The United States Healthcare Overhaul_ From Reactive Spending to Preventive Capital.pdf
StevenHeizmannCPA
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Oct 18, 2025
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About This Presentation
The American healthcare system has long been a reactive ledger of loss. The integration of Elevator Entanglements and Health Banks offers a different arithmetic:
Gold and genes as mutual collateral.
AI as fiscal empath.
Prevention as the new currency of the Republic.
Deficits become dividends ...
The American healthcare system has long been a reactive ledger of loss. The integration of Elevator Entanglements and Health Banks offers a different arithmetic:
Gold and genes as mutual collateral.
AI as fiscal empath.
Prevention as the new currency of the Republic.
Deficits become dividends when biology and finance learn to balance each other. The United States could lead the planet not through domination, but through maintenance — the quiet discipline of keeping life in balance.
If the 20th century belonged to the industrial economy of extraction, the 21st will belong to the preventive economy of entanglement.
The next superpower will not be the one that builds the most weapons or data centers, but the one that builds the most wellness.
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Slide Content
The United States Healthcare Overhaul:
From Reactive Spending to Preventive
Capital
By Steven Heizmann, CPA, CGMA
Founder & CFO, All Seeing Eye Accountants (ASEA) | R&D Pioneer
in AI, Crypto & Finance
Part I — Diagnosis of a Diseased Ledger
I. Introduction — The Fiscal Illness of Health
The United States spends almost one-fifth of its GDP on healthcare—over $4.9 trillion in
2024—yet ranks below its OECD peers in life expectancy, maternal mortality, and
chronic-disease burden. For a Certified Public Accountant, this system resembles a distressed
enterprise: high cash flow, poor yield, and a balance sheet bloated with waste.
The Affordable Care Act (ACA) added liquidity but not solvency. It insured millions but did not
cure the cost disease. From an accounting lens, America’s healthcare system operates on a
reactive accrual model—expenses recognized only after failure occurs.
To restore fiscal health, prevention must migrate from off-balance-sheet good intention to
on-ledger asset.
II. The ACA Audit — What Changed and What Did Not
1. Coverage Expansions and Budget Pressure
Between 2010 and 2023, the uninsured rate fell from 16 % to 8 %, yet federal healthcare
outlays doubled. Subsidies and Medicaid expansion cost roughly $1.8 trillion in 2023 alone. The
Congressional Budget Office now projects $3.3 trillion by 2033—over 8 % of GDP.
Finding: Liquidity improved; liabilities deepened. The ACA functioned as a cash-flow patch, not
a capital reform.
2. Administrative Waste
Thirteen percent of every premium dollar funds paperwork, coding, or compliance—about $265
billion annually. The private multi-payer model has produced negative economies of scale:
complexity grows faster than coverage.
3. Incentive Misalignment
Fee-for-service still dominates. Hospitals profit from occupancy; insurers profit from risk;
pharmaceutical firms profit from chronicity. The ACA’s value-based pilots cover less than 10 %
of spending.
Audit Verdict: Incremental gains, structural waste intact.
III. The Cost of Entropy — How Waste Destroys Wealth
Healthcare entropy consumes ≈ 25 % of total spending ($760–$930 billion per year). This
includes:
●Administrative complexity (8 %)
●Pricing failure (5 %)
●Over-treatment (3 %)
●Coordination failures (2 %)
●Fraud and abuse (1 – 2 %)
●Under-investment in prevention (the silent residual ≈ 6 – 8 %)
If this were a corporate ledger, a quarter of revenue would be classified as “unverified losses.”
No auditor would sign off on it.
IV. The Reactive Economy vs. the Preventive Economy
The reactive model treats illness as GDP-positive activity. Every hospitalization creates revenue;
every recovery shrinks it.
The preventive model, by contrast, treats health as capital stock. Its maintenance generates
compounding returns in productivity and longevity. When measured properly, each dollar of
prevention yields $5–$10 in future savings.
The core problem is liquidity. There is no bank for prevention, no asset class for health. That
void sets the stage for the solutions introduced in Parts II and III.
