Universal HealthcareBy NextBestFit
Phase 1: Enactment & build · Step 1.6

Sign up providers & set participation rules

Months 6–18 · UHA Provider Enrollment; state licensing boardsDiscuss this step

Pros & cons of this step

Pros
  • +One enrollment, one contract, one set of rules for every provider.
  • +Every participating provider sees every patient: networks no longer exist.
Cons
  • −Some high-demand specialists (dermatology, plastic surgery, some psychiatry) may opt out and go cash-only, shrinking public capacity.
  • −The balance-billing ban removes a revenue source for physicians in high-cost areas.
  • Allowing opt-out keeps the system voluntary for providers (and constitutionally safer) but creates a private cash tier for the wealthy. Banning opt-out would be more equal but would push some physicians into early retirement.
high confidence

Choice: of plan vs. of doctor

People lose the choice of insurance plan but gain an unrestricted choice of doctors and hospitals, since networks disappear.

Today
Choice of plan is mostly the employer's choice: about half of firms offering coverage offer only one plan type. Narrow networks are common in Marketplace and MA plans.
Under the plan
One plan for everyone; every participating provider is in network.
Who gains
  • People in narrow-network plans
  • People who change jobs or move
Who loses
  • People who valued choosing between plans (e.g., MA vs. traditional Medicare)
  • People who would buy faster access if allowed

Magnitude: Qualitative.

  • Canada, Taiwan
    Free choice of physician within the public system; no plan choice.
Mitigations
  • Integrated care organizations provide a choice of care model.
Risk that remains: Opted-out providers create a de facto cash tier for the wealthy.

Trade-off behind each system change