories/new-poll-majority-of-voters-want-congress-to-take-action-to-lower-health-care-prices.

[ix]      Kavita K. Patel and Kevin A. Schulman, “Policy Options to Reduce Prescription Drug Costs Across Medicare, Medicaid, and Commercial Insurance,” Stanford Medicine, Department of Medicine News, accessed March 27, 2025, https://medicine.stanford.edu/news/current-news/standard-news/policy-options-white-paper.html#:~:text=While%20cost%2Dsavings%20in%20Medicare,market%20more%20transparent%20and%20accessible

[x]       Juliette Cubanski, Tricia Neuman, and Meredith Freed, “Explaining the Prescription Drug Provisions in the Inflation Reduction Act,” KFF, January 24, 2023, https://www.kff.org/medicare/issue-brief/explaining-the-prescription-drug-provisions-in-the-inflation-reduction-act/#:~:text=The%20law%20that%20established%20the,require%20a%20particular%20formulary%20or

[xi]      Patel and Schulman, “Policy Options to Reduce Prescription Drug Costs Across Medicare, Medicaid, and Commercial Insurance,” see note ix.

[xii]     Emma Wager, Cynthia Cox, and Krutika Amin, “What Are the Recent and Forecasted Trends in Prescription Drug Spending,” Health System Tracker, September 15, 2023, https://www.healthsystemtracker.org/chart-collection/recent-forecasted-trends-prescription-drug-spending/#Total%20out-of-pocket%20retail%20prescription%20drug%20spending,%20projections%20before%20&%20after%20passage%20of%20the%20Inflation%20Reduction%20Act.

[xiii]     Matt Wirz, “Private Equity’s Food Binge Goes Sour,” Wall Street Journal, February 18, 2021, https://www.wsj.com/articles/private-equitys-food-binge-goes-sour-8f830dd4?gaa_at=eafs&gaa_n=ASWzDAjYiRe4SCFGboJ1X7c_tvCy-iBE--SigerotuMCoXyv10G8KImrYMaLxERZB9A%3D&gaa_ts=683a5e55&gaa_sig=aPAoy0N7dTvceXwzPknM1KPsUUfyQuM51L-xDFdJ4kgT5hlrsS6Ff2e-08sUvIyqGXSjdVMOOimakjJqDxr9Ag%3D%3D.

[xiv]     Erica Socker, “New Poll: Majority of Voters Want Congress to Take Action to Lower Health Care Prices,” Arnold Ventures, June 30, 2021, https://www.arnoldventures.org/stories/new-poll-majority-of-voters-want-congress-to-take-action-to-lower-health-care-prices.

[xv]     Scott Zamost, “Inside the Mind of Criminals: How to Brazenly Steal $100 Billion from Medicare and Medicaid,” CNBC, March 9, 2022, https://www.cnbc.com/2023/03/09/how-medicare-and-medicaid-fraud-became-a-100b-problem-for-the-us.html.

[xvi]     Christopher Weaver, Tom McGinty,  Anna Wilde Mathews, and  Mark Maremount, “Insurers Pocketed $50 Billion From Medicare for Diseases No Doctor Treated,” Wall Street Journal, July 8, 2024, https://www.wsj.com/health/healthcare/medicare-health-insurance-diagnosis-payments-b4d99a5d.

[xvii]    Scott Zamost, “Inside the Mind of Criminals: How to Brazenly Steal $100 Billion from Medicare and Medicaid,” CNBC, March 9, 2022, https://www.cnbc.com/2023/03/09/how-medicare-and-medicaid-fraud-became-a-100b-problem-for-the-us.html.

[xviii]   Francesca Mari, “A $60 Billion Housing Grab by Wall Street,” New York Times, October 22, 2021,  https://www.nytimes.com/2020/03/04/magazine/wall-street-landlords.html.

[xix]     Valerie Stahl, “Welcome to Blackstone: How Private Equity Is Gobbling Up the American City and Turning Residents into Collateral,” Tablet, July 4, 2023, https://www.tabletmag.com/sections/news/articles/welcome-blackstone-usa.

[xx]     Laurie Goodman, Amalie Zinn, Katherine Reynolds, and Owen Noble, “A Profile of Institutional Investor Owned Single-Family Rental Properties,” Housing Financial Policies Center – Urban Institute, April 25, 2023,  https://www.urban.org/sites/default/files/2023-04/A%20Profile%20of%20Institutional%20Investor%E2%80%93Owned%20Single-Family%20Rental%20Properties_0.pdf.

[xxi]     Ezra Klein and Derek Thompson, Abundance (Avid Reader Press / Simon & Schuster, 2025).

[xxii]    David M. Dworkin and Dennis C. Shea, “Across the Aisle, Americans Look to Congress to Address Housing,” Newsweek, June 25, 2024, https://www.newsweek.com/across-aisle-americans-look-congress-address-housing-opinion-1915898.

[xxiii]   “HM1.1. Housing Stock and Construction,” OECD Affordable Housing Database, accessed April 3, 2025,  https://www.oecd.org/content/dam/oecd/en/data/datasets/affordable-housing-database/hm1-1-housing-stock-and-construction.pdf.

[xxiv]    Shannon Ongaro, “US Minimum Wage By State: A Guide for Employers [2025],” Deel, June 20, 2025, https://www.deel.com/blog/us-minimum-wage-laws/

[xxv]    Sharon Zhang, “74 Percent of Voters Support Raising Federal Minimum Wage to $20 an Hour,” Truthout, May 30, 2023, https://truthout.org/articles/74-percent-of-voters-support-raising-federal-minimum-wage-to-20-an-hour/.

[xxvi]   Matthew Desmond, Poverty by America (Crown, 2023).