Universal HealthcareBy NextBestFit
Phase 5: Stabilize & govern · Step 5.1

Set a spending growth target

Annual, starting Year 5 · Payment Rates Board; Congress (veto)Discuss this step
fiscallikelihood: mediumimpact: high

Costs come in at the costly case

Provider lobbying raises rates, induced demand is higher, and drug savings are smaller. The ledger's costly case adds about $842.8B a year in required general revenue.

Early warning signs
  • First-year actual vs. ledger by line
  • Rates Board recommendations overridden
Mitigation
  • Automatic household-premium adjustment
  • Standby copay option
  • Spending growth target

Implementation risks

RiskMitigation
Repeated congressional overrides (the SGR precedent).Overrides require offsets within the Trust Fund.