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
How other countries handled this same piece of implementation, what happened, and what it means for this plan.
Side by side
| Country | Approach | Result | Lesson for this plan |
|---|---|---|---|
| This plan (U.S.) | 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. | ||
| Taiwan | One national agency (NHIA) runs all claims, with about 2,800 staff at launch for 21 million people. | Administrative costs under 2% of spending. | A single national agency can be lean. |
| England | NHS England (arm's-length body) plus commissioning boards; repeated reorganizations (2002, 2013, 2022, and NHS England's 2025 abolition). | Reorganization costs and distraction. | Pick a durable structure and avoid serial reorganizations. |
| Canada | Thirteen provincial and territorial ministries administer plans. | Low administrative cost, uneven performance across provinces. | Regional administration enables experimentation but creates unequal access. |
Taiwan
- What they did
- One national agency (NHIA) runs all claims, with about 2,800 staff at launch for 21 million people.
- What happened
- Administrative costs under 2% of spending.
- Lesson for this plan
- A single national agency can be lean.
England
- What they did
- NHS England (arm's-length body) plus commissioning boards; repeated reorganizations (2002, 2013, 2022, and NHS England's 2025 abolition).
- What happened
- Reorganization costs and distraction.
- Lesson for this plan
- Pick a durable structure and avoid serial reorganizations.
Canada
- What they did
- Thirteen provincial and territorial ministries administer plans.
- What happened
- Low administrative cost, uneven performance across provinces.
- Lesson for this plan
- Regional administration enables experimentation but creates unequal access.
More precedent
- Medicare enrolled 19 million seniors within 11 months in 1965–66 using Social Security field offices.
- Taiwan's Bureau of National Health Insurance launched with about 2,800 staff for 21 million people.