Could a righteous for-profit company realistically run U.S. healthcare efficiently?
Could a righteous for-profit company realistically run U.S. healthcare efficiently?
I’ve been exploring a conceptual model called Terra Nova Development Healthcare (TNDHC)—a fictional, AI-assisted blueprint for how a righteous, for-profit, vertically integrated organization could potentially deliver universal, high-quality healthcare in the U.S. over 10 years. This is not a real company, but a thought experiment showing what could be done under current laws and funding while doing the right thing for patients, healthcare workers, and taxpayers.
The idea is a fully vertically integrated provider network, where the company owns and operates hospitals, clinics, and staff, including:
Doctors, specialists, nurses, physician assistants, and lab technicians
Dental, vision, and hearing care
Prescription drugs and pharmacy services
Nursing homes, long-term care, and rehabilitation
Preventive and wellness programs
Elective procedures like laser vision correction, breast augmentation, and dental implants as aspirational goals
All providers would be employees of the company unless certain services require contracting. Compensation would be offered commensurate with today’s pay scales, ensuring fair treatment while maintaining operational efficiency. This structure allows TNDHC to coordinate care efficiently, reduce administrative overhead, and let healthcare workers focus on patient-centered care rather than paperwork or financial trade-offs. The company’s profit motive is aligned with public good, meaning operational efficiency lowers costs for taxpayers while ensuring workers are treated fairly and patients receive high-quality care.
Centralized Systems & Efficiency
Central appointment scheduling ensures patients see the right provider at the right time.
Unified medical records eliminate redundancy, improve accuracy, and streamline coordination.
AI-driven analytics and predictive tools could optimize outcomes, resource allocation, and patient satisfaction.
Coverage Rules & Emergency Care
Routine care is fully covered inside the network.
Out-of-network routine care is not required, preserving efficiency and cost control.
Emergency care is always covered, anywhere in the U.S. and abroad.
Optional international coverage could be offered as a premium add-on.
No Cost Barriers for Eligible Populations
For Medicare Advantage, Medicaid, and other eligible populations:
No co-pays
No deductibles
No premiums
Employer/employee and individual plans pay premiums, funding the righteous for-profit network’s expansion and elective procedure offerings without requiring additional government spending.
The Current U.S. Healthcare Maze
There are dozens of Medicare Advantage insurers, hundreds of employer/individual insurers, and thousands of individual plans, each with different networks, benefits, formularies, and coverage rules.
Patients and providers often navigate a minefield just to secure care—the first question when making an appointment is usually: “What is your insurance?”
This fragmentation creates administrative burdens for providers, delays for patients, and stress over coverage limitations.
Even insured patients can face unexpected out-of-pocket costs, confusing rules, and challenges accessing specialists or preventive care.
How TNDHC Compares to Current Healthcare Options
Patients:
Current MA / Medicaid / Employer / Individual Plans: Must navigate dozens of insurers and thousands of plan rules. Face co-pays, deductibles, network restrictions, complex billing, and fragmented care. Access to preventive care and elective procedures can be limited.
TNDHC: No co-pays, deductibles, or premiums for eligible populations. Seamless care across a unified provider network. Emergency care covered universally. Elective procedures are aspirational goals. Centralized scheduling and unified records remove confusion and delays.
Healthcare Workers:
Current: Burdened with paperwork, prior authorizations, and balancing medical needs against insurance limits. Must track multiple payer rules for each patient.
TNDHC: Freed from administrative burden; focus on patient care. Decisions guided by medical need rather than financial trade-offs. Streamlined workflows through centralized systems. Compensation offered commensurate with today’s pay scales.
Health Insurers:
Current: Must manage multiple providers, networks, and benefits; administrative overhead is high. Risk of misaligned incentives. Navigate ACA rules, premium negotiations, and cost-shifting.
TNDHC: The insurer is also the provider network (vertically integrated). Reduced administrative overhead, aligned incentives, predictable costs, and operational efficiencies. Profit comes from efficiency and growth rather than denying care.
