Universal HealthcareBy NextBestFit
Phase 1: Enactment & build · Step 1.5

Define the benefit package & cost sharing

Months 0–12 · Congress (statutory categories); UHA Chief Medical Officer; HTA InstituteDiscuss this step

Pros & cons of this step

Pros
  • +No one skips covered care because of cost; medical debt from covered care ends.
  • +Seniors and working adults gain dental, vision, and hearing coverage that Medicare and many plans lack.
  • +No bills means no billing staff, collections, or bad debt for covered care.
Cons
  • −Free care increases demand About $349.6B a year, which competes for the same appointment slots.
  • −A single national package removes the ability to buy richer or leaner coverage for covered services.
  • −Some services people use now (e.g., some elective procedures) may be excluded after HTA review.
  • Zero cost sharing removes financial barriers but also the price signal against low-value care. The plan relies on clinical guidelines and the HTA Institute instead of prices to limit low-value use.
  • Broad benefits (dental, home care) cost more but end the largest remaining out-of-pocket burdens. A Medicare-equivalent package would cost about $110–150B a year less but keep those burdens.
high confidence

Financial protection from medical bills

Out-of-pocket spending falls from $556.6B to $197.3B. No deductibles, copays, surprise bills, or medical debt for covered care.

Today
About 100 million Americans carry some medical debt (KFF). Deductibles average about $1,800 for single coverage in employer plans (KFF). Bankruptcy filings often cite medical bills.
Under the plan
Medical debt from covered care ends. Remaining out-of-pocket spending is for non-covered items.
Who gains
  • Everyone who gets sick
  • Especially people with chronic conditions and cancer
Who loses
  • Hospitals' and collection agencies' patient-collections revenue (offset by global budgets)

Magnitude: $359.3B a year less paid at the point of care.

  • Every universal system
    Medical bankruptcy is rare or non-existent in Canada, the UK, and Taiwan.
Risk that remains: Nursing-home room and board remains a large out-of-pocket cost for some.

Trade-off behind each cost item

Trade-off behind each system change