The Tiered Benefits System
The first major component of EMBRACE is its three-tiered benefits system, which determines coverage according to the severity of medical conditions and the scientific evidence supporting available treatments. Tier 1 includes life-threatening conditions, services demonstrated to extend life, and interventions shown to prevent life-threatening illnesses. Examples include heart attacks, cancer, pregnancy, severe depression, hypertension, diabetes, and high cholesterol when treatment is intended to reduce serious health risks. Tier 1 also covers scientifically validated diagnostic testing needed to determine whether a patient has a potentially life-threatening condition. Coverage would be automatic and universal, regardless of age, employment status, preexisting conditions, gender, or military service. EMBRACE would therefore ensure that every person has access to essential, potentially lifesaving care without depending on employment or the purchase of private insurance.
Tier 2 would cover conditions that significantly affect quality of life but have not been demonstrated to reduce life expectancy or increase the risk of other life-threatening conditions. Examples include osteoarthritis, chronic lower back pain, and irritable bowel syndrome. This tier would also include certain treatments for serious conditions that lack sufficient scientific evidence to qualify for Tier 1 coverage. Unlike Tier 1, Tier 2 coverage would generally be purchased through private insurance or paid for out of pocket. EMBRACE proposes an online comparison system modeled on Medicare supplement insurance (so-called Medigap), allowing consumers to compare coverage options, benefits, and premiums before selecting a plan. These policies could be tailored to specific populations, including older adults, veterans, and employees, and would be portable across state lines and changes in employment.
Tier 3 would encompass elective or luxury services, such as cosmetic facelifts and LASIK surgery, that have little or no demonstrated effect on mortality or quality of life. These services would generally not be covered by insurance (as is currently the case).
Placing catastrophic and lifesaving care in Tier 1 would reduce the cost of supplemental insurance and make Tier 2 coverage significantly more affordable than commercial insurance is now.
The Healthcare Information Platform
The second major component is the Healthcare Information Platform (HIP), a centralized, secure, web-based system intended to simplify healthcare administration and improve the exchange of medical information. Under this proposal, all licensed healthcare providers would use a standardized electronic form, called the Universal Billing Form (UBF), for patient encounters. The HIP would process the information, determine which benefit tier applies to the services provided, and direct payment accordingly. Tier 1 services would be paid automatically, regardless of the patient’s insurance status, while Tier 2 services would trigger a search for applicable private insurance coverage. If a patient lacked coverage for a Tier 2 or Tier 3 service, the system would bill the patient directly on behalf of the provider. By reducing the need for extensive paperwork, insurance claim reviews, and negotiations between healthcare providers and insurers, EMBRACE aims to reduce administrative burdens and costs. It has been estimated that these changes could save as much as $350 billion annually.
Beyond billing, the HIP would serve as a shared technological infrastructure for electronic medical records, healthcare applications, and the exchange of clinical information. EMBRACE envisions an open platform through which application developers could create tools accessible throughout the healthcare system. This would address the problem of incompatible electronic medical record systems that cannot easily exchange information, potentially reducing duplicated services, improving coordination, and lowering costs. Centralized access to healthcare data would also enable more comprehensive monitoring of clinical outcomes, public health initiatives, medication safety, and medical device effectiveness. These capabilities could also facilitate the early detection of emerging epidemics and provide timely feedback about the performance of healthcare interventions. In this way, the HIP is intended not only to streamline administration but also to create a foundation for continuous improvements in medical care and public health.
The National Medical Board
The third major component is the National Medical Board (NMB), an independent, nongovernmental organization modeled in part on the structure and independence of the Federal Reserve. The NMB would oversee the broader U.S. healthcare system, consolidating responsibilities that are currently distributed among multiple government agencies and private organizations. Its proposed leadership would include a chair with experience in public health and healthcare economics, appointed by the president and confirmed by Congress for a ten-year term. A Board of Governors would represent major areas of healthcare, including public health, pharmaceuticals and medical devices, medical research, insurance benefits, patient-centered care, hospitals, nursing, veterans’ healthcare, medical imaging, laboratory services, and postgraduate medical education. An advisory council would provide representation for stakeholders such as pharmaceutical companies, medical device manufacturers, commercial insurers, businesses, and religious organizations. Regional chapters would account for geographic differences in healthcare needs. The NMB’s central mission would be to promote the health of everyone in the United States while coordinating the activities and policies of the national healthcare system.
Finally, the NMB would be responsible for determining which conditions and treatments belong in each benefit tier and updating those classifications as new scientific evidence becomes available. These decisions would be grounded in medical research, published clinical guidelines, treatment effectiveness, and the severity of illnesses. Existing medical research often has limitations, because studies may be designed primarily to obtain regulatory approval for particular drugs or devices rather than to compare treatments or improve healthcare delivery. The NMB would therefore have the authority to commission additional studies that directly address coverage decisions, comparative treatment effectiveness, and public health priorities. As new evidence emerges, the board could revise the benefit tiers to reflect the changing state of medical knowledge.
A Unified Healthcare System
Ultimately, EMBRACE envisions a unified healthcare system in which universal coverage for essential services, private insurance for additional benefits, centralized information technology, and coordinated national oversight work together. Its benefits would include broader access to lifesaving care, lower administrative expenses, improved transparency, and more evidence-based healthcare decisions.