{
  "nhe_2024_usd_millions": 5278588,
  "cms_projected_nhe_2025_2034_usd_millions": 72135310,
  "historical_through": 2024,
  "projected_years": [
    2025,
    2034
  ],
  "scenarios": [
    {
      "scenario": "conservative",
      "annual_attributed_usd_millions": 105698.3,
      "dollars_per_100_nhe": 2.0,
      "ordinary_surrounding_system_per_100": 98.0,
      "attributed_2025_2034_usd_millions": 1444435.1,
      "method": "All CMS NHE research plus a high billed-charge envelope for current solid-organ transplants; omits most advanced delivery categories."
    },
    {
      "scenario": "central",
      "annual_attributed_usd_millions": 220916.3,
      "dollars_per_100_nhe": 4.19,
      "ordinary_surrounding_system_per_100": 95.81,
      "attributed_2025_2034_usd_millions": 3018963.4,
      "method": "Conservative scenario plus 25% of all cancer care and 50% of domestic pharmaceutical R&D. These are explicit attribution assumptions, not observed allocations."
    },
    {
      "scenario": "high",
      "annual_attributed_usd_millions": 440584.3,
      "dollars_per_100_nhe": 8.35,
      "ordinary_surrounding_system_per_100": 91.65,
      "attributed_2025_2034_usd_millions": 6020868.3,
      "method": "Credits all cancer care and all domestic pharmaceutical R&D, despite ordinary cancer care and global R&D financing; excludes CAR-T separately to avoid cancer double counting."
    }
  ],
  "peer_summary": {
    "peer_countries": [
      "Switzerland",
      "Germany",
      "France",
      "United Kingdom",
      "Netherlands",
      "Sweden",
      "Denmark",
      "Canada",
      "Japan",
      "Australia"
    ],
    "unweighted_peer_averages": {
      "spending_per_capita_usd_ppp_2024": 7737.983,
      "spending_pct_gdp_2024": 10.969,
      "life_expectancy_years_latest": 82.53,
      "avoidable_mortality_per_100k_latest": 162.0,
      "health_price_index_2023": 97.605,
      "health_volume_index_2023": 112.382
    },
    "us": {
      "spending_per_capita_usd_ppp_2024": 14884.941,
      "spending_pct_gdp_2024": 17.16,
      "life_expectancy_years_latest": 78.4,
      "avoidable_mortality_per_100k_latest": 312.0,
      "health_price_index_2023": 152.0,
      "health_volume_index_2023": 151.556
    },
    "us_per_capita_spending_above_peer_average_percent": 92.4,
    "us_price_index_above_peer_average_percent": 55.7,
    "us_volume_index_above_peer_average_percent": 34.9
  },
  "interpretation": "Scenarios are transparent attribution exercises, not categories identified in NHE or causal savings estimates."
}