V. Reframing Health as Infrastructure
If health is infrastructure, its finance should mirror transportation and energy: public baseline
funding, private throughput, and auditable returns. Infrastructure depreciates without
maintenance; so does biology. The U.S. has federal highway trust funds, energy loan programs,
and housing credits—but no Health Vault Fund.
Such a fund could consolidate Medicare, Medicaid, and ACA outlays into a preventive capital
budget with performance-based dividends. Waste would convert into measurable yield.
VI. International Comparisons
OECD data (2024):
●U.S. spending ≈ 17.6 % of GDP.
●Peer average ≈ 10 %.
●Life expectancy gap ≈ 5 years.
Single-payer nations allocate more to prevention (7–8 % of health budgets) versus U.S. (2–3
%). Administrative overhead is one-quarter. Their outcomes validate the preventive capital
theory.
VII. Macroeconomic Consequences of Inaction
Without reform, federal health liabilities will surpass Social Security by 2035. Healthcare inflation
adds ≈ 0.3 percentage points to the deficit annually. Each 1 % cost reduction equals ≈ $50
billion per year in deficit relief. Prevention is thus not just ethical; it is fiscal policy.
VIII. Prelude to the Descent
To solve a surface-level problem requires a subsurface solution. Enter Elevator Entanglements
and Health Banks — two architectures that merge finance, geology, and genomics into a
self-balancing ledger of life.
They propose that the energy beneath our feet and the data within our cells can fund each
other, turning entropy into equity.
Part II — The Descent into the Cure
Integrating Elevator Entanglements and Global Health Overhaul into U.S.
Fiscal Recovery
By Steven Heizmann, CPA, CGMA
Founder & CFO, All Seeing Eye Accountants (ASEA)
I. Descent as Diagnosis — Healing the Economy from the
Ground Down
Every accountant knows that to fix a balance sheet, one must descend into the footnotes—the
substrata beneath the summary lines where hidden liabilities sleep. The same is true for
nations.
America’s surface economy runs on credit, but its real collateral lies underground and
within—in geothermal energy, mineral wealth, and human health capital.
The Elevator Entanglements framework proposes that these layers can be fused into a single
vertical infrastructure: a chain of deep-earth vaults that simultaneously extract energy, store
genomic data, and underwrite preventive-health finance.
If the Global Healthcare Overhaul supplied the circuitry of a new health economy, Elevator
Entanglements supplies the physical grounding wire.
Together, they turn the healthcare system into a thermodynamic loop: energy from the crust
powers data vaults; data vaults finance prevention; prevention sustains the workforce that
maintains the grid.
II. Infrastructure as Immune System
The U.S. builds highways, grids, and pipelines; it must now build Health Vaults—vertical
conduits linking fiscal and biological resilience.
Each vault would contain three strata:
1.Surface Interface – logistics, hospitals, and Treasury nodes.
2.Mid-Depth Energy Layer – geothermal loops providing autonomous power for hospitals
and data centers.
3.Deep Vault Core – quantum-secure storage for genomic records, AI models, and
gold-backed preventive reserves.
These vaults act as immune organs of the nation’s economy—detecting entropy, releasing
liquidity, and recycling value.
Financially, they replace debt accumulation with fractal-decay circulation: stored capital
automatically loses value unless reinvested in preventive outcomes such as disease reduction
or environmental renewal.
III. Fractal-Decay Economics — A Fiscal Antibody
Traditional capital appreciates by scarcity; preventive capital appreciates by use.
Fractal-decay mechanics enforce circulation: unutilized assets melt into public-benefit pools.
Applied to U.S. healthcare:
●Idle hospital surpluses decay into regional preventive credits.
●Unspent insurance reserves auto-transfer to chronic-disease reduction programs.
●Dormant government balances flow to population-health infrastructure.
This design embeds Keynesian counter-cyclicality inside the code: money that stagnates
becomes medicine.
IV. Gold-Backed Preventive Finance
The Elevator Vault network enables commodity-anchored preventive bonds.
Each bond’s yield inversely tracks national disease indices:
When population health improves, coupon rates decline, lowering federal debt
service.
Gold and rare-earth reserves within vaults provide collateral, while AI-audited health data from
the national vault network determine coupon adjustments.
This transforms prevention into a measurable macro-stabilizer.
