Universal HealthcareBy NextBestFit
Phase 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

Every concrete action this step requires, who is responsible, and when it happens relative to enactment.

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1.1.1Transfer CMS Center for Medicare staff (about 2,000 FTE) and its Medicare Administrative Contractor (MAC) contracts to the UHA.HHSMonth 0–3Transferring Medicare staff gives instant expertise but carries over Medicare's institutional habits and legacy processes.
1.1.2Nominate and confirm the Administrator, Deputy for Operations, Chief Medical Officer, and Chief Information Officer.President / SenateMonth 0–4Senate confirmation adds legitimacy but can delay leadership for months.
1.1.3Open 10 regional offices aligned with HHS regions; each runs hospital budget negotiation, provider relations, and wait-time monitoring for its region.UHAMonth 3–12Ten regional offices bring decisions closer to local conditions but create variation in how rules are applied.
1.1.4Constitute the Payment Rates Board (11 members: economists, clinicians, and patient advocates; no current industry employees) and the Health Technology Assessment Institute.UHA / CongressMonth 2–8Barring current industry employees from the Rates Board reduces capture but excludes people with the most operational knowledge.
1.1.5Create the Office of Patient Advocacy: an ombudsman, an appeals process with 30-day decisions, and a 24/7 multilingual help line.UHAMonth 6–15A 30-day appeals standard protects patients but requires staffing that adds to administrative cost.
1.1.6Hire about 40,000 staff through direct-hire authority, with priority for displaced insurer, Medicaid-agency, and Marketplace staff.UHA / OPMMonth 3–18Hiring displaced insurance staff eases job losses but brings in people trained in denial-oriented utilization management.
1.1.7Publish a governance charter: conflict-of-interest rules, a 2-year revolving-door ban for board members, and open meetings.UHAMonth 3Revolving-door bans reduce capture but make board positions harder to fill with experienced people.