Universal HealthcareBy NextBestFit
Phase 2: Wave 1: seniors, near-seniors, and children · Step 2.6

Expand capacity before demand peaks

Year 0 onward; continuous · HRSA; UHA; states (scope of practice)Discuss this step

Pros & cons of this step

Pros
  • +Addresses the main cause of long waits in Canada and the UK: too little capacity, not single payer per se.
  • +The U.S. already has a projected shortage of up to 86,000 physicians by 2036 (AAMC), so this is needed regardless.
Cons
  • −Training takes 4–11 years, so capacity lags demand by years.
  • −Scope-of-practice expansion is opposed by physician groups.
  • Spending more on capacity raises costs now, but it is the only durable way to keep waits short with zero cost sharing.
medium confidence

Speed of access for people with employer insurance

Today, commercially insured patients are the most profitable patients, so they get scheduled first. Under one price for everyone, that advantage disappears. Employer-insured people will likely wait somewhat longer for non-urgent specialist care, especially in Years 1–5.

Today
Private insurers pay hospitals about 2.2–2.5x Medicare and physicians about 1.4x. Practices limit Medicaid slots and prioritize commercial patients. New-patient waits across 15 large metros already average about a month.
Under the plan
Every patient pays the provider the same rate. Physician-visit demand rises about 12% ($113.0B a year), while supply grows slowly. The commercially insured lose their place at the front of the line.
Who gains
  • Medicaid enrollees
  • The uninsured
  • Underinsured people who delay care due to deductibles
Who loses
  • People with generous employer coverage in specialties with tight supply (dermatology, orthopedics, psychiatry, gastroenterology)

Magnitude: Likely days to a few weeks longer for elective specialist care in Years 1–5 for the previously commercially insured, if capacity investment lags. No predicted change for emergency or cancer care, which is triaged by urgency.

  • U.S. Medicaid
    Only about 74% of physicians accept new Medicaid patients versus 96% for private insurance; secret-shopper studies find Medicaid callers get appointments much less often. Availability rose when Medicaid fees rose, so the gap is about price, not public coverage itself.
    Sources: Holgash & Heberlein, Health Affairs Forefront (2019); Polsky et al., NEJM (2015)
  • U.S. Medicare
    About 88% of physicians accept new Medicare patients, close to private insurance. Medicare is public, pays roughly Medicare rates by definition, and its access is broadly comparable to commercial. UHP pays 112–120% of Medicare.
    Sources: Holgash & Heberlein, Health Affairs Forefront (2019)
  • Canada
    Median 28.6 weeks from GP referral to treatment in 2025, ranging from 19.2 weeks in Ontario to 60.9 in New Brunswick. Driven by low capacity (fewer MRI units, operating-room time limited by global budgets) and the ban on private duplicative insurance.
    Sources: Fraser Institute (2025)
  • United Kingdom
    About 7.4 million cases on NHS England's waiting list in 2025; about 59% treated within 18 weeks against a 92% standard. Long-term underinvestment and post-COVID backlog.
    Sources: NHS England (2025)
  • Germany
    Short waits overall, but privately insured patients (about 11%) get specialist appointments substantially faster than statutory-insured patients because physicians earn more from them. The same dynamic as U.S. commercial vs. Medicaid.
    Sources: European Observatory on Health Systems and Policies (2020)
  • Taiwan
    Single payer with very short waits and high visit volumes, but short physician visits (often a few minutes) and high physician workloads.
    Sources: Taiwan National Health Insurance Administration (2024)
Mitigations
  • Pay rates above Medicare (120% hospitals, 112% physicians) so participation matches Medicare's.
  • Legally binding wait-time guarantee with vouchers to any provider.
  • $12.0B a year in workforce investment and $50.0B in capacity capital.
  • Keep U.S. capital spending at today's level: the U.S. has far more MRI/CT units per capita than Canada and the UK.
  • Expand nurse practitioner and PA scope; telehealth.
Risk that remains: Training takes years. If demand grows faster than supply, waits rise for everyone, and the employer-insured, who wait least today, notice most. This is the most likely politically fatal failure mode.

Trade-off behind each cost item

Trade-off behind each system change