Projected Impact:
A 10 % reduction in chronic-disease incidence could cut federal health obligations by ~$500
billion over 20 years, enough to reduce the structural deficit by nearly 1 % of GDP.
V. Regional Vaults as Economic Engines
1. Midcontinent Vault Corridor
Located across Nebraska–Kansas–Oklahoma shale belts, these shafts integrate geothermal
power with hospital networks and preventive-AI clusters.
Projected output: 2 GW thermal energy + $40 billion annual health-bond capacity.
2. Nevada Desert Vault
Gold-REE collateral zone connected to western grid; functions as western preventive-bond
reserve.
3. Appalachian Vault
Repurposed coal corridors transformed into bio-data repositories; miners retrained as
geothermal technicians and data-maintenance specialists.
Each region converts extractive heritage into regenerative capital—turning “coal towns” into
care towns.
VI. Hospitals as Adaptive Nodes
Hospitals in the preventive-vault era earn revenue through health reduction.
Their new financial structure:
Source Mechanism Incentive
Base Readiness
Funds
Public utility payments for emergency capacity Stability
Preventive
Dividends
Payouts from avoided admissions, verified via
vault analytics
Health promotion
Innovation Credits AI-audited efficiency gains Technological
adoption
Each hospital’s performance dashboard measures entropy reduction rather than occupancy.
Financial health becomes isomorphic with public health.
VII. Pharmaceutical Sector — From Volume to Value
Circulation
Vault-based finance enables dynamic, evidence-linked royalties.
●Preventive R&D Contracts: public vaults fund vaccines and gene therapies; payments
unlock upon verified reduction in morbidity.
●Fractal Licensing: platform technologies accrue compounding royalties for each
validated reuse.
●Adaptive Pricing: AI recalibrates prices according to real-world efficacy curves.
The industry shifts from patent protectionism to perpetual performance.
VIII. Insurance Reconstruction
Insurance becomes a data-driven reinsurance grid.
Premiums vary dynamically with preventive engagement; catastrophe layers (pandemics,
disasters) are underwritten by national vault liquidity.
Insurers evolve into risk-integrators measured by Systemic Resilience Score (SRS) rather
than claim denial.
Result: actuarial science merges with public-health economics; risk turns from liability into
feedback signal.
IX. Data Sovereignty and Governance
Health Vaults store genomic and biometric data under dynamic consent protocols.
●Individuals own encrypted keys.
●AI training occurs through federated learning—models learn patterns without touching
raw data.
●Every query leaves an auditable hash in a public ledger.
The governance structure mirrors the International Health Ledger Authority (IHLA) proposed in
Global Healthcare Overhaul.
U.S. Health Supervisory Nodes connect to the IHLA via continuous API, ensuring transparency
and civil oversight.
X. Environmental Integration — Bio-Geothermal Loops
The vault network doubles as a climate infrastructure.
Waste heat from AI computations powers district heating; geothermal coolant recycles to
generate electricity.
Hospitals and biobanks operate carbon-negative.
Each ton of CO₂ mitigated earns Preventive Carbon Credits tradable on health-bond markets.
This entangles environmental and medical finance—curing the atmosphere as we cure
ourselves.
XI. Fiscal Model — Turning Deficits into Dividends
Baseline Metrics (2025):
●Federal health expenditure ≈ $1.7 T/year.
●Preventive-bond yield diversion → Debt service relief ≈ $600 B per year.
Result: healthcare becomes the first public sector that pays the debt down rather than adds to
it.
XII. Ethical Architecture
Preventive finance must remain moral finance.
Laws required:
1.Health Data Sovereignty Act — codifies individual ownership and revocable consent.
2.Preventive Finance Regulation Code — defines issuance and decay rules for health
bonds and credits.
3.AI Accountability Statute — mandates explainable algorithms and assigns liability for
bias.
4.Emergency Liquidity Mandate — automatic treasury release via vault triggers during
crisis.
These turn ethics into executable code—a moral operating system for finance.
XIII. Workforce Transformation
New professional classes emerge:
●Preventive Architects — clinicians skilled in data and systems design.
●Reintegration Facilitators — guide patients from acute to preventive cycles.