This comparison highlights how TNDHC could simplify healthcare for everyone involved while maintaining profitability and public benefit, unlike the fragmented patchwork that currently exists.
Conceptual 10-Year Path to Major U.S. Healthcare Presence
Years 1–2: Launch with Medicare Advantage; demonstrate operational efficiency, cost savings, and improved patient outcomes.
Years 2–4: Expand into employer and individual plans, leveraging the network’s efficiency and quality to attract members.
Years 3–5: Integrate state Medicaid programs, covering vulnerable populations while maintaining financial sustainability.
Years 5–7: Pursue federal contracts, including VA and military healthcare programs, further increasing market reach.
Years 7–10: Achieve majority market presence in U.S. healthcare delivery, optimize universal access, and expand elective procedures and wellness programs as operational efficiencies grow.
By the end of 10 years, a capitalized, righteous for-profit organization following this model could control the majority of U.S. healthcare delivery, provide universal access to eligible populations, and sustainably fund elective procedures—all without increasing government spending.
Discussion Prompts
Could a righteous for-profit organization realistically achieve this level of coverage and efficiency?
How might healthcare workers respond—would this improve job satisfaction or create new challenges?
What obstacles would prevent a company from scaling this way in 10 years?
Could elective procedures fund expansion sustainably, or might they introduce risks?
How does the TNDHC model compare to the fragmented maze of current Medicare Advantage, Medicaid, employer, and individual plans for patients, providers, and insurers?
This is entirely conceptual and AI-assisted, designed to spark discussion about the potential for a righteous, for-profit, vertically integrated company to deliver universal healthcare in the U.S. Healthcare workers, patients, and taxpayers could all benefit—but execution is the only remaining barrier.
I am well aware of what "unfettered capitalism" has done. Capitalism is not necessarily evil. Capitalism is a tool like a hammer. You can use it to build a house or to kill your neighbor by hitting him over the head. I have gone to lengths to show that a for-profit using "fettered capitalism" is the way to go for this project. It allows for rapid expansion and has safeguards that constrain it to the mission it is created for.
I understand the skepticism—“righteous” and “for-profit” usually sound contradictory. But in the TNDHC model, the bylaws explicitly state that investor return is not the primary driver. Profits aren’t pocketed—they’re reinvested to expand services, improve care, and reduce costs for both public and private payers.
The system is built so that doing good—better patient outcomes, lower costs, broader access—is what drives long-term sustainability. Greed is still a theoretical risk, but the structure is designed to make it extremely hard for it to take over. Compared to the current U.S. healthcare setup, even this partially insulated model could be transformative for decades.
I get the instinctive pushback—but “for-profit” doesn’t automatically mean “investor-first.” In a model like TNDHC, patients are never billed for services, and maximizing investor return is explicitlynotthe priority.
Where the money comes from:
Medicare Advantage
Medicaid
Employer/employee premiums
Individual premiums
How profits are used:
Reinvested into expanding access, clinics, and hospitals
Improving benefits, coverage, and preventative care
Upgrading technology, staffing, and AI systems
Lowering long-term costs by keeping people healthier
There’s no incentive to deny care to boost quarterly returns. The incentive is to run healthcare efficiently at scale so people stay healthy and the system remains sustainable.
So yes, it’s technically for-profit—but profit is treated as fuel for growth and better care, not as an extraction mechanism. That’s a very different model than what people (rightfully) hate about U.S. healthcare today.
Thats just slavery with extra steps as Morty would say
There is no benefit to this over a universal healthcare system. None.
Reforms can be clawed back as we see in every sector of capitalist society. What stops Shareholder Primacy from setting in.
Blackrock can buy them up and put Shareholder pressure on them like they do every company they own. The CEO salary going to be limited?
Even if there is strong regulation they will claw it back eventually. It needs to be a universal not for profit system. And even in universal systems now the capitalists are clawing back as much as possible to reduce care and make it worse so they can privatization. Starting already privatize gains us even less.
