By NextBestFitStabilize & govern
Keep costs growing no faster than the economy, keep waits within the guarantee, keep the program honest, and decide with evidence whether to change the core design.
- Per-capita spending growth at or below the target for 3 consecutive years.
- 90%+ of patients treated within the guarantee in every specialty and region.
- Improper payment rate below 3%.
- Year-10 review completed and voted on.
Changes from chosen paths in this phase: 29
18 chosen solution paths (draft picks awaiting review) land in this phase. See every change.
- Prize funds and advance market commitments
- National stockpile and onshore production
- Minimum nurse staffing ratios
- Invest outside health care
- No-fault compensation for medical injury
- Feedback and clinician nudges
- Minimum staffing and financial transparency
- Shift to small homes and home care
- Let health budgets pay for housing and food
- Spending-growth target tied to GDP, reviewed publicly
- Lower costs for clinicians, not only pay
- Hold the single payer to service standards
- Monitor supply and adjust prices quickly
- Phase mandates in with workforce growth, funded in rates
- Hardship waivers for shortage areas
- Standardized needs assessment and tiered benefits
- Cash benefit option for family caregivers
- Independent audits and few, simple measures
Detailed steps
- 5.1Set a spending growth target
Total UHP spending per person grows at most at GDP-per-capita growth + 0.5 points. The Rates Board sets fee updates and hospital budget growth to meet it.
3 tasks · 0 cost items · Annual, starting Year 5 - 5.2Run program integrity & fraud control
With one payer, fraud schemes that exploit gaps between payers disappear, but every scheme now targets one payer. UHP funds fraud control at a higher rate than Medicare does today.
4 tasks · 0 cost items · Year 1 onward - 5.3Run an independent evaluation and the Year-10 review
An independent evaluator reports annually on access, quality, waits, health outcomes, costs, and the labor market. In Year 10 Congress must vote on the duplicative-insurance ban and the cost-sharing standby option based on that evidence.
3 tasks · 0 cost items · Annual reports; Year 10 vote - 5.4Pilot a no-fault patient compensation system (optional)
Replace malpractice litigation in pilot states with an administrative compensation system for avoidable injuries, funded from the Trust Fund, paired with mandatory safety reporting.
3 tasks · 0 cost items · Years 3–10 - 5.5Plan capacity regionally
Regional capital boards allocate the $168.2B-a-year capital budget toward the services with the longest waits, and publish 5-year capacity plans.
3 tasks · 1 cost items · Annual