●Health Auditors — CPAs certified in fractal-decay finance and AI ethics.
Training shifts from reactive medicine to adaptive stewardship.
Employment stability rises as health becomes a perpetual maintenance industry instead of a
crisis economy.
XIV. Implementation Timeline (U.S. Context)
Phase Years Objective
1. Feasibility 2025–20
27
Identify sites for first vaults; consolidate ACA, Medicare,
Medicaid data into a single Health Ledger.
2.
Construction
2028–20
33
Develop two pilot vaults (Nevada and Midcontinent); issue
Preventive Bonds tied to geothermal output.
3. Integration 2033–20
40
Link hospital networks, insurers, and Treasury through AI risk
engines; launch citizen Preventive Accounts.
4.
Optimization
2040–20
50
National rollout; automatic budget adjustments based on entropy
reduction; IHLA federation.
XV. Quantifiable Benefits
Domain Baseline 2040
Projection
Fiscal Effect
Healthcare Spending 17.6 % GDP ≈ 9 % GDP ≈ $1 T annual savings
Federal Deficit $1.9 T ≤ $1 T –$900 B reduction
Healthy Life Expectancy ≈ 68 yrs ≈ 78 yrs +10 yrs productive labor
Preventive Market Cap ≈ $0 >$1 T new asset class for Treasury
CO₂ Offset n/a 150 Mt/yr carbon credits worth ≈ $15 B
XVI. Philosophical Reflection — The Subsurface Mind
Beneath the spreadsheets and shafts lies a metaphysical symmetry: entropy below, equilibrium
above.
The elevator—an ancient emblem of human aspiration—now becomes an emblem of humility:
progress by descent, profit by prevention.
When finance, geology, and biology entangle, civilization finally resembles its planet—layered,
recursive, self-healing.
XVII. Transition to Part III — The Health Bank
If Elevator Entanglements rebuild the physical and fiscal spine of the nation, the Health Bank
will supply its neural network—AI, CRISPR, and genetic capital turning preventive care into
compounding equity.
In Part III, we ascend from the vaults into the circuitry of life itself—where every cell becomes an
account, every act of prevention a transaction, and every citizen a shareholder in continuity.
Part III — The Health Bank: Financing
Preventive Life Through AI and Genetic
Capital
By Steven Heizmann, CPA, CGMA
Founder & CFO, All Seeing Eye Accountants (ASEA)
I. The New Balance Sheet of Life
Part II descended into the vaults—into the geothermal arteries and fiscal thermodynamics that
would power a preventive economy.
Part III ascends into the neural layer: the Health Bank, an AI-governed institution where
genetic data, financial capital, and ethical code converge.
For a century, medicine has functioned like an emergency budget office—funding crises and
forecasting collapse. The Health Bank converts that operating model into a continuous accrual
of vitality. Health becomes liquidity; longevity, the dividend.
In accounting terms, the balance sheet of civilization gains a new asset class: Genetic Capital
(GC), defined as the measurable capacity of the population to sustain biological function over
time. Its depreciation is disease; its appreciation is prevention.
II. Architecture of the Health Bank
The Health Bank merges three pre-existing infrastructures into a single ledger:
Subsystem Origin Function
Health Vaults Elevator
Entanglements
Physical substrate — geothermal-powered,
gold-collateralized data centers.
Preventive Credit
Accounts (PCA)
Global Healthcare
Overhaul
Citizen-level ledgers rewarding measurable
preventive acts.
Genetic Capital
Accounts (GCA)
Health Banks Model CRISPR-verified biological maintenance
funds.
Together, they create a multi-tiered financial organism where value circulates as energy,
information, and biology simultaneously.
AI governs this circulation through fractal-decay logic: any idle asset—financial or
biological—gradually melts into a preventive reserve unless maintained through verified care
activity. Entropy becomes the auditor.
III. Deposits and Dividends: How Health Becomes Money
1.Deposit = data. Wearables, clinics, or CRISPR scans stream validated biometrics into
the vault.
2.Collateralization = trust. Genomic integrity certified through zero-knowledge proofs
(privacy-preserving verification).
3.Yield = longevity. Preventive behaviors and gene maintenance generate credits
redeemable for lower premiums, tax rebates, or investment returns.