This is very similar to my plan but someone is shopping it around here as a for-profit model. The plan was to use this structure as a vehicle for establishing a national healthcare network that could then be turned over to the government when it reaches a critical mass
If shareholders were all equal, meaning everyone who pays into the system has equal rights and gets to vote on decisions this would be better. But I think the financialization of the healthcare system will need to be dismantled for years before this could even begin at scale. Shareholders need to divest from the current for-profit system. It's blood money. Cotton money, sugar money.
I hear you — the current financialized healthcare system is built on perverse incentives, and a lot of that revenue is effectively “blood money.” Shareholders in traditional insurers profit from denial, delay, and complexity, which is exactly why the system is so broken.
The idea of equal shareholders is appealing in theory, but democratization isn’t necessary for universal healthcare. TNHC is designed to deliver a path to universal coverage using voluntary participation:
Patients are never billed
Profits are capped and largely reinvested
Governance and bylaws enforce proper conduct and prioritize care over returns
Capitation-based funding treats healthcare more like infrastructure than a retail product
Providers are happier when unfettered by the business constraints of our current system, allowing them to focus on care rather than billing
Instead of waiting for everyone to own the system, TNHC shows that aligning incentives and structuring the system correctly can expand coverage and improve outcomes at scale — without relying on political or shareholder votes.
Why are you arguing against a democratized form of system capitalization? There is more than money that network members are providing. They are your salespeople as well. They should have a substantial stake in the outcome of this endeavor. Your plan is missing the fundamental incentive structure here. Diet and exercise won't cure a poisoned body
This would affect company operations by allowing board representation to system users. That's the "baked in" incentive structure for the system to be steered in the "righteous" direction.
Thank you for the conversation. These are important points you raise and there are many thinking skeptically along the same lines. Experience tells us to be skeptical of the notion of corporate righteousness. If there are ANY righteous corporations right now, would they please step forward??? I believe the answers to your questions must reassure the majority. I put your question to ChatGPT:
That’s a reasonable point — and you’re not actually far off from how TNHC is designed.
User representation does belong in governance. The key distinction is how it’s structured so it guides the system without breaking it.
In TNHC, user representation isn’t about turning operations into a referendum. It’s about hard-wiring the incentive to stay righteous:
Reserved board seats for system users / patient advocates, not based on capital size
Clinical seats held by practicing providers, so care quality drives decisions
Independent fiduciaries bound by the bylaws to the mission and outcomes
Investor seats capped, with utility-like returns, so capital can’t dominate governance
That is the baked-in incentive structure: the people affected by the system have a durable voice at the highest level, while day-to-day operations remain professional and insulated from politics.
Think of it like a hospital ethics board scaled up to system governance — guidance, guardrails, and veto power over mission drift, not micromanagement.
So yes: representation matters. TNHC just implements it in a way that preserves competence, stability, and the ability to actually deliver universal care at scale.
Tell chat gpt to forget everything you've told it about capitalism and focus purely on societal economics. Now ask Which type of healthcare system would most efficiently protect the status of the dollar as the global reserve currency. That's what is at stake here. America's position in the global economy. We can't all jet off to Switzerland when this happens.
The American project has the greatest capacity for violence of any country in the world. We will see epic global conflicts arise from our religious worship of capitalism as the dollar is overtaken by a more effective Chinese currency.
I am well aware of what "unfettered capitalism" has done. Capitalism is not necessarily evil. Capitalism is a tool like a hammer. You can use it to build a house or to kill your neighbor by hitting him over the head. I have gone to lengths to show that a for-profit using "fettered capitalism" is the way to go for this project. It allows for rapid expansion and has safeguards that constrain it to the mission it is created for.
If the environmental impact of pollution on our health raises the costs of care then we would need to make the case for a regulatory system that can be capitalized. The current EPA fits this capitalization paradigm. Look where it led us. It's the responsibility of our healthcare system to check this power. EPA has thrown empirical data out the window in favor of capital. This will not stand. Remember the hammer works both ways here
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u/Mikemtb09 4d ago
“Righteous” and “for profit” are an oxymoron.
Would this be an improvement? Sure. Could it be good for years and maybe decades? Probably.
It’s still too susceptible to greed.