By NextBestFitPhase 1: Enactment & build · Step 1.2
Create the UHP Trust Fund
Months 0–12 · Treasury (managing trustee), UHADiscuss 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.) | All dedicated revenues (the payroll taxes, household premium, state MOE, and redirected federal appropriations) flow into a single trust fund with permanent budget authority to pay claims, so a government shutdown never stops payment for care. | ||
| Germany | Central Health Fund (Gesundheitsfonds) pools payroll contributions and federal subsidies, then distributes risk-adjusted payments to sickness funds; it holds a liquidity reserve. | Stable financing; reserve absorbs shocks. | A pooled fund with a reserve smooths recessions. |
| France | Social security health branch financed by payroll and the earmarked CSG income tax. | Persistent deficits financed through a dedicated debt agency (CADES). | Dedicated revenue doesn't prevent deficits without spending controls. |
Germany
- What they did
- Central Health Fund (Gesundheitsfonds) pools payroll contributions and federal subsidies, then distributes risk-adjusted payments to sickness funds; it holds a liquidity reserve.
- What happened
- Stable financing; reserve absorbs shocks.
- Lesson for this plan
- A pooled fund with a reserve smooths recessions.
France
- What they did
- Social security health branch financed by payroll and the earmarked CSG income tax.
- What happened
- Persistent deficits financed through a dedicated debt agency (CADES).
- Lesson for this plan
- Dedicated revenue doesn't prevent deficits without spending controls.
More precedent
- Medicare HI and SMI Trust Funds; Canada's Canada Health Transfer (formula-based, not annual appropriation).