Designing Collective Solvency for a Fair and Human Healthcare Economy

1. The Failure We All Feel

Every American knows the feeling of financial vertigo that follows a medical bill.

This is not failure of science—it is failure of architecture. We built a health-finance machine that rewards opacity, bloats administration, and converts care into arbitrage. The Pharmacy Benefit Manager (PBM) was meant to coordinate savings; instead it became a toll booth on every transaction.

What if coordination could feel like connection? What if the system itself were capable of gratitude, reciprocity, and fairness?

2. The Premise: Collective Solvency

Imagine replacing the fear of insolvency with collective solvency—a shared capacity to absorb risk without destroying individuals.

Each person contributes proportionally to means; each claim is cleared transparently through a civic utility that all can audit.

The Healthcare Clearing Commission (HCC) is the proposed engine of that world: an independent, NASA-like body whose sole mission is to ensure that money, data, and meaning move cleanly through healthcare.

It would not replace care delivery. It would replace the fog that surrounds it.

3. The Architecture in Plain Sight

3.1 — The Universal Clearing Layer (UCL)

At the heart sits an open protocol—think of it as the DTCC for health.

Every transaction, from prescription fill to surgical procedure, passes through a shared ledger that verifies:

1. Who delivered the service
2. What it cost to produce
3. What price corridor it falls within
4. How much margin each actor may retain

Each service, drug, or diagnostic becomes a Node in an Enumerated Health Graph.

Node values adjust dynamically—similar to stock‑market floats—using aggregated, anonymized actuarial data. Prices can rise or fall within bounded corridors (say ±15%), rewarding efficiency while preventing predation.

3.2 — The Shared‑Risk Vault (SRV)

Every citizen contributes to a pooled reserve proportional to income—a modernized, tax‑bracket‑style premium. The vault automatically reinsures catastrophic cases (>$50,000 per year) while routine care runs on direct, transparent pricing. Advanced models continuously rebalance exposure so that risk is distributed before it becomes tragedy.

3.3 — Transparent Arbitration

Disputes between payers, providers, or patients are resolved in public view. All precedents are published; all algorithms that set prices or flags are open‑sourced and explainable. Justice in billing becomes as traceable as justice in courts.

3.4 — Auditors and Committees

Algorithmic proposals meet human ratification. Rotating committees—clinicians, patients, economists, ethicists, and employers—review rate corridors and governance metrics. Every seat has a “shadow‑seat”: a civic observer who can trace, simulate, and contest decisions on‑chain. This prevents capture while cultivating trust.

4. Economic Reality: Doing More With Less

Today, administrative overhead consumes 15–25% of every U.S. healthcare dollar.

The HCC’s clearing model would function on 0.05–0.15% per transaction—one‑tenth of that cost. Surplus revenue funds ethics research, anti‑fraud automation, and public education grants. Capped gain becomes design, not afterthought: no stakeholder earns beyond fixed net margins per class of service. Savings flow directly back to members as dividends of wellness—lower premiums, debt forgiveness, or pooled community benefits.

5. The Human Layer: Care‑Infused Design

Money alone does not heal; meaning does. The HCC re‑introduces humanity through three simple mechanics:

1. Thank‑You Economics — When a member chooses a cost‑saving alternative, they receive a gratitude message, not loyalty points: “Because of your choice, our plan saved $312—enough to fund a month of insulin for another member.” Reciprocity without guilt.
2. Voluntary Care Boards — Anonymous, opt‑in spaces where people share milestones or reflections. Aggregated stories, never forced, remind participants that efficiency funds empathy.
3. Healing Infrastructure — Language shifts from “fighting disease” to “living supported.” Systems regulate alongside patients—co‑regulation instead of heroism.

Through these micro‑moments of delight, the apparatus of finance becomes an instrument of collective nervous‑system calm.

6. Governance and Ethics

The HCC would be non‑governmental yet public‑minded—a research and grant‑driven agency with the independence of NASA and the oversight clarity of the SEC.

• AI Ethics Office audits every predictive or pricing model for bias.
• Fraud‑Waste‑Abuse Core uses real‑time anomaly detection to expose exploitative billing before payment.
• Public Dashboard publishes every dollar of float, every arbitration outcome, every algorithm update.

Governance is emergent: citizens, professionals, and organizations can fork oversight boards or propose new modules as collective understanding evolves. It is democracy rendered in code.

7. Why Innovation Survives

Capped corridors do not smother creativity; they stabilize it. Pharmaceutical innovators still earn profit, but inside transparent boundaries. Hospitals still compete on experience and efficiency, not coding acrobatics. Entrepreneurs can plug into the open infrastructure the way fintechs plug into banking rails. When rent‑seeking collapses, genuine ingenuity finally pays.

8. The First 100 Days

If the Healthcare Clearing Commission were launched tomorrow, its inaugural agenda would be clear:

1. Form the Founding Circle
   • Chief Ethicist (AI alignment)
   • Chief Actuary / Systems Engineer
   • Chief Public Advocate
   • Chief Data Architect (FHIR + ledger integration)
2. Secure Anchor Partnerships
   • Academic health‑economics labs
   • State employee benefit plans willing to pilot transparent clearing
   • Major EHR vendors for standards alignment
3. Build the Prototype Exchange
   • Start with one drug class (insulins) and one procedure (outpatient imaging).
   • Publish full cost stack: acquisition, distribution, facility, professional fee.
   • Clear transactions at dynamic corridor prices in real time.
4. Launch the Symbolic Gesture — On Day 100, release the Public Receipt: a single interactive page showing every transaction cleared, every anomaly caught, and the administrative cost—down to the cent. The message to the public: “The era of opaque healthcare is over.”

9. Safeguards for Humanity

Three constitutional guardrails anchor the model:

1. Transparency as a Right — every citizen can see how health dollars move.
2. Contribution by Means — nobody pays beyond their capacity; solvency scales with compassion.
3. Care Without Shame — seeking help is never portrayed as costing others; utilization fuels learning, not blame.

These clauses transform payment into participation.

10. Why the Commission Must Exist

Because opacity is not complexity—it’s neglect. Because innovation without ethics is extraction. Because every invoice is a moral document that tells us what we value.

The Healthcare Clearing Commission is not another agency; it is a new social instrument. A resilient arbiter that merges actuarial intelligence with civic tenderness. A system that can finally say, in code and in conscience:

No more surprise bills.
No more silent insolvency.
No more moral fog around the price of being alive.

We can build this. The infrastructure already exists: open APIs, FHIR standards, federated ledgers, privacy‑preserving computation. What has been missing is will—and wonder.

11. Invitation

To engineers, clinicians, economists, ethicists, and citizens who believe that fairness can be designed: come play. Come write the protocols, model the corridors, and craft the micro‑moments of gratitude that make collective solvency real.

This is not government versus market—it is community versus entropy. Let us clear the fog together. Let us build the world’s first Healthcare Clearing Commission and prove that transparency can heal.

(c) 2025 Andrew Vargas | Pharmacist Write Essays Series — “On Collective Solvency”