We are having the wrong conversation on healthcare.

Instead of addressing the underlying problems driving unaffordability and access, we Democrats are spending all our time arguing over who is the most zealous in wanting to cover Americans. Over who has wanted to do so longer. Over who cares more about the health of Americans.

We talk about how we’re going to pay for it, but the reality is we’re already paying for it. We pay for it when we can’t switch jobs. We pay for it when new jobs are temp or gig jobs that don’t provide healthcare. We pay for it when all of our prices are higher. We pay for it when healthcare costs drive us into bankruptcy.

To be clear, I support the spirit of Medicare for All, and have since the first day of this campaign. I do believe that swiftly reformatting 18% of our economy and eliminating private insurance for millions of Americans is not a realistic strategy, so we need to provide a new way forward on healthcare for all Americans.1

As Democrats, we all believe in healthcare as a human right. We all want to make sure there is universal affordable coverage. We know we have a broken healthcare system where Americans spend more money on healthcare to worse results. But, we are spending too much time fighting over the differences between Medicare for All, “Medicare for All Who Want It,” and ACA expansion when we should be focusing on the biggest problems that are driving up costs and taking lives.

We need to be laser focused on how to bring the costs of coverage down by solving the root problems plaguing the American healthcare system.

That means controlling the cost of prescription drugs. That means investing in innovative technology to cut waste and boost access. That means changing the incentive structure for providers. That means shifting our focus on more stages of care. That means revamping what comprehensive care means in the 21st century to include crucial aspects of wellbeing. That means taking on the powerful lobbyists in D.C.

Diagnosing and addressing these underlying problems is the first and most important step in ensuring everyone has access to healthcare, because we cannot extend quality coverage to everyone without real strategies on how to avoid the toxic incentives of our current system. We can’t afford to mess this up.

Fundamentally, we need to have a more productive conversation about healthcare in America. It’s time to take a step back from enrollment mechanisms and creative accounting to focus on lowering costs and improving quality.

We need to fix our broken healthcare system by tackling the root problems through a six-pronged approach:

Control the cost of life-saving prescription drugs , through negotiating drug prices, using international reference pricing, forced licensing, public manufacturing facilities, and importation. Invest in technologies to finally make health services function efficiently and reduce waste by utilizing modernized services like telehealth and assistive technology, supported by measures such as multi-state licensing laws. Change the incentive structure by offering flexibility to providers, prioritizing patients over paperwork, and increasing the supply of practitioners. Shift our focus and educating ourselves in preventative care and end-of-life care options. Ensure crucial aspects of wellbeing, including mental health, care for people with disabilities, HIV/AIDs detection and treatment, reproductive health, maternal care, dental, and vision are addressed and integrated into comprehensive care for the 21st century. Diminish the influence of lobbyists and special interests in the healthcare industry that makes it nearly impossible to draft and pass meaningful healthcare reform.

My plan is a statement on the critical failings of our system and viable paths to solve them. We cannot find the answers to one of the most serious problems in modern American history unless we are asking the right questions. It’s time we start asking the right questions.

1. Control Prescription Drug Cost

Why do prescription drugs in this country cost so much? Individual drugs change prices at the whims of those running pharmaceutical companies. Brand name prescription drug prices have risen 76% over the past 6 years, and they’re not slowing down.2 Patent trolls, or nonoperating companies that extract cash settlements from companies they accuse of patent infringement, can drive the prices of certain medications up while providing no value themselves to the US healthcare system.

And while drug companies complain constantly about the high cost of research, they fail to mention that almost all FDA-approved drugs over the past several years relied on basic research funded by the National Institute of Health (NIH). They also don’t mention the record-high profits they’ve been experiencing in recent years. While drug companies bring in only 23% of healthcare’s U.S. revenue, they make 63% of the total profits.3 In 2017, Purdue Pharma alone earned more than $35 billion from OxyContin sales.4

It’s making it impossible for Americans who need drugs to afford their treatment—many are choosing between their medicine and food or shelter.

The runaway growth in drug prices since the turn of the century has led the US per capita spending on pharmaceuticals to exceed $1,000 a year, hundreds more than our peers in France, Germany, or the United Kingdom.5

We need to put pressure on these companies to get their prices under control and more in line with the rest of the world. Americans pay twice as much as Australians and three times as much as the Dutch on prescription drugs due to lack of price control. We have to give the federal government authority to negotiate drug prices and use standard international price reference points so pharmaceutical companies can no longer exploit our market and the American people.

If these companies are not willing to compromise, we need to ensure the U.S. government has the ability to force licenses for these drugs to companies who will. Additionally, we need to authorize the creation of public manufacturing facilities to make these drugs, as well as other necessary drugs and unprofitable but necessary medications, for the American people. If all else fails, we need to allow the importation of medications from other countries.

As President, I will…

Work with Congress to pass a law to negotiate drug prices.

Use international reference pricing to set a baseline and allow for forced licensing of medications if companies can’t come to a reasonable agreement with the federal government on cost in line with international prices.

