By NextBestFitEvery licensed provider is in-network
Under one payer or all-payer rates, any licensed provider can see any patient at the standard rate.
Follows from one payer and one rate.
Review ledgerHow this path connects
Concrete changes if chosen
What would actually have to change in law, agencies, payment rules, or systems.
- Require the payer to pay any licensed, enrolled provider at the standard rate
- Create one national provider enrollment and credentialing system
Effects
Each effect has its own page: the evidence, the case that it is or isn't a real cost, and whom it affects.
- Narrow networks and out-of-network surprises
Allowing every licensed provider to treat patients at a standard rate ends network surprises and directory errors and preserves free choice of doctor and hospital. Providers no longer need separate credentialing with many payers.
- About $1 trillion a year in administrative cost
A standard rate with universal provider access removes separate credentialing with many payers.
- Raises spending or loosens control over it
Universal provider access removes insurers' ability to steer patients toward cheaper or higher-quality providers.
- Medical errors and poor care coordination
Without selective contracting, weak providers retain patients they might otherwise lose.
7 paths soften this
Mandatory error reporting and learning systemMedical errors and poor care coordinationChosenEvery person registered with a primary care homeMedical errors and poor care coordinationChosenStandby payments to keep labor units openMaternity care desertsChosenMinimum nurse staffing ratiosNursing and direct-care shortages and burnoutChosenEvidence-based coverage decisionsLow-value care and overtreatmentChosenShift to small homes and home careNursing home understaffing and qualityChosenNational health record and patient IDRecords don't follow patientsChosen
Who's affected
- People with ongoing or specialist care needs
- Narrow networks and out-of-network surprises: Needed specialists and therapists are often out of network.
- Doctors, nurses, and other clinicians
- About $1 trillion a year in administrative cost: Time goes to billing and insurer rules instead of patients.
- People with employer coverage
- About $1 trillion a year in administrative cost: Premiums pay for the administration.
- Taxpayers and public budgets
- About $1 trillion a year in administrative cost: Public programs pay for it too.
- Hospitals, clinics, and care organizations
- Medical errors and poor care coordination: Fee-for-service providers are paid for treating complications.
- Health insurers, brokers, and their shareholders
- Narrow networks and out-of-network surprises: Narrow networks let insurers offer lower premiums.
- About $1 trillion a year in administrative cost: Insurers, billing firms, and clearinghouses earn from the complexity.
- Hospitals and specialist groups with high private prices
- Narrow networks and out-of-network surprises: Out-of-network providers can bill high charges.
- Insurance and billing workers
- About $1 trillion a year in administrative cost: Their jobs exist because of the complexity.
- Taxpayers and public budgets
- Raises spending or loosens control over it: Public budgets pay the added spending.
- People with ongoing or specialist care needs
- Medical errors and poor care coordination: Delivery and coordination failures cause preventable harm.
Where it has been tried
- Traditional Medicare, Canada: Nearly all physicians accept the public payer.
- United States: As of November 2024, 1.2% of active non-pediatric physicians had formally opted out of Medicare.Sources: KFF (2025)