If the shortage of care is counterfeit, the question stops being whether to dissolve it and becomes the more interesting one: in what order. Scarcinality is, at root, a claim about ordering. It says the scarcities binding an economy are ranked rather than flat. A roadmap is the same claim turned toward action, a ranking of which counterfeit scarcity to dissolve first, second, and last, chosen so the repair never tips the system out of the regime where money is the thing that binds.
That last clause is the whole discipline. The counterfeit-shortage reading is licensed only in the lower-left of the plane, where money binds and the labor market has slack. A repair done too fast, or compressed into a tight economy, pushes the system up and to the right, where care becomes a real shortage and the same monetary push arrives as medical price inflation rather than as more care. So the sequence is not administrative tidiness. It is how you stay inside the quadrant that makes the remedy work. Four phases, in order.
Phase 0. Sever the household overhang first
The tightest grip is on the household balance sheet, so it goes first. A hard out-of-pocket ceiling near two thousand dollars, sliding to zero at low incomes, placed over every existing plan at once, with balance billing banned, medical debt struck from credit files, and enrollment made automatic. This is the descent reversed at the level where it bites hardest. In Fisher and Minsky terms it is a deleveraging of the household sector, the removal of the largest source of involuntary household debt. It needs no new architecture, which is why it can move first and fast, and it retires the hardest goal, the end of medical bankruptcy, before anything structural is touched. Nothing real has to be built. A gate simply stops being a gate.
Phase 1. Build the floor on rails that exist
Do not manufacture a new scarcity of administrative capacity by standing up a system from nothing. The Medicare chassis, its billing rails, its provider network, its rate-setting, already exists, and the cheapest counterfeit to avoid is the one you would create by ignoring it. A universal floor auto-enrolls the uninsured, folds in Medicaid to end the eligibility churn, and lowers the age in steps, sixty-five to sixty to fifty-five. The stepping is not caution for its own sake. It is the phase-plane discipline made concrete: release demand in waves into available slack, never in a single surge into a tight economy.
Phase 2. Reroute the money, federally
By now the floor is visible and working, which is the moment to move the financing, because the contribution can be seen for what it is: a premium relabeled, not a burden added. Employer premiums convert to a payroll contribution, the employer tax exclusion is recovered, and the existing public dollars are pooled. The money does not appear. It changes address. This is the master-scarcity claim rendered as a budget line, and it must be federal, because the two obstacles that sink any state attempt, the preemption that shields self-insured employers and the impossibility of folding in Medicare without Congress, both dissolve only at the national level.
Sequencing is scarcinality applied to time. You dissolve the counterfeit scarcities in the order of their grip, and you never let the repair cross into a real one.
Phase 3. Draw the line between counterfeit and real
The last phase is a definition, and it is the framework's own distinction. Necessary care was a counterfeit shortage, and the floor dissolves it. But speed, private rooms, broader choice, and cosmetic procedures are not counterfeit scarcities. They are real preferences for things that are genuinely optional, and a market for them is legitimate precisely because it is no longer a gate in front of necessary care. So private insurance survives, demoted, in three honest roles, complementary, supplementary, and extras, and earns a second living administering the public benefit at capped margins. The payers are not abolished. They are moved off the road and into the shop.
The corridor on the plane
Standing ledger
Each line is a conditional claim this roadmap commits to, with the observation that would falsify it. Status updates as evidence arrives. These are statements about direction and order, not forecasts of magnitude.