Create public manufacturing facilities to produce generic drugs (and produce drugs through a forced license) to keep costs at a minimum. Also manufacture unprofitable medications and important high-demand medications.

If all of the above fail, allow for the importation of prescription drugs from other countries.

2. Invest in Innovative Technology

Can innovation help reduce healthcare costs? The advancement of health and communication technology has the potential to increase access to care while reducing overhead. We should invest in expanding existing technologies to reach those in underserved areas, especially the 77% of rural counties that are considered rural primary care deserts, 9% of which have no physicians at all.6

With greater telehealth infrastructure, we can help nurse practitioners and other health professionals provide a higher level of care under the digital supervision of a doctor. By harnessing the power of technology, we can ensure that the healthcare system functions more efficiently and effectively.

Utilizing Telehealth to Meet Provider Demands

The demand for physicians is outpacing the available supply, and the shortage is causing problems for the nation’s growing and aging population. Telehealth is an effective approach for doctors across the country to provide care for patients in rural and underserved areas over the internet without needing a specific redundant license to practice medicine in the patient’s state. Utilizing telehealth will enhance quality of life and reduce hospital visits, while curbing deaths from chronic diseases.

Patients will be able to access treatment that may not be conveniently located. About 62% of rural counties are not equipped to provide services such as Diabetes Self-Management Education and Support (DSMES). Numerous case studies have illustrated the benefits of telehealth for DSMES so far. For example, once a rural clinic in Montana implemented it, 61% of participants began monitoring their blood sugar accurately after just six months, an improvement from 31% pre-telehealth.7 The services have also shown positive results for mental health, stroke treatment, cardiac rehabilitation and cancer treatment.8, 9, 10

Medication abortion has similar efficacy of terminating early pregnancy as in-person abortions. Enlarging the geographical footprint of medical providers through telehealth can improve access to abortion in the 27 US cities with populations greater than 50,000 people that have no abortion clinics within 100 miles.11

Telehealth is a cost-effective alternative to the more traditional face-to-face way of providing medical care and has the potential to save billions annually, while improving healthcare related to strokes, cardiac services, diabetes, and epilepsy.12 Ensuring healthcare for all also requires federal regulation of telehealth and expanding it in a way where we can distribute services and treatment.

As President, I will…

Encourage the use of telehealth in rural areas and for mental health services.

Invest into the use of telehealth in rural areas including ensuring broadband access for 99.9% of Americans.

Allow licensed physicians to administer medical services and medication through telehealth services.

Assistive Technology to Boost Coverage

As we continue to invest in medical innovation, we must integrate assistive technology into the primary care provided by doctors and nurses. Existing technologies like telehealth and emerging technology like medical AI must be leveraged to expand care. Working together through telemedicine, teams of nurses, AI, and doctors will be able to provide care to thousands of Americans that currently have limited access to healthcare.

As this technology advances, we need to trust in our nurses and nurse practitioners to provide care that’s historically the responsibility of MDs. This will be essential in providing access to care across rural areas and can even be supervised by a doctor through a telehealth system. This new system, combining the best of AI, telehealth, and professional expertise will allow for a more flexible and responsive health force without sacrificing quality of care.

As President, I will…

Invest in the development and deployment of medical technology in rural areas to assist Nurse Practitioners and other professionals in administering vital care in areas where an MD is not physically present.

Multistate Licensing and Federal Registration for Physicians

Human anatomy doesn’t change across state lines, but doctors are still required to obtain medical licenses for each state they practice in. These onerous relicensing requirements discourage qualified doctors from providing essential care through telemedicine to those in other states. We must streamline the licensing system and introduce a single, comprehensive telemedicine license that, once granted, will allow care providers to see patients in all 50 states. Federal regulation of medical licensing will remove friction and encourage doctors to start practicing telemedicine and make inroads into primary care deserts.

As President, I will…

Implement federal regulations over telehealth.

Implement federal medical licensing to physicians to practice telehealth across state lines.

3. Improve the Economics of Healthcare

How do we improve the economic incentives of our healthcare system? Like any other industry in the country, the healthcare system in America has evolved into the mess that it is today because the incentive structure allowed it to do so. So let’s change it. We can rebuild and modernize the Electronic Health Record to minimize the hours doctors spend on administrative tasks. This way, we can get doctors back to seeing patients and spending less time behind computer screens. Let’s move to a system that incentivizes maximizing health instead of administrative activity. Let’s free up practitioners to focus on doing their jobs, unencumbered by administration and unaligned incentives.

Transition to 21st Century Payment Models

Most doctors are still compensated through the fee-for-service model. This model pays doctors according to how many services they prescribe and thus incentivizes them to do unnecessary tests and procedures. This model wastes hundreds of billions of dollars every year. To get these wild costs under control, we should follow the lead of the Cleveland Clinic and the Mayo Clinic and help transition doctors onto a salary model.