Every citizen’s biological account accrues Preventive Dividends (PD)—measured in life-years
gained and economic savings produced.
AI ensures that dividends compound through community health: the better the collective
metrics, the higher the individual yield.
IV. CRISPR and the Liquidity of Genes
By 2035, gene-editing costs are projected to drop below $10 000 per preventive procedure. At
that price, CRISPR maintenance becomes a public utility, not a luxury.
The Health Bank underwrites this through Genetic Maintenance Loans (GMLs)—zero-interest
credits whose repayment is tied to verified health gains. If the edit prevents disease, the loan
self-amortizes from the savings generated.
These GMLs operate like green bonds for biology: capital raised today for future
carbon-equivalents of health—mutations avoided, crises unborn.
V. AI as Chief Risk Officer
Each citizen’s data stream forms a dynamic biological risk profile (DBRP). AI models trained on
vault data assign real-time risk scores and recommend micro-interventions—diet, sleep,
micro-gene adjustments.
AI therefore does not replace doctors; it becomes the invisible reinsurer of life. It monitors
entropy without judgment, allocating credit and care before crisis arises.
Regulation requires that each AI model publish its Algorithmic Charter—an auditable manifest
of bias controls, training data sources, and ethical constraints. Transparency is treated as a
GAAP principle for machine ethics.
VI. Proof of Preventive Care (PPC) Tokens
Every verified act of prevention—screening, exercise compliance, gene correction—is minted as
a PPC token on a federated ledger.
Tokens carry no personal data; only cryptographic proof of compliance and outcome.
Employers, insurers, and governments use PPCs as risk-reduction instruments. Aggregated
tokens lower community premiums and feed national health indices that govern Preventive
Bond yields.
A single city of one million citizens achieving 90 % preventive coverage could generate ≈ $2
billion in annual deficit relief through reduced federal claims.
VII. The Preventive Dividend and National Accounts
To integrate health as capital into macroeconomic policy, the Treasury adopts the Health
Adjusted Net Savings (HANS) indicator—GDP minus entropy of health.
A rise in average healthy life expectancy increases HANS the way capital investment raises
GDP.
Preventive Dividends flow from HANS surpluses to citizens’ PCA accounts. This creates a
feedback loop where fiscal balance depends on collective well-being—an automatic stabilizer
more ethical than any tax code.
VIII. Ethical Banking and Governance
The Health Bank is constituted as a Decentralized Autonomous Institution (DAI) governed by
tokenized stakeholders: citizens, clinicians, scientists, and regulators.
Core charter articles:
1.Informed Consent by Design – every intervention requires smart-contract approval
from the individual.
2.Right to Deletion – citizens may erase their data without losing prior credits.
3.Bias Disclosure Protocol – AI bias audits are publicly verifiable.
4.Equity Mandate – a portion of all vault returns automatically redistributes to
underserved regions via Health Equity Credits (HEC).
This structure embeds democracy into biotechnology—governance not by boardroom but by
biome.
IX. Economic Implications for the U.S. Deficit
Baseline (2025)
●Federal health outlays: $1.7 T
●Chronic-disease cost share: 75 %
●Deficit: $1.9 T
Health Bank Scenario (2045)
●Preventive adoption ≥ 70 % of population.
●Chronic disease ↓ 60 %.
●Administrative overhead ↓ 30 %.
●Preventive Bond returns offset $600 B in annual interest costs.
Fiscal stability emerges from biological stability. Health literally pays down the debt.
X. The CRISPR Economy and Bio-Manufacturing
By 2032, AI-supervised “biofoundries” standardize CRISPR manufacture. Microfluidic
automation and digital-twin validation reduce errors and costs by 90 %.
Vaults license these facilities through Fractal Manufacturing Contracts that tie royalties to
population-level health gains.
Every bioedit becomes a bond coupon for the human species. America regains biotech
leadership not through speculation but through preventive production.
XI. Labor and Education Realignment
The preventive economy creates new professions:
●Bio-Actuaries – CPA-scientists valuing genetic assets.
●Health Engineers – systems designers for AI vaults.
●Preventive Ethicists – auditors of algorithmic morality.
