Reference

Glossary

§1498: 28 U.S.C. §1498: lets the federal government use a patented invention (e.g., make a generic drug) while paying the patent holder reasonable compensation.
Balance billing: A provider billing the patient for the difference between its charge and what the insurer paid. Banned under UHP.
DRG: Diagnosis-Related Group: a per-case hospital payment based on the patient's diagnosis.
Dual eligibles: People enrolled in both Medicare and Medicaid (about 12 million).
Duplicative insurance: Private insurance that covers the same services as the public plan, typically bought for faster or more private care.
ESI: Employer-sponsored insurance: health coverage through a job (about 179 million people in 2024).
Fee schedule: A list of prices for each service code. Medicare's physician fee schedule uses RBRVS.
Global budget: A fixed annual payment to a hospital or system for all its services, instead of payment per claim.
HCBS: Home- and community-based services: long-term care at home (aides, adult day care) instead of in an institution.
HTA: Health technology assessment: evaluating whether a treatment works and is worth its price (e.g., UK NICE).
Induced demand: Additional care used when out-of-pocket costs fall to zero.
Integrated care organization (ICO): Under this plan: a provider-run system (like Kaiser) paid a single per-person budget for patients who choose it.
LTSS: Long-term services and supports: help with daily activities for people with disabilities or chronic illness.
MAC: Medicare Administrative Contractor: a private company that processes Medicare claims for a region.
Medicare Advantage (MA): Private plans paid by Medicare to cover beneficiaries (Part C). About 54% of Medicare enrollees in 2024. Ends under the plan.
Medigap: Private supplemental insurance that pays traditional Medicare's cost sharing. Ends under the plan.
MOE: Maintenance of effort: states keep paying what they paid for Medicaid, now to UHP.
Multi-payer: Several insurers (public, nonprofit, or private) pay for care, usually under tight regulation in universal systems.
NHE: National Health Expenditures: CMS's official measure of all U.S. health spending ($5,278.6B in 2024).
Opt-out: A provider choosing not to participate in UHP; under the plan, they may not bill UHP for anyone for two years.
PBM: Pharmacy benefit manager: an intermediary that runs drug benefits for insurers and negotiates rebates.
Price effect: In this site's ledger: the change in spending from paying different prices for the same amount of care.
QALY: Quality-adjusted life year: a measure combining length and quality of life, used in cost-effectiveness analysis.
RBRVS: Resource-Based Relative Value Scale: Medicare's method for setting relative prices across physician services.
Single payer: One public insurer pays for all covered care. Delivery (hospitals, doctors) can still be private.
Supplementary insurance: Private insurance for services the public plan doesn't cover.
Tax exclusion: Employer health premiums aren't counted as taxable income, a federal subsidy of roughly $400B a year.
UHA: Universal Health Administration: the agency inside HHS that runs UHP.
UHP: Universal Health Program: the single public payer this plan creates.
Utilization effect: In this site's ledger: the change in spending from people using more care once it is free and universal.
Wage pass-through: Employer health costs ultimately coming out of (or going into) workers' wages.
Wait-time guarantee: Maximum legal waits; if missed, the patient may go to any provider at UHP's expense.