We can incentivize hospitals and clinics to adopt the salary model through cost savings and ease of billing process. This will allow doctors and administrators to focus on patient care instead of byzantine payment models with insurance companies.

To give hospitals the fiscal freedom they need to transition doctors to a salary model, we should explore the capitation payment model. This would mean that hospitals could receive lump sums based on their patient intake instead of using complicated fee-for-service arrangements.

Any capitation payment method would be responsibly calibrated to ensure that doctors aren’t forced to see more patients than they can handle and low-intake rural hospitals receive enough funds to cover their operating costs.

A model in which hospitals are paid through capitation and in turn pay physicians on a salary can align incentives so that patient care and compensation are on the same side. Doctors will be paid for providing great patient care, not for prescribing them unnecessary tests and procedures. This would allow doctors to focus on a patient’s health in the most effective way instead of the most expensive. This performance-based payment system incentivizes physicians to consider best practices for providing quality preventative health. It’s not only cheaper to take care of a healthy person rather than treat an ill person, it keeps people healthier by ensuring they see a doctor for their illness rather than self-diagnosing and risking negative consequences from improper treatment.13

As President, I will…

Work with clinics and hospitals to increase the use of salary-based compensation for doctors.

Explore capitation payment options for health providers and utilize the use of electronic records to track success.

Move Away From Defensive Medicine

Doctors operate under constant threat of malpractice lawsuits. These cases are only decided by a verdict 5% of time, and when they are, they land in the doctor’s favor 80% of the time.14 Despite the fact that doctors are almost always exonerated, malpractice suits can take years. As a result, doctors often prescribe needless procedures and tests to avoid being sued.

We need to allow doctors to practice medicine that prioritizes their patients’ health without legal fear in the back of their minds. In order to do this, we must reform the bloated tort system that takes up a larger percentage of GDP in the US than other developed countries.15

As President, I will…

Discourage doctors from practicing defensive medicine by making them less vulnerable to frivolous malpractice lawsuits and providing institutional support to doctors, resulting in an increase in time spent with patients.

Decrease Administrative Waste

Today, doctors spend two hours doing paperwork for every one hour they spend with a patient.16 This explosion of administrative tasks is due in large part to the adoption of the Electronic Health Record (EHR). The record was supposed to ease the documentation and billing processes, but its poor construction has doctors spending six hours a day on administrative tasks.17

We must leverage existing technology to automate routine administrative tasks and rebuild the EHR from the ground up. Opening up the vendor process to include third-party developers or standardizing APIs across EHRs could incentivize innovation and create a race to the top. This will allow doctors to spend more productive time doing what they love—treating patients. It will also reduce the high doctor burnout rate that costs healthcare $4.6 billion every year.18

As President, I will…

Direct the complete overhaul of the Electronic Health Record with an emphasis on modernization and ease of use.

Incentivize innovation in EHR by opening up vendors to include third-party developers and explore standardizing APIs across EHRs.

Increase Availability of Primary Care

In order for everyone to receive primary preventative care, we need more doctors. We currently have a shortage of doctors, and the problem is only going to get worse if we don’t make some changes.19 The astronomical cost of medical school is also a disincentive, because becoming a lower paid, primary care doctor does not make sense for medical students with hundreds of thousands of dollars in debt.

We must take immediate steps to expand loan forgiveness programs for medical students who choose to become primary care or family doctors. This will help grow the primary care workforce. America has plenty of smart kids capable of being doctors, but not enough spots in schools to train them. We must stop artificially restricting the amount of doctors we train and start expanding medical schools.

To increase primary care, we must also look to our nation’s 3 million nurses and 270,000 nurse practitioners. These professionals are trained and qualified to provide critical care to services, but are banned from providing them due to restrictive regulations.20 Our nation should follow the example of states like Virginia, which passed a bill that allows seasoned nurse practitioners to open up their own practices and provide medical care to their communities.21 Responsible deregulation can open up our medical system and connect more patients to primary care.

As President, I will…

Lift the regulations and funding caps that currently limit medical residents and other health professionals from entering the medical field.

Provide loan forgiveness programs for doctors who go into general practice, especially in rural areas.

Work to expand medical schools that focus on primary care.

4. Shift Focus of Care

Can shifting our focus of care help us reduce healthcare costs? Preventative care is a critical part of managing our nation’s health. Whether that means going for annual physical exams, eating healthier food, quitting smoking, or exercising regularly, preventative care helps us avoid chronic medical problems that are the main drivers of healthcare costs. We need to stress the importance of preventative care and provide education on building healthy habits that will help people live longer, healthier lives.

Preventative Care

Patients should have low-cost access to essential preventative care, like physicals and cancer screenings. By focusing on our citizens’ health before they get sick, we can reduce the huge costs associated with managing chronic health conditions.22

In addition to more preventative healthcare, it is essential that we recognize the impact of factors outside the clinic or hospital that contribute to health outcomes. We must teach healthy habits to young people and children. Eating an apple a day may not keep the doctor away, but it does promote healthy eating. Teaching kids the basics of a nutritious diet (and providing them healthy meals at school) and providing early screenings to identify flags like behavioral issues and different types of disabilities are key pieces in building towards positive outcomes. Tackling these issues early gives kids the best shot at leading a healthy life.

