By NextBestFitAnnual appropriations from general revenue
The health budget is set every year alongside other spending.
Draft decision:RejectedConfidence: medium · not yet reviewed
Conflicts with the trust fund; underfunding risk.
Review ledgerHow this path connects
This path
Annual appropriations from general revenue
Creates or worsens
Concrete changes if chosen
What would actually have to change in law, agencies, payment rules, or systems.
- Fund health through annual appropriations
- Set a real per-capita spending floor
Effects
Each effect has its own page: the evidence, the case that it is or isn't a real cost, and whom it affects.
The question it answers
Chronic underfunding by government budgetsSetting the health budget annually alongside other spending provides strong spending control and lets health compete openly with other priorities. Health funding is squeezed in downturns.
What it fixes
None identified.
What it creates or worsens
- Longer waits if demand grows faster than capacity
Waits rise when annually set health budgets lag demand.
12 paths soften this
Legal wait-time guaranteesLonger waits if demand grows faster than capacityChosenBuild capacity before demand risesLonger waits if demand grows faster than capacityChosenPay for activity on top of budgetsLonger waits if demand grows faster than capacityChosenFund more residency slotsPhysician shortage, especially in primary careChosenFull practice authority for NPs, PAs, pharmacists, dental therapistsScope-of-practice limits waste capacityChosenTeam-based care with physician oversightScope-of-practice limits waste capacityRejectedFee-for-service at public fee scheduleU.S. prices are far higher than in other countriesChosenKeep means testing, but expand home careLong-term care requires spending down to povertyChosenAllow private insurance for covered servicesTwo-tier care: a private fast lane for those who can payRejectedBudgets adjust automatically for population, age, and volumeFixed budgets can ration careChosenBase budget plus activity paymentsFixed budgets can ration careChosenWaiting-time guarantees as a backstopFixed budgets can ration careChosen - Fixed budgets can ration care
Setting the health budget annually can leave funding behind demand, with longer waits for care.
Who's affected
Who gains
- Taxpayers and public budgets
- Fixed budgets can ration care: Global budgets cap spending.
Who loses
- People with employer coverage
- Longer waits if demand grows faster than capacity: They are seen fastest today and would share one queue with everyone.
- People with ongoing or specialist care needs
- Longer waits if demand grows faster than capacity: They need specialists and procedures most often.
- Fixed budgets can ration care: Hospitals may slow elective procedures when demand exceeds fixed budgets.
Other ways to soften the losses
- A legal floor (e.g., per-capita spending cannot fall in real terms)
Where it has been tried
- UK NHS: Years of below-trend budget growth after 2010 were followed by record waiting lists.Sources: NHS England (2025)
- Canada: Federal transfers to provinces were cut in the 1990s, followed by longer waits.Sources: Fraser Institute (2025)