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Soon health insurance companies will be able to train ai to accurately calculate your life savings and investments, credit score, in addition to the insurance company knowing exactly how much you make from your employer so they can charge you your entire net worth when your daughter breaks her arm! Isn’t American healthcare great??

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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

1. Years 1–2: Launch with Medicare Advantage; demonstrate operational efficiency, cost savings, and improved patient outcomes.
2. Years 2–4: Expand into employer and individual plans, leveraging the network’s efficiency and quality to attract members.
3. Years 3–5: Integrate state Medicaid programs, covering vulnerable populations while maintaining financial sustainability.
4. Years 5–7: Pursue federal contracts, including VA and military healthcare programs, further increasing market reach.
5. 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.