13.7 million children and adolescents and 93.3 million adults in the U.S. are battling obesity.23 Genetics is a factor, but so are a lack of physical activity and consumption of ultra-processed foods.24 Exercise for people of all ages has been recommended by physicians to prevent and help not only obesity, but also cardiovascular disease, stroke, Type 2 diabetes, many types of cancer, and depression.25, 26

We have seen a significant reduction in the use of combustible cigarettes and tobacco, but there is always room to improve. Nearly 38 million American adults still smoke cigarettes every day and nearly 9 million vape, not including the recent spike in the number of youth vaping.27, 28 The risks associated with smoking, whether combustible cigarettes or e-cigarettes, pose long-term health hazards that we must continue to combat.29, 30

Low-income Americans are often faced with a terrible choice: buy food, or pay for medical care. Increasing Americans’ buying power through the Freedom Dividend will create great new demand for healthy grocers to open stores in food deserts. By alleviating constraints on access to care and to healthy foods, we can improve people’s lives and reduce the amount of money we spend on long-term care.

America is one of the most developed countries in the world, but 41 million Americans face hunger, including nearly 13 million children.31 Food insecurity disproportionately affects households with children led by single women and people living below the poverty level. Other families are scraping by, but their incomes make them ineligible for any form of federal food assistance. Food security through public health intervention not only ensures Americans have enough food, it has the potential of reducing the development of malnutrition, cardiovascular disease, and other health risks. This extensive problem has a solution, but it needs the support of the food banks, clinics, and the federal government. We have to build programs that create partnerships between clinics and food banks to address food security and health. Indianapolis has implemented a program like this in 2017 and continues to serve an average of 135 households in the community.32 Imagine how many Americans we can promise nutritious food at the table by implementing this on a larger scale.

As President, I will…

Encourage doctors to educate their patients about the importance of diet, nutrition, and physical activity on overall health.

Incentivize integrated preventative care and healthy activities, like gym memberships, biking to work, and consuming fresh produce.

Offer incentives for food banks and clinics to partner together to promote food accessibility and reduce health disparity.

Americans Deserve Better Quality End-of-Life Care

End-of-life care should provide comfort and choice during this sensitive time while respecting the wishes of the individual. Despite the increasing population of aging Americans, only 30% have had end-of-life care discussions with their loved ones.33 We need to ensure that people head into this decision informed and with a clear plan so that they can spend their last days in a manner of their choosing, not at the whims of the healthcare system.

Many providers try to prolong end-of-life care to get as much money out of a dying patient as possible.34 8.5% of all health spending goes toward care for people during their last year of life, and families average out-of-pocket costs for end-of-life obligations of $11,618.35, 36 Incentives under fee-for-service result in more use of end-of-life care services, including more transitions among care settings (hospital days, intensive care, emergency care) and late enrollment in hospice.37 These kinds of services jeopardize the quality of end-of-life care and add to its cost.

Access to palliative care decreases emergency room visits, increases patient quality of life, increases overall survivorship, and improves cost savings in Medicare programming because of proactive care.38

Increased knowledge and preparedness of end-of-life care will allow patients and their loved ones to make informed decisions about their care. 71% of American say that given the choice, they would prefer to pass away at home, yet only 25% do.39, 40 We should give them that choice and guarantee they will be properly cared for.

As President, I will…

Encourage providers to have direct and honest conversations about end-of-life planning.

Allow for patients and families to be more involved in decisions around end-of-life care.

Respect a patient’s decision to choose home care, even when it won’t extend their life.

Take into account quality of life instead of just length of life for terminal patients.

Ensure that there are enough doctors educated about end-of-life and palliative care to provide effective treatment rather than acute medicine.

5. Coverage Should Include All Aspects Of Wellbeing

What does comprehensive care mean? Once we control the costs of healthcare, we need to address the fact that current levels of coverage are inadequate. We must do more than just expand the level of services provided to all Americans at the edges; we need to ensure comprehensive care. Care that includes all aspects of wellbeing, such as integrated mental health, sexual health needs, maternal health needs, care for person with disabilities, and dental and vision, regardless of sex, race, or income level.

Comprehensive care is not just a moral imperative—it makes economic sense. A robust healthcare system with comprehensive services, where everyone has accessible and affordable coverage and no one goes bankrupt, will build a healthier population and reduce our expenditure on long-term medical costs.

