By NextBestFitWave 1: seniors, near-seniors, and children
Cover the 176 million people who are 55+ or under 19, upgrade Medicare into UHP, and prove the system works at scale.
- Claims paid within 14 days (clean claims) at 95%+.
- No measurable drop in physician participation among those who accepted Medicare.
- Wait-time registry live in every region with baseline data.
- Medicare Advantage and Medigap contracts ended without coverage gaps.
Changes from chosen paths in this phase: 16
8 chosen solution paths (draft picks awaiting review) land in this phase. See every change.
- Every licensed provider is in-network
- Prevent new debt by ending point-of-care bills
- Eliminate prior authorization except for a short list
- Fold Medicare Advantage into the public program
- Global budgets for rural hospitals
- Standby payments to keep labor units open
- Cover ambulance and non-emergency transport
- Universal long-term care insurance
Detailed steps
- 2.1Upgrade Medicare enrollees into UHP
All 67 million Medicare enrollees move into UHP on day one. Part B and Part D premiums, deductibles, and coinsurance end. Dental, vision, and hearing are added.
7 tasks · 1 cost items · Year 1, Day 1 - 2.2Enroll children and adults 55–64
About 73 million children and 42 million adults aged 55–64 join. Children's Medicaid and CHIP coverage converts automatically, and private family coverage stops covering children.
5 tasks · 0 cost items · Year 1, Day 1 - 2.3Enforce maintenance of compensation
Employers that paid health premiums must convert their savings into wages or other compensation. In steady state employers paid $1.05T in premiums (private, federal, state & local) and owe $873.4B in the new tax; 85% of the difference is assumed to reach paychecks.
5 tasks · 1 cost items · Years 1–4 (requirement lasts 3 years after each worker's wave) - 2.4Run the Hospital Transition Fund
Hospitals whose revenue falls more than 5% below baseline when commercial rates disappear receive temporary support that tapers to zero by Year 6, conditioned on cost-reduction plans.
4 tasks · 1 cost items · Years 1–5 - 2.5Launch the wait-time guarantee
Legally binding maximum waits, monitored in a national registry. If UHP misses the standard, the patient may go to any provider, including opted-out providers, and UHP pays up to 150% of its rate.
5 tasks · 1 cost items · Year 1 (registry), Year 2 (enforceable guarantee) - 2.6Expand capacity before demand peaks
Utilization rises by $349.6B a year at steady state. Without more clinicians and facilities, that demand turns into longer waits. This step funds training slots, scope-of-practice changes, and facilities in shortage areas.
8 tasks · 5 cost items · Year 0 onward; continuous - 2.7Launch dental, vision & hearing benefits
Adult dental, vision, and hearing are the largest benefit additions. Dental spending rises from $189.2B to $238.8B, and durable equipment (eyeglasses, hearing aids) from $86.4B to $93.3B.
4 tasks · 2 cost items · Year 1 for Wave 1 populations