Three Constitutional Guardrails
1) Transparency as a Right
Every citizen can see how health dollars move. Each cleared transaction exposes its cost stack (acquisition, distribution, dispense/admin fees, margin) and the corridor that governed its price. Disputes, model updates, and solvency metrics are public by default.
2) Contribution by Means
Solvency scales with compassion. Contributions to the Shared‑Risk Vault are capacity‑based (e.g., income‑banded), with hard caps to prevent hardship. No one is priced out of necessary care; catastrophe is absorbed collectively.
3) Care Without Shame
Seeking help is never framed as “costing others.” Utilization fuels learning and better coverage. Gratitude, not guilt, is the default—members see how their choices and their care both strengthen the whole.
Closing Arguments
Opacity is not complexity—it’s neglect.
Every invoice is a moral document that tells us what we value.
We’ve normalized financial fog as a feature of modern medicine. It isn’t. The Healthcare Clearing Commission is a simple proposition: settle truth before money. Clear every transaction on an open rail; cap gain by design; publish the rules; protect people at their most vulnerable moments.
No more surprise bills. No more silent insolvency. No more moral fog around the price of being alive.
Invitation: Community vs. Entropy
This is not government versus market—it’s community versus entropy. The pieces already exist—open standards, actuarial methods, direct‑care pilots. What’s missing is coordinated will. If you’ve felt the pull to build something cleaner than the status quo, your seat is waiting.
What we’re building next: the prototype exchange for insulins and outpatient imaging, a public arbitration docket, and the Day‑100 Public Receipt that shows clearing cost down to the cent.
Practitioner Appendix: Call for Expertise
To build this, we’re assembling a cross‑functional working group. If any of the below fits you, we’d love your help:
1) Pharmacists & Actuaries — formularycommons
- Model corridor rules for insulin classes; define the reference cost sources and exception logic (shortages, device changes, clinical hardship).
- Publish cost stacks (acquisition, distribution, dispense/admin, site‑of‑care) and simulate ±15% corridor impact on member OOP and plan spend.
2) Data Architects (FHIR/API/Ledger) — Universal Clearing Layer
- Extend a Node schema that maps FHIR, X12, and NCPDP to cost‑stack metadata; design
corridorId,referenceCost,provenanceextensions. - Stand up
POST /claims/clear,POST /disputes, andGET /nodes/{id}/corridorwith signed traces and a public audit surface.
3) Ethicists & Economists — Governance & Bias Audits
- Draft model cards, bias tests, and red‑team protocols for corridor updates and SRV layers.
- Write the oversight playbook: mixed committees, shadow seats, conflict disclosures, and public minutes.
4) Clinicians & Patient Advocates — Human Layer
- Design Thank‑You Economics copy; advise on voluntary care boards and “safe‑to‑be‑seen” messaging.
- Define member‑first arbitration UX: fast, respectful, and precedent‑aware.
How to raise your hand: join via the hub’s invite form, or email with subject “HCC Working Group” and 3–5 lines on where you can contribute most. We’ll convene small, focused pods with clear artifacts and timelines.
Missed earlier parts? Start with Spoke 1: The Failure We All Feel, or jump to the premise of Collective Solvency.