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AMERICA'S NATIONAL Health Insurance Plan DISCUSSION
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WORKING PROPOSAL
Designing a comprehensive healthcare framework for the United States requires balancing universal access with the country’s existing infrastructure and economic realities. The following proposed framework—the "American Unified Care Model" AUCM, is a hybrid system designed to provide a universal floor of coverage while maintaining a regulated private market
for choice and innovation.
1. The Core Pillar: Universal Basic Coverage, UBC
The foundation of the AUCM is a federally funded, state-administered basic coverage tier. This "Universal Floor" ensures that no citizen or resident is left without essential care:
* Eligibility: Automatic enrollment for every US citizen and legal resident from birth.
* Essential Benefits: Covers primary care, emergency services, preventive screenings, maternal health, and mental health services.
* Cost at Point of Service: 0 co-pays for primary and preventive care to encourage early intervention and reduce long-term costs.
* Funding: Funded through a dedicated "National Health Levy" (a payroll tax) and the consolidation of current federal subsidies.
2. The Multi-Payer Marketplace: Regulated Choice
To preserve the innovation and choice valued in the US, the framework allows for a "Second Tier" of private insurance:
* Supplemental Insurance: Private insurers offer plans for services not covered by UBC (e.g., private hospital rooms, elective procedures,
or advanced dental/vision).
* Employer-Based Options: Employers can still offer "Premium Plans" as a benefit, but they must contribute a portion of those premiums
toward the National Health Levy to support the universal floor.
* Standardization: All private plans must use a single, unified claims and billing interface to reduce the $250+ billion currently spent on
administrative waste.
3. Cost Control & Sustainability
A primary challenge in the US is the high cost of care. The AUCM addresses this through structural price regulation:
* National Drug Negotiation: The federal government uses the collective bargaining power of all UBC enrollees to negotiate drug prices,
similar to models used in the UK and Australia.
* All-Payer Rate Setting: To prevent price gouging, a federal commission sets maximum allowable rates for hospital procedures, which
apply to both the public and private tiers.
* Investment in Preventive Care: By removing cost barriers to primary care, the system shifts focus from "sick care" to "wellness,"
reducing the prevalence of expensive chronic conditions like Type 2 Diabetes and Heart Disease.
4. Digital Infrastructure: The National Health Stack
Modernizing the back-end of healthcare is essential for efficiency and patient outcomes.
* Unified Patient ID: A secure, blockchain-verified digital ID that allows a patient’s records to follow them between any provider in the country.
* Telehealth Integration: Universal broadband access and a standardized Tele-Health platform ensure rural populations have 24/7 access to specialists.
Comparison of Healthcare Costs
The primary goal of this framework is to move the US closer to the spending-to-outcome ratio of other developed nations. Currently, the US spends significantly more per capita without achieving universal coverage.
Reference
Switzerland
Switzerland’s healthcare system is unique because it achieves universal coverage without using a single-payer "socialized" model like the UK's NHS or a tax-funded model like Canada's. Instead, it is a highly regulated, mandatory private insurance market.
Here is a breakdown of how the system functions:
1. The Individual Mandate
Every person living in Switzerland is legally required to purchase basic health insurance within three months of arriving or being born.
* Not Employer-Based: Unlike in the U.S., insurance is not tied to your job. Individuals buy their own plans directly from private insurers.
* Guaranteed Issue: Insurance companies cannot refuse anyone for basic insurance, regardless of age, pre-existing conditions, or health risks.
2. How it is Funded
The system is funded primarily by individual premiums, not through general taxation.
* Premiums: You pay a monthly fee to your chosen insurer. These are "community-rated," meaning everyone in the same region pays the same for the same plan, regardless of their health status.
* Non-Profit Requirement: By law, insurance companies cannot make a profit on basic insurance. They can only make a profit on "supplemental" plans (like for dental or private hospital rooms).
* Subsidies: If your insurance premium exceeds a certain percentage of your income (usually around 8%), the government provides a subsidy to help you pay for it.
3. Cost-Sharing for Patients
Patients share the cost of their care through three mechanisms:
* The Franchise (Deductible): An annual amount you must pay out-of-pocket before insurance starts paying. You can choose a deductible ranging from CHF 300 to CHF 2,500. Choosing a higher deductible lowers your monthly premium.
* The Retention Fee (Co-payment): Once you hit your deductible, you still pay 10% of your medical costs, but this is capped at CHF 700 per year for adults.
* Hospital Contribution: A small daily fee (usually CHF 15) if you are hospitalized.
4. Choice and Quality
Switzerland consistently ranks among the best in the world for healthcare quality, but it is also one of the most expensive.
* No Waiting Lists: Because the system is well-funded and highly competitive, there are almost no waiting lists for specialists or surgeries.