By NextBestFitFast transition in one or two years
Everyone moves to the new system at once after a preparation period.
Draft decision:RejectedConfidence: medium · not yet reviewed
Too risky at U.S. scale.
Review ledgerHow this path connects
This path
Fast transition in one or two years
Creates or worsens
Concrete changes if chosen
What would actually have to change in law, agencies, payment rules, or systems.
- Switch everyone in one or two years after preparation
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
- Transition disruption: jobs, companies, and familiar coverage
Moving everyone after a preparation period brings benefits and savings quickly and avoids parallel systems, but causes abrupt job losses.
- About $1 trillion a year in administrative cost
Moving everyone to the new system together avoids operating parallel coverage systems.
What it creates or worsens
- Requires new or changing information systems
Moving everyone together means information-system and enrollment failures affect everyone at once.
Who's affected
Who gains
- People with employer coverage
- Transition disruption: jobs, companies, and familiar coverage: People leave plans most of them rate well, and must re-learn how coverage works.
- About $1 trillion a year in administrative cost: Premiums pay for the administration.
- Insurance and billing workers
- Transition disruption: jobs, companies, and familiar coverage: Jobs selling coverage and processing claims end.
- Health insurers, brokers, and their shareholders
- Transition disruption: jobs, companies, and familiar coverage: Insurers lose their core business, and shareholders lose value.
- Uninsured people
- Transition disruption: jobs, companies, and familiar coverage: Moving everyone after a preparation period brings benefits and savings quickly and avoids parallel systems, but causes abrupt job losses.
- Doctors, nurses, and other clinicians
- About $1 trillion a year in administrative cost: Time goes to billing and insurer rules instead of patients.
- Taxpayers and public budgets
- About $1 trillion a year in administrative cost: Public programs pay for it too.
Who loses
- Health insurers, brokers, and their shareholders
- About $1 trillion a year in administrative cost: Insurers, billing firms, and clearinghouses earn from the complexity.
- Insurance and billing workers
- About $1 trillion a year in administrative cost: Their jobs exist because of the complexity.
Other ways to soften the losses
- Large up-front worker transition program
Where it has been tried
- Taiwan: Merged its insurance programs and launched NHI within about a year in 1995.