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Engine 2 of 9

Distributed Healthcare

Architecture deep-dive: a universal essential floor with a Medigap-style regulated supplemental on top, under AHQB governance. The rollout phases who enrolls when — never the rate: tranches by employer size and average payroll, regions by VHA and Post Office 2.0 density plus COMPASS shortage score, inside a ten-year full phase-in with enrollment complete at Year 7, each cell capacity-gated; the floor's benefit composition widens only through the AHQB one-way ratchet.

HealthcareArchitectureCoverageTransitionCapacityGovernanceLimits
What Distributed Healthcare is — and what it covers — lives at /healthcare. That page is the canonical surface for the universal essential floor (comprehensive across categories, $0 premiums for the floor) and the Medigap-style regulated supplemental on top of it. This engine page is the architecture index for legislative staff, healthcare-policy professionals, and provider organizations: component-level detail on structure, rollout phases, capacity channels, governance, and population transitions.

Five aspects

7 components
Architecture
How the system is built. The essential floor, four payment methods, the public arm, geography, the supplemental layer, and long-term care.
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4 components
Coverage
What the floor buys and who decides. AHQB, the coverage standard, reproductive and fertility care, and drug pricing.
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5 components
Transition
The binary questions, each with a date. Who moves when, who pays under what structure, who bears the adjustment, and what the overlap years cost.
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6 components
Capacity
The access trajectory. Travel-time distributions, the build, the workforce pipeline, capacity payment and transport, and the deferred benefits.
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6 components
Governance
Authority, review and durability. The two-stage cost brake, appropriate provision, appeal rights, and what keeps the program alive.
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3 components
Limits
What the program sacrifices, where it stays inefficient, how it fails, and the statutes none of it works without.
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Funding clarification

The payroll tax is uncapped and applies to all compensation — wages, bonuses, equity, deferred income. It provides the largest single funding stream for Distributed Healthcare, replacing fragmented current funding through FICA-Medicare, employer health premiums, and employee premium contributions.

The new payroll tax is the largest single source — not "most of the cost." Federal general-fund redirection from current Medicare, Medicaid, and VA budgets provides comparable revenue. Federal Medicaid absorption brings additional flow; states retain their share. Supplemental tiers are separately priced in the regulated market — never bundled with the payroll tax. AHQB cost controls reduce baseline expenditure compared to current US healthcare spending (18.0% of GDP, CMS 2024).

Canon and references: Blueprint Chapter 20 — Distributed Healthcare System · Expert Boards (AHQB) · Five Macrogovernors (Healthcare Cost Brake)