Mental Health Coverage

Mental health is an important component of our overall health, and it should be treated that way by our healthcare system. There is a mental health crisis in America with 1 in 5 adults experiencing mental illness annually.41

Our life expectancy is declining due in part to increasing rates of suicide, especially among American youth. The teen suicide rate has gone up 56% from 2007 to 2017, and it is the second leading cause of death for Americans between the ages 10 and 34.42, 43 7.7 million youth aged 6-17 experience a mental health disorder each year, but only half receive treatment. Anxiety and depression levels are at record highs.44, 45 People of color and the LGBTQ community also experience higher risk of mental health issues due to disproportionate social and economic challenges.

Our veterans also do not receive the necessary mental health treatment they need when they come home. 22 veterans commit suicide every day since many don’t seek treatment due to embarrassment or shame.46 We need to destigmatize veteran treatment and support their stability to ensure successful transition to civilian life.

Substance abuse and mental health account for 1 of 8 emergency department visits.47 Only 43% of Americans with a mental illness receive treatment due to inadequate insurance coverage and provider shortages.48 It is urgent to integrate mental health care into health insurance plans and destigmatize mental health care while encouraging an increase in the number of people able to provide treatment.

Outside of mental illness, applying evidence-based stress relief methods in hospitals has been shown to shorten the length of stay. This is just one example of how caring for a patient’s mental health has demonstrable cost benefits. By creating a healthcare system that recognizes mental health as an integral part of physical health, we can improve both.

As President, I will…

Integrate regular mental health checkups into primary care.

Provide new funds for suicide prevention and awareness competency training for school administrators and teachers, and provide greater access to mental health services in schools.

Build the mental health workforce through expansion of training programs and loan forgiveness programs for those that choose to provide these services to rural and underprivileged areas.

Invest in veteran mental health, and improve funding to crisis helplines.

Utilize the current telehealth system to alleviate the widespread shortage of mental healthcare professionals, remove accessibility barriers caused by distance and transportation, and provide treatment from the privacy of patients’ homes.

Care for People with Disabilities

Today, 1 in 4 adults has a disability in the U.S., but 1 in 3 people with a disability do not have access to a primary healthcare provider and has unmet healthcare needs due to high costs.49 People with disabilities are much more likely to experience secondary complications that exacerbate their medical conditions and often need fast access to hospitals and treatment. Under the current system, these people disproportionately lack the access that they need because of high unemployment and homelessness rates, and higher rates of poverty. Additionally, there are issues with accessibility, both at healthcare provider locations and in transportation.

13.3 million children in the U.S. live with special healthcare needs.50 As the father of a son with autism, I understand the hardships millions of other American families face everyday. Children with disabilities need a wide range of medical and long-term services and support that our current healthcare system does not prioritize. Either not all medical services are covered, or they are only available in limited amounts through private insurance. 47% of children with disabilities are covered by Medicaid or CHIP, another 49% are dependent on private insurance, and the remaining 4% have no insurance at all. That is 4% too many. Early detection, intervention, and on-going support is critical for parents of children with disabilities to understand and meet their child’s needs. Our healthcare system should ensure all families have access to necessary experts and resources that equally uplift our children.

We need to ensure that all people, including children and persons with disabilities, have equal access to the healthcare they need. Outside of ensuring Americans with Disabilities Act (ADA) compliance at all healthcare providers and covering transportation costs, technologies such as telehealth will provide new and more convenient ways for persons with disabilities to access preventative care in a format of their choice and at an affordable cost.

As President, I will…

Ensure that hospitals are ADA compliant.

Make healthcare more accessible to people with disabilities through telehealth, while also ensuring public transit to facilities is accessible and covered by insurance.

Ensure healthcare covers preventative care services for people with disabilities like assistive mobility devices, hearing aids, adequate catheters, and sufficient physical therapy visits to prevent further secondary conditions.

Ensure that all families have access to experts and resources for early detection, intervention, and care for children with disabilities.

HIV/AIDS Care

Today in the U.S., there are over 1.2 million people living with HIV, and over 17,000 living with AIDS.51 Racial minorities, LGBTQ+ people, and the uninsured are among those who are most vulnerable to the impact of HIV. The truth is that major improvements have been made in treating HIV/AIDS that allow people to live long and healthy lives, but the exorbitant cost of HIV/AIDS medications has made treatment unaffordable for many. Nearly 30% of those living with HIV are uninsured and are not receiving necessary treatment. Additionally, PrEP medications are expensive and unavailable to at-risk populations, despite the patent belonging to the Centers for Disease Control (CDC).

Early diagnosis of HIV is essential to tackling this epidemic. It means better outcomes for people who are diagnosed and prevents further transmission. Planned Parenthood has been an indispensable resource for many Americans in this respect, particularly in rural areas.

HIV/AIDS drug costs are thousands of dollars per month, despite the fact they were developed using taxpayer dollars.52 The major corporation that owns these treatments, Gilead Sciences, has made remarkable profit off of these lifesaving drugs while many go without treatment because it’s unaffordable. This is unacceptable. We need to make testing, as well as life-saving drugs for treating and preventing HIV/AIDS, available and affordable to all Americans.

