By NextBestFitRely on universal coverage and uniform rates
Universal coverage plus one rate for every patient ends payer-based discrimination (Medicaid patients paying less).
One rate for every patient.
Review ledgerHow this path connects
This path
Rely on universal coverage and uniform rates
Requires:
All-payer rate settingU.S. prices are far higher than in other countriesChosenCreates or worsens
Concrete changes if chosen
What would actually have to change in law, agencies, payment rules, or systems.
- Pay one rate for every patient regardless of former coverage
Effects
Each effect has its own page: the evidence, the case that it is or isn't a real cost, and whom it affects.
What it fixes
- Racial, income, and geographic disparities
Universal coverage and uniform payment rates provide a simple way to end payer-based discrimination, including turning away Medicaid patients. Disparities can shrink but still remain under universal coverage.
What it creates or worsens
- Solves only part of the problem
Universal coverage and uniform rates do not address nonfinancial barriers such as distance, language, and trust.
Who's affected
Who gains
- Black, Hispanic, and Native communities
- Racial, income, and geographic disparities: Access and outcomes differ by race, income, and location.
- Rural residents
- Racial, income, and geographic disparities: Access and outcomes differ by race, income, and location.
- Low- and middle-income households
- Racial, income, and geographic disparities: Access and outcomes differ by race, income, and location.
Who loses
- Hospitals, clinics, and care organizations
- Racial, income, and geographic disparities: They can select better-paying patients over those with lower-paying coverage.
Where it has been tried
- Canada: In 2023, 42.8% of Canadian adults in the lowest income group reported very good or excellent health, compared with 60.9% in the highest group.Sources: Statistics Canada (2025)