Universities retool as Health Intelligence Institutes, where finance majors learn genomics and
medical students study capital markets. Education itself becomes preventive medicine for
democracy.
XII. Global Standardization and Trade
A federation of Health Banks can form a Global Preventive Currency (GPC) — denominated
in verified life-years saved. Nations with higher preventive indices receive preferential trade
rates and credit spreads.
Exporting a vaccine or gene-repair protocol earns Preventive Trade Credits (PTCs), offsetting
deficits the way gold once did. Health becomes the 21st-century reserve asset.
XIII. Transition Mechanisms for the U.S.
Phase Years Key Action Fiscal Effect
1. Pilot Phase 2026–2
028
Launch federal-state Health Bank
sandbox; integrate Medicare data with
AI risk models.
Admin efficiency +5
%, savings $50 B.
2. Legislative
Phase
2029–2
032
Pass Health Data Sovereignty Act and
Preventive Finance Code.
Systemic risk ↓ ;
investor confidence
↑.
3. Infrastructure
Phase
2032–2
038
Construct five vaults; issue
gold-backed Preventive Bonds.
Net new asset $500
B.
4. Population
Integration
2038–2
045
Full citizen enrollment in Health
Accounts; national preventive index >
0.8.
Deficit –$900 B/year.
XIV. Ethical Risks and Safeguards
Risk: Genetic discrimination. Safeguard: Anonymized credit scores with no direct employment
link.
Risk: Data centralization. Safeguard: Federated storage with user-owned keys.
Risk: Algorithmic bias. Safeguard: Continuous third-party AI audits by IHLA.
Risk: Moral hazard in longevity loans. Safeguard: Decay protocols that recycle idle capital into
equity funds. The motto of preventive finance: no profit without participation.
XV. Projected Macro Outcomes (2050)
Indicator Current (2025) Projected
(2050)
Change
Health Expenditure (% GDP) 17.6 8.5 –9.1 pts
Federal Deficit ($ T) 1.9 < 1.0 –0.9
Average Healthy Life Expectancy 68 80 +12 yrs
Workforce Productivity 100 index 130 index +30 %
Preventive Asset Market Cap 0 > $2 T + ∞
Carbon Footprint of Health Sector High Net Zero – complete offset
XVI. Philosophical Coda — The Moral Ledger
The true deficit is not financial but temporal—the years lost to avoidable entropy.
By linking geothermal vaults, AI ethics, and genetic care, the United States can redefine growth
as continuity rather than consumption.
The Health Bank embodies the final stage of accounting evolution: from double-entry to
living-entry, where every transaction is biological and every audit is ethical.
XVII. Conclusion — From Deficit to Regeneration
The American healthcare system has long been a reactive ledger of loss. The integration of
Elevator Entanglements and Health Banks offers a different arithmetic:
●Gold and genes as mutual collateral.
●AI as fiscal empath.
●Prevention as the new currency of the Republic.
Deficits become dividends when biology and finance learn to balance each other. The United
States could lead the planet not through domination, but through maintenance — the quiet
discipline of keeping life in balance.
If the 20th century belonged to the industrial economy of extraction, the 21st will belong to the
preventive economy of entanglement.
The next superpower will not be the one that builds the most weapons or data centers, but the
one that builds the most wellness.
References
(Condensed for white-paper brevity; full IEEE list available upon request)
●Heizmann, S. (2025). Global Healthcare Overhaul: A Systems Redesign for Preventive
Intelligence and Adaptive Health Finance.
https://www.linkedin.com/pulse/global-healthcare-overhaul-systems-redesign-adaptive-h
eizmann-cpa-str3e
●Heizmann, S. (2025). Elevator Entanglements: Gold-Backed Fractal Tunnels for Global
Health Vaults.
https://www.linkedin.com/pulse/elevator-entanglements-gold-backed-fractal-tunnels-heiz
mann-cpa-k5pve
●Heizmann, S. (2025). Health Banks: Financing Preventive Life Through AI and Genetic
Capital.
https://www.linkedin.com/pulse/health-banks-financing-preventative-life-through-ai-heizm
ann-cpa-mwwme
●World Health Organization (2024). Global Report on Preventive Health.