As President, I will…

Bring down the cost of HIV/AIDS treatment through international reference pricing and public manufacturing facilities, if necessary.

Cover HIV/AIDS treatment.

Break the patent on TRUVADA to provide low-cost PrEP to anyone who might be at risk.

Provide funding for clinics like Planned Parenthood that can screen for HIV/AIDS, especially in rural areas.

Reproductive and Sexual Health

Despite the $3.5 trillion spent on U.S. health expenditures per year, the reproductive and sexual health sector experiences some of the widest disparities in health outcomes.53 Under the current healthcare system, one-third of women in the U.S. report skipping needed medical care due to costs, and one-fourth of women who received care spent $2,000 or more in out-of-pocket expenses.54, 55

Unfortunately, high out-of-pocket costs, deductibles, copayments, and restrictive legislation have made it difficult for millions of women to access contraception, which reduces unintended pregnancy and abortion rates.56

Women do not casually decide to have an abortion; abortion is an incredibly difficult and personal decision. Access to abortion, whether surgical or by use of oral medication, is vital to the respect of women’s own bodies and of their right to life, health, privacy, and non-discrimination.

The Hyde Amendment’s ban on federal funding for abortions other than to save a mother’s life or to terminate a pregnancy that arises out of rape or incest, along with stringent state laws, are a violation of women’s privacy. Not only that, but inaccessibility to abortion increases their chances of poverty, unemployment, and dependence on public assistance programs, especially among women of color.57

The LGTBQ+ community is another demographic that faces discrimination in the healthcare system and is not provided quality reproductive health care. For example, in several states, gender affirming healthcare and services are considered “cosmetic” and therefore are not required to be covered by many insurance plans. Planned Parenthood is one of the only organizations that provides non-discriminatory, knowledgeable, and respectful healthcare services for the LGBTQ+ community, particularly for transgender people. The Title X Gag Rule threatens Planned Parenthood funding and 4,000 other family planning clinics across the country, which affects all demographics using these facilities for sexual and reproductive health services outside of abortion.

Expanding reproductive health care will allow thousands of Americans to stay sexually healthy, limit the spread of sexually transmitted infections, and lower teenage pregnancy rates. In addition to the medical benefits, access to sexual health care furthers gender equality by empowering women to continue their education and pursue a fulfilling and economically secure career path.

We need to cover the full spectrum of reproductive health care, including STD screenings, contraception, prenatal care, and abortion. It should also be inclusive of services related to transgender people. Our healthcare system should encourage Americans to prevent and maintain, or diagnose and treat, their sexual and reproductive health care needs without fear of financial restrictions or stigma. Access to sexual and reproductive health care is just as important to the overall health and well-being of people’s lives as is an annual physical checkup.

As President, I will…

Ensure Americans have access to comprehensive sexual and reproductive care, including STI screenings, contraception, and abortion.

Ensure contraceptives and medication abortion pills can be accessed over the counter.

Ensure access to non-discriminatory healthcare, like gender-affirming services.

Protect funding to Planned Parenthood by repealing the Title X Gag Rule.

Repeal the Hyde Amendment, and refuse to sign any budget including it.

Maternal Care

While the rest of the world is improving maternal care, pregnant women and new moms are dying in the US at a multi-decade high.58 To make matters worse, the majority of the 700 pregnancy-related deaths each year are preventable.59 While this trend should terrify all of us, it is even more worrying for Black women, who are 3-4 times more likely to die from pregnancy-related causes than white women.60 This is unacceptable. We must ensure that every woman and mother has access to the maternal health services they need and doctors have the training they need to save the lives of their patients.

The U.S. has made strides in lowering infant mortality rates, but not enough attention or resources are placed on maternal care. Only 6% of grants for “maternal and child health” actually went to the health of mothers, and only a fraction of national obstetric research is focused on maternal health.61 We need to place more attention and care on expecting and recent mothers in our healthcare system. We need to ensure sure that every mother has access to the quality care that she and her baby need to thrive.

As President, I will…

Allocate more resources to maternal health research.

Fully cover all maternity costs.

Invest in implicit bias training for healthcare providers to ensure Black women receive life-saving maternal care.

Establish objective treatment guidelines for childbirth care to mitigate pregnancy-related deaths.

Dental and Vision

74 million Americans lack dental health insurance, and nearly 62 million don’t have any kind of vision coverage.62 This has large costs associated with it for people’s health, educational, and economic opportunities.

Oral health is an important aspect of overall health, and preventative care can prevent bigger, non-dental health issues, such as endocarditis (heart disease). Regular dental visits can also prevent more costly care later on.

Similarly, regular vision coverage can also help diagnose non-vision related issues, including diabetes, high blood pressure, and high cholesterol. Additionally, children who lack coverage can struggle in school when they have uncorrected vision issues, which frequently leads to behavioral issues.

Preventative dental and vision visits can save emergency room costs, quite literally paying for themselves over time. There’s no reason this coverage shouldn’t be provided.63

As President, I will…

Ensure comprehensive care includes vision and dental services.

