Coverage authority, payment authority, audit and appeals sit in separate bodies, because concentrating them would make a coverage mistake, a payment mistake and a governance mistake mutually reinforcing. The cost brake runs in two stages and both read access-adjusted spending, so a fall caused by undelivered care never registers as a saving. Prior authorization is abolished and replaced by retrospective, collective review. Durability is engineered: universality, mandatory appropriation, ring-fenced capital, insulated rate-setting.
Anchor
The cost brake
Two stages, both reading access-adjusted spending, so a fall caused by undelivered care never registers as a saving. Read component →
Primary
Appropriate provision
Liability safe harbour, closure of self-referral, and satisfaction scoring removed from every decision where 'no' is the right answer. Read component →
Primary
Review and appeal
Petition, exceptional-patient review with a clock that defaults toward the patient, an independent tribunal, then federal court. Read component →
Primary
Oversight and receivership
Published standardized cost is the enforcement instrument; receivership runs on the FDIC model, and service never stops. Read component →
Primary
The middle layer
Authorities buy from their own federal providers at the same published price they pay anyone else — so shifting work carries no arbitrage in either direction. Read component →
Primary
Durability
Universality, mandatory appropriation, ring-fenced capital, insulated rate-setting, and a constituency built on purpose. Read component →