By NextBestFitPart 1 · Decisions
Build your plan
Pick one or more solution paths for each problem. The summary combines what they fix, what they create or worsen, who gains and who loses, the concrete changes they need, and any conflicts or new problems your picks create. Your picks stay in this browser.
Who your plan covers
Counts in millions, from different surveys and years (see inputs), so they are not summed. U.S. resident population: 342 million.
| Group | Millions | Status | Why |
|---|---|---|---|
| Citizens (U.S.-born and naturalized) | 307 | Undecided | No payer structure picked yet. Today about 26.7 million people are uninsured. |
| Lawful permanent residents | 13 | Undecided | No payer structure picked yet. Today about 26.7 million people are uninsured. |
| Other lawfully present residents (work and student visas, families) | 3.2 | Undecided | No payer structure picked yet. Today about 26.7 million people are uninsured. |
| Unauthorized immigrants | 11–14 | Undecided | No immigrant-coverage path picked yet. |
| New immigrants arriving from abroad | 0.57 /yr | Undecided | No residence-period path picked yet. |
| Short-term visitors and tourists | 68 /yr | Emergency care only | Not residents under any path: emergency care is billed or paid by travel insurance, as in most countries. |
| Active-duty military and families (TRICARE) | 2.8 | Separate system | TRICARE continues as a separate system; no path changes it. |
| Veterans enrolled in VA health care | 9.1 | Separate system | VA care continues; veterans are also covered as residents by the payer structure you pick. |
| American Indians and Alaska Natives served by IHS | 2.8 | Separate system | IHS continues; people it serves are also covered as residents. |
| People in prisons and jails | 1.9 | Separate system | Correctional health care stays with prisons and jails; no path changes it. |
| U.S. territories (Puerto Rico, Guam, USVI, American Samoa, N. Mariana Islands) | 3.5 | Not addressed | No territories path picked. Their federal Medicaid funding is capped, unlike the states'. |
What your plan costs
The site's cost model prices one design: a single public payer. Pick Single public payer for everyone to see national spending, federal spending, and the funding gap. Other payer structures are compared in each path's precedents but not priced here.
Coverage & eligibility
| Tens of millions of people have no coverage No path picked | |
|---|---|
| People lose coverage when their life changes (churn) No path picked | |
| Job lock: people stay in jobs to keep insurance No path picked | |
| Underinsurance: covered, but can't afford to use it No path picked | |
| Narrow networks and out-of-network surprises No path picked | |
| Immigrants and mixed-status families fall through gaps No path picked | |
| U.S. territories get capped, lower federal health funding No path picked |
Affordability & medical debt
| Medical debt affects about 100 million people No path picked | |
|---|---|
| Premiums are a large, flat, hidden tax on wages No path picked | |
| Patients can't know prices in advance No path picked | |
| Surprise billing and a runaway arbitration system No path picked |
Insurer practices
| Claim denials No path picked | |
|---|---|
| Prior authorization delays and blocks care No path picked | |
| Medicare Advantage overpayments and coding intensity No path picked | |
| Insurer overhead and profit No path picked | |
| Pharmacy benefit managers profit from opaque drug pricing No path picked |
Prices & market power
| U.S. prices are far higher than in other countries No path picked | |
|---|---|
| Hospital and physician consolidation raises prices No path picked | |
| Private equity roll-ups in medicine No path picked | |
| Facility fees: the same service costs more in a hospital-owned building No path picked | |
| Executive pay and nonprofit status No path picked |
Drugs, patents & supply chain
| Brand-name drug prices far above production cost No path picked | |
|---|---|
| Patent thickets and evergreening delay generics No path picked | |
| R&D is funded by high prices, which ties innovation to unaffordability No path picked | |
| Drug shortages of cheap, essential generics No path picked | |
| Pharmacy closures and pharmacy deserts No path picked |
Geography & physical access
| Rural hospital closures No path picked | |
|---|---|
| Maternity care deserts No path picked | |
| Health professional shortage areas No path picked | |
| Getting to care: transportation and ambulances No path picked |
Workforce
| Physician shortage, especially in primary care No path picked | |
|---|---|
| Medical education debt shapes specialty choice No path picked | |
| Nursing and direct-care shortages and burnout No path picked | |
| Clinician burnout from paperwork and EHR work No path picked | |
| Scope-of-practice limits waste capacity No path picked |
Quality, safety & outcomes
| Worse outcomes than peer countries despite the highest spending No path picked | |
|---|---|
| High maternal mortality and postpartum coverage gaps No path picked | |
| Medical errors and poor care coordination No path picked | |
| Racial, income, and geographic disparities No path picked | |
| Malpractice system: slow, costly, and drives defensive medicine No path picked |
Administration & complexity
| About $1 trillion a year in administrative cost No path picked | |
|---|---|
| Simplifying billing would displace hundreds of thousands of workers No path picked |
Waste, fraud & low-value care
| Low-value care and overtreatment No path picked | |
|---|---|
| Fraud and improper payments No path picked |
Mental health & substance use
| Mental health care is hard to get No path picked | |
|---|---|
| Overdose crisis and gaps in addiction treatment No path picked |
Long-term & end-of-life care
| Long-term care requires spending down to poverty No path picked | |
|---|---|
| Nursing home understaffing and quality No path picked | |
| Hospice growth, for-profit entry, and fraud No path picked |
Dental, vision & hearing
| Dental, vision, and hearing are mostly uncovered No path picked |
|---|
Public health & prevention
| Prevention and public health are underfunded No path picked | |
|---|---|
| Housing, food, and transportation drive health, but health care isn't designed for them No path picked |
Data, technology & privacy
| Records don't follow patients No path picked | |
|---|---|
| Cyberattacks can halt payments and care No path picked | |
| Health privacy No path picked |
Risks a universal system can create
| Longer waits if demand grows faster than capacity No path picked | |
|---|---|
| Two-tier care: a private fast lane for those who can pay No path picked | |
| Chronic underfunding by government budgets No path picked | |
| Under-investment in equipment and facilities No path picked | |
| Slower access to new drugs and technology No path picked | |
| Providers leave, retire, or go cash-only if pay drops No path picked | |
| Transition disruption: jobs, companies, and familiar coverage No path picked | |
| One payer becomes one target No path picked |