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Voice to Congress | |
What the American People Require Congress to Provide
The American healthcare system is too expensive, too complicated, too uneven, and too hard to use. Too many people still lack coverage. Too many people have coverage they cannot afford to use. Too many families delay care because of cost. Too many patients face medical debt, denied claims, unclear notices, narrow networks, long wait times, and confusing appeals. Too many providers spend time fighting paperwork instead of caring for patients.
The problem is not only insurance. The problem is the system. A real healthcare solution must provide coverage, access, affordability, quality, equity, simplicity, public health readiness, data transparency, fraud control, privacy, funding, and accountability.
This page summarizes the draft Healthcare System Requirements Specification in plain English so citizens, reviewers, and congressional staff can see what Congress should be asked to provide and how future Healthcare metrics and report cards should be built.
The United States currently has a fragmented healthcare system made up of employer-sponsored insurance, Medicare, Medicaid, CHIP, ACA Marketplace coverage, private individual coverage, Veterans health programs, charity care, uncompensated care, and many state-level variations.
This system provides care to many people, but it also creates gaps, complexity, uneven access, high costs, and inconsistent accountability. Coverage and care often depend on job status, income, state of residence, paperwork, network rules, benefit rules, provider availability, and ability to navigate the system.
We want a healthcare system that works in real life. The system should cover every eligible person, protect people from financial harm, provide timely access to real care, improve outcomes, reduce disparities, simplify administration, protect privacy, control fraud and waste, and publish clear public evidence showing whether the system works.
| Requirement Area | Public Requirement | SRD Trace |
|---|---|---|
| Universal Coverage | Every eligible person should have healthcare coverage. People should not lose healthcare because of paperwork, job loss, income fluctuation, moving, pregnancy, disability, aging, family change, or state administrative failure. | HC-COV |
| Affordability | Covered care should be usable. Healthcare should not cause medical debt, unaffordable out-of-pocket cost, delayed treatment, or financial ruin. | HC-AFF |
| Benefits and Medical Necessity | People should know what care is covered, why something was denied, what it will cost, and how to challenge a wrong decision. | HC-BEN |
| Timely Access | Coverage is meaningless if people cannot get care. Access should be measured by real availability, not just provider names in a directory. | HC-ACC |
| Quality and Safety | The goal is not merely to process claims. The goal is better health, safer care, prevention, chronic disease control, and better outcomes. | HC-QLT |
| Equity | Where people live, how much money they make, whether they are disabled, what language they speak, or what group they belong to should not determine whether they can get healthcare. | HC-EQY |
| Administrative Simplicity | A healthcare system should help people get care, not force them through a maze of forms, denials, prior authorizations, appeals, and billing confusion. | HC-ADM |
| Provider Capacity | The system should have enough participating providers, accurate provider directories, reasonable appointment availability, and workforce planning. | HC-PRO |
| Prescription Drugs | People should not skip medicine because it is too expensive, unavailable, blocked by opaque rules, or trapped in an inaccessible pharmacy network. | HC-PHR |
| Long-Term Care and Disability Support | Families should not be destroyed financially, emotionally, or physically because the system ignores long-term care, disability support, home care, or caregiver needs. | HC-LTC |
| Mental Health and Substance Use Care | Mental health and substance use care are healthcare. Behavioral health care should not be harder to get than other medically necessary care. | HC-MNT |
| Maternal, Child, and Family Health | Mothers, babies, children, and families should not fall through gaps during pregnancy, birth, childhood, family change, or coverage transitions. | HC-MAT |
| Public Health and Preparedness | A healthcare system should prevent harm before people are sick, and it should be ready for emergencies, outbreaks, drug shortages, disasters, and public health threats. | HC-PUB |
| Data and Public Reporting | No more hidden failure. The public deserves transparent, understandable evidence showing whether the healthcare system is working. | HC-DAT |
| Fraud, Waste, Abuse, and Integrity | Public money should go to care, not fraud, waste, bureaucracy, abusive billing, or improper payments. Integrity controls must also protect legitimate access to care. | HC-FWA |
| Security and Privacy | People should not have to trade privacy, dignity, or cybersecurity to get healthcare. Sensitive information must be protected and auditable. | HC-SEC |
| Funding and Fiscal Sustainability | Healthcare reform must be paid for honestly, not through hidden premiums, deductibles, medical debt, provider underpayment, unfunded state mandates, or accounting tricks. | HC-FIN |
| Governance and Accountability | The system must define who is responsible, who is accountable, who pays, who operates, who audits, and who fixes problems. | HC-GOV |
