By NextBestFitSign up providers & set participation rules
For-profit providers
Can investor-owned hospitals, nursing homes, and practices participate, and can UHP payments fund their profits?
About a quarter of U.S. hospitals and roughly 70% of nursing homes are for-profit. Excluding them at once would remove capacity the plan needs. Disclosure, capital controls, and fixed rates remove most of the strategies (out-of-network billing, commercial price leverage, upcoding) that made investor ownership profitable.
Allow with disclosure & capital controls (chosen)
As described.
- +Keeps all existing capacity
- +Fixed rates and capital rules remove the main profit strategies
- −Profit motive persists inside a public budget, for example through cutting nursing-home staffing
- −Requires ongoing oversight of ownership and quality
Bar payments from funding profit (Medicare for All Act §614)
Payments may not fund profit, marketing, or utilization bonuses; investor-owned providers are effectively pushed to convert or exit.
- +Every dollar goes to care
- +Removes incentives to cut quality for margin
- −Mass conversions or closures of for-profit hospitals and nursing homes during a capacity crunch
- −Takings and compensation litigation over forced conversions
Precedent: Canada's hospitals are almost all nonprofit or public; many long-term-care homes are for-profit, and COVID-19 deaths were higher in for-profit homes in Ontario.
Allow without restriction
Same rules as any provider.
- +Simplest; attracts private capital
- −Private-equity roll-ups and staffing cuts continue unchecked
- A system fully free of profit-driven provider behavior.
- Unrestricted private capital investment in health facilities.