Burdened Businesses

Health insurance in America is tied to employment because of a historical accident. When Franklin D. Roosevelt froze wages during WWII to fight a labor shortage, employers competed for workers by offering various benefits, including health insurance. Since then, employers have become the primary sponsors of health insurance in the United States.64 We still have this system even though it has become a burden to businesses, constrained innovation and new business formation, and trapped Americans in the wrong jobs (“job lock”).

Today, many new jobs are temporary or gig work. One of the biggest factors driving the gig economy is the cost of insuring employees. Businesses spend thousands of dollars per full-time employee in healthcare costs, so to limit these growing expenses, many employers are choosing to hire people as independent contractors.65 This way, they don’t need to pay for their healthcare.

We need to give more choice to employers and employees in a way that removes barriers for businesses to grow.

As President, I will…

Explore ways to reduce the burden of healthcare on employers, including by giving employees the option to enroll in Medicare for All instead of an employer-provided healthcare plan.

6. Addressing the Influence of Lobbyists

Is Washington D.C. actually capable of passing comprehensive healthcare reform? The best interest of the American people is often not in the interest of powerful players in the healthcare industry. Healthcare has become a political animal in Washington, and the grip of these special interests makes it almost impossible to draft and pass meaningful healthcare reform. Any attempt at legislation gets stalled by in-fighting and the intense lobbying efforts of industry players. With the magnitude of healthcare reform that we need, we cannot afford the interference of interest groups in our government.

Private insurance, drug companies, hospital chains, medical equipment manufacturers, and other private players all hold sway in Congress, but none of them represent the actual patients. For example, ridiculous drug prices are terrible for citizens but great for drug manufacturers who currently have a lot of influence in Washington. This gulf between the power of the people and that of special interests is endemic in American politics, but especially toxic in the arena of health care.

Expert advice is important, but limitless lobbying is dangerous. To pass meaningful healthcare reform, we need healthcare lobbyists out of the room. My plan to raise the salaries of government officials and bar them from transitioning into the private sectors that they regulated will help prevent the influence of industry lobbyists in my administration.

To diminish healthcare lobbying influences on Congress, I will implement Democracy Dollars to supercharge grassroots campaign and minimize the influence of lobbyists’ campaign contributions.

As President, I will…

Refuse to hire anyone in my administration who formerly worked as an executive in the pharmaceutical industry or as a lobbyist for pharmaceuticals, medical devices, or private insurers.

Provide an Anti-Corruption Stipend for all members of the Executive Branch after the termination of their employment, to be paid as long as they don’t accept anything of value in exchange for advocating for a position to members of the federal government.

Provide every American voter with $100 Democracy Dollars for each election cycle to protect their representatives from medical lobbyists.

Increase salaries for government officials who regulated the medical bodies to much higher levels, but ban them from receiving anything of value in exchange for currying favor for special interests.

This is the new way forward to fix the broken healthcare system in America and ensure every American receives the healthcare they need.

– Andrew

Footnotes:

1 – https://www.cms.gov/newsroom/press-releases/cms-office-actuary-releases-2017-2026-projections-national-health-expenditures

2 – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6547085/

3 – https://www.axios.com/pharma-health-care-economy-q3-profits-53b950b2-5515-4d79-b1f5-7067bf3652d1.html

4 – https://www.whitehouse.gov/sites/whitehouse.gov/files/images/The%20Underestimated%20Cost%20of%20the%20Opioid%20Crisis.pdf

5 – https://www.commonwealthfund.org/publications/issue-briefs/2017/oct/paying-prescription-drugs-around-world-why-us-outlier

6 – https://globalhealth.harvard.edu/blog/medical-deserts-america-why-we-need-advocate-rural-healthcare

7 – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3208251/

8 – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5723163/

9 – https://www.cdc.gov/chronicdisease/resources/publications/factsheets/telehealth-in-rural-communities.htm

10 – https://ascopubs.org/doi/10.1200/EDBK_200141

11 – https://www.wired.com/story/telemedicine-makes-it-safe-to-get-abortion-drugs-in-the-mail/

12 – https://www.ncbi.nlm.nih.gov/books/NBK459384/

13 – https://www.thebalance.com/preventive-care-how-it-lowers-aca-costs-3306074

14 – https://www.reuters.com/article/us-docs-win-most-idUSBRE84M11N20120523

15 – https://www.instituteforlegalreform.com/uploads/sites/1/ILR_NERA_Study_International_Liability_Costs-update.pdf

16 – https://pnhp.org/news/physicians-spend-two-hours-on-ehrs-and-desk-work-for-every-hour-of-direct-patient-care/

17 – http://www.annfammed.org/content/15/5/419.full

18 – https://www.healthcaredive.com/news/physician-burnout-costs-industry-46b-annually/555631/

19 – https://www.aamc.org/news-insights/press-releases/new-findings-confirm-predictions-physician-shortage