| Transition and Readiness Gates | Congress should not authorize a vague massive launch. Healthcare reform should use requirements, pilots, readiness gates, scale gates, corrective action, and independent review. | HC-TRN |
| Verification and Traceability | Every major requirement should trace to goals, metrics, sources, laws, funding, verification evidence, and public reporting. | HC-VNV |
| Public Question | Example Metrics |
|---|---|
| Are people covered? | Coverage rate, uninsured rate, coverage gap rate, coverage continuity rate. |
| Can people afford care? | Out-of-pocket burden, medical debt rate, delayed care due to cost, prescription nonadherence due to cost. |
| Can people get care? | Primary care wait time, specialty wait time, behavioral health wait time, provider availability, rural access gap. |
| Is care safe and effective? | Preventable hospitalizations, readmissions, preventive care completion, chronic disease control, preventable harm. |
| Is the system fair? | Disparity index, language access, disability access, rural access, affordability gaps, outcome gaps. |
| Is the system simple? | Administrative cost ratio, denial rate, appeal time, prior authorization burden, provider administrative burden. |
| Are prescriptions affordable and available? | Medication affordability, drug spending growth, pharmacy network adequacy, drug shortage impact. |
| Are vulnerable populations protected? | Long-term care access, home and community-based services access, maternal outcomes, child coverage continuity, mental health access. |
| Is public money protected? | Improper payment rate, payment accuracy rate, fraud detection yield, audit finding closure. |
| Is privacy protected? | Privacy control compliance, audit log completeness, security incident response, disaster recovery test results. |
| Is the system funded honestly? | Total health spending, per-capita spending, funding adequacy, fiscal risk, total cost growth. |
| Is Congress doing its job? | Relevant bills, sponsors, cosponsors, votes, committee action, funding, oversight, enactment, and implementation evidence. |
The future Healthcare Congressional Report Card should separate healthcare system performance from member legislative performance.
| Layer | What It Measures |
|---|---|
| Healthcare System Grade | Whether coverage, affordability, access, quality, equity, simplicity, funding, integrity, privacy, and public reporting are improving. |
| Congressional / Member Grade | Whether Congress and individual members are advancing laws, funding, oversight, and implementation that meet the Healthcare requirements. |
| Component | Purpose |
|---|---|
| Legislative Effort | Did the member sponsor or cosponsor relevant healthcare legislation tied to the requirements? |
| Legislative Advancement | Did the member help move requirements through committee, floor action, passage, conference, or implementation? |
| Public Result / Became Law | Did the work become law, funding, rulemaking, implementation, or measurable public result? |
| Agenda-Control Accountability | Did leadership or committee gatekeepers advance or block healthcare requirements? |
| Duty / Continuity | Did Congress remain operational and available to perform its healthcare duties? |
Healthcare metrics should be based on public or auditable evidence. Primary sources should be used whenever possible.
| Source Category | Example Sources | Purpose |
|---|---|---|
| Coverage | Census, CMS, Medicaid/CHIP, ACA Marketplace | Coverage rate, uninsured rate, coverage type, continuity, state variation. |
| Spending and Funding | CMS National Health Expenditure Accounts, CBO | Total spending, per-capita spending, fiscal impact, public/private cost. |
| Quality and Disparities | AHRQ, CDC, CMS quality datasets | Quality, outcomes, patient safety, disparities, preventive care. |
| Workforce and Access | HRSA, provider datasets, state access data | Shortage areas, workforce capacity, network adequacy, rural access. |
| Prescription Drugs | FDA, CMS, CBO, KFF, OECD | Drug shortages, affordability, drug spending, access, cost control. |
| Program Integrity | GAO, HHS OIG, CMS improper payment reports | Fraud, waste, abuse, improper payments, audits, corrective action. |
| Legislation | Congress.gov, CBO, committee records, Federal Register | Bills, votes, funding, oversight, rules, enactment, implementation evidence. |
The American People require Congress to provide a healthcare system that:
| Item | Status | Next Step |
|---|---|---|
| Healthcare SRD core requirement groups | Draft complete | Review for completeness, conflicts, testability, and public readability. |
| KPI dictionary starter | Draft starter | Confirm source availability, formulas, baselines, and data quality rules. |
| Requirements Traceability Matrix | Draft starter | Export to CSV and map goals to requirements, KPIs, sources, verification, and legislation. |
| Source manifest | Draft starter | Confirm CMS, Census, AHRQ, HRSA, FDA, CBO, Congress.gov, GAO, HHS OIG, OECD, Commonwealth Fund, and KFF sources. |
| Healthcare metrics dashboard | Not started | Build only after source manifest and KPI dictionary are reviewed. |
| Healthcare Congressional Report Card | Not started | Build after requirements, metrics, source evidence, and legislative traceability are ready. |
The next step is to review and baseline these requirements before creating Healthcare metrics or Congressional grades. Once the requirements, KPI dictionary, RTM, source manifest, and review checklist are ready, Healthcare can move from Draft Requirements Review toward Requirements Baseline Candidate.
Draft v1. This page is intended to be edited as the Healthcare SRD, KPI dictionary, source manifest, and review checklist mature.