By NextBestFitPhase 1: Enactment & build · Step 1.1
Create the Universal Health Administration
Months 0–18 · HHS Secretary; UHA Administrator (Senate-confirmed, 6-year term, removable only for cause)Discuss this step
Stand up the agency that runs UHP by absorbing CMS's Medicare operations, then building out 10 regional offices, independent rate-setting and technology-assessment boards, and an Office of Patient Advocacy.
Legal vehicle
Universal Health Act, Title I. CMS's Center for Medicare is transferred by statute.
Who does it
HHS Secretary; UHA Administrator (Senate-confirmed, 6-year term, removable only for cause)
When
Months 0–18
One-time cost
$9.0B
Recurring, per year
+$96.5B
Start-up staffing is $9.0B one-time. Steady-state UHP administration is $96.5B a year (2.5% of benefits) in the 'Public program administration' ledger line, which replaces Medicare and Medicaid administration.
In this step
Tasks
7 tasks
Design choice & alternatives
2 decisions with alternatives
Costs & calculations
3 cost items, each with its calculation
Trade-offs
3 pros · 3 cons · 2 trade-offs
Risks
3 risks with mitigations
What changes in the system
4 existing laws, programs, or institutions changed
Other countries
5 comparisons
Cost items
- Public program administration$107.5B
- Agency start-up before steady-state funding$9.0B
- Jobs created: Universal Health Administration & claims contractors$0.0B
Biggest risk for this step
Rate-setting captured by providers or politics. See risks.
Depends on
Nothing: this step can start first.
Steps that depend on this one
- 1.2 Create the UHP Trust Fund
- 1.3 Build the claims, payment & data systems
- 1.4 Enroll everyone automatically
- 1.6 Sign up providers & set participation rules
- 1.7 Set the national fee schedule
- 1.8 Set hospital global budgets
- 1.9 Create the national formulary & negotiate drug prices
- 1.10 Create the Health Technology Assessment Institute
- 1.14 Set data governance & privacy rules
- 2.1 Upgrade Medicare enrollees into UHP