20 – https://www.ncbi.nlm.nih.gov/books/NBK350160/

21 – https://www.nixonlawgroup.com/nlg-blog/2018/6/18/can-nurse-practitioners-run-their-own-practice-in-virginia

22 – https://www.chronicdisease.org/page/whyweneedph2imphc

23 – https://www.cdc.gov/obesity/data/childhood.html

24 – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5787353/

25 – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1405860/

26 – https://www.mayoclinic.org/healthy-lifestyle/fitness/in-depth/exercise/art-20048389

27 – https://www.cdc.gov/media/releases/2018/p0118-smoking-rates-declining.html

28 – https://www.fda.gov/tobacco-products/youth-and-tobacco/2018-nyts-data-startling-rise-youth-e-cigarette-use

29 – https://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/effects_cig_smoking/index.htm

30 – https://tobacco.ucsf.edu/first-evidence-long-term-health-damage-ecigs-smoking-e-cigarettes-daily-doubles-risk-heart-attacks

31 – https://www.feedingamerica.org/about-us/press-room/new-data

32 – https://hungerandhealth.feedingamerica.org/2017/10/food-bank-clinic-partnership-support-senior-health/

33 – https://www.pbs.org/newshour/health/need-end-life-discussions-united-states

34 – https://www.cbsnews.com/news/the-cost-of-dying-end-of-life-care/2/

35 – https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2017.0174

36 – https://www.nber.org/aginghealth/2010no2/w16170.html

37 – https://books.google.com/books?id=pXH2BwAAQBAJ&pg=PT196&lpg=PT196&dq=fee-for-service+Medicare+result+in+more+use+of+end-of-life+care+services,+including+more+transitions+among+care+settings+(hospital+days,+intensive+care,+emergency+care)+and+late+enrollment+in+hospice.+These+kinds+of+services+jeopardize+the+quality+of+end-of-life+care+and+add+to+its+cos&source=bl&ots=mE-9cwUS5s&sig=ACfU3U0gFETxKsZFeShqvG4Np88UQsq7XQ&hl=en&sa=X&ved=2ahUKEwj-7bOI7v7lAhVFOKwKHS1RDQwQ6AEwAHoECAoQAQ

38 – https://www.health.harvard.edu/newsletter_article/early-palliative-care-extends-life-in-lung-cancer-study

39 – https://www.kff.org/report-section/views-and-experiences-with-end-of-life-medical-care-in-the-us-findings/

40 – https://www.pbs.org/wgbh/pages/frontline/facing-death/facts-and-figures/

41 – https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHNationalFindingsReport2018/NSDUHNationalFindingsReport2018.pdf

42 – https://www.cdc.gov/nchs/data/databriefs/db352-h.pdf

43 – https://www.nimh.nih.gov/health/statistics/files/suicide-leading-causes-of-death-chart_155157.pdf

44 – https://jamanetwork.com/journals/jamapediatrics/article-abstract/2724377?guestAccessKey=f689aa19-31f1-481d-878a-6bf83844536a

45 – https://www.cbsnews.com/news/stress-anxiety-depression-mental-illness-increases-study-finds/

46 – https://www.va.gov/opa/docs/suicide-data-report-2012-final.pdf

47 – https://www.hcup-us.ahrq.gov/reports/statbriefs/sb216-Mental-Substance-Use-Disorder-ED-Visit-Trends.pdf

48 – https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHNationalFindingsReport2018/NSDUHNationalFindingsReport2018.pdf

49 – https://www.cdc.gov/ncbddd/disabilityandhealth/infographic-disability-impacts-all.html

50 – https://www.kff.org/medicaid/issue-brief/medicaids-role-for-children-with-special-health-care-needs-a-look-at-eligibility-services-and-spending/

51 – https://www.hiv.gov/hiv-basics/overview/data-and-trends/statistics

52 – http://www.treatmentactiongroup.org/tagline/2016/spring/prep-pricing-problems

53 – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3833575/

54 – https://www.commonwealthfund.org/chart/2018/more-one-third-women-us-skip-care-because-cost-vs-5-percent-uk

55 – https://www.commonwealthfund.org/chart/women-us-report-highest-rates-spending-1000-or-more-out-pocket-medical-expenses

56 – https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Health-Care-for-Underserved-Women/Access-to-Contraception?IsMobileSet=false

57 – https://ajph.aphapublications.org/doi/10.2105/AJPH.2017.304247

58 – https://www.nationalgeographic.com/culture/2018/12/maternal-mortality-usa-health-motherhood/

59 – https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pregnancy-relatedmortality.htm

60 – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1595019/

61 – https://www.npr.org/2017/05/12/528098789/u-s-has-the-worst-rate-of-maternal-deaths-in-the-developed-world

62 – https://www.usatoday.com/story/money/personalfinance/2017/09/15/chew-this-dental-coverage-gives-protection-within-limits/665409001/

63 – https://www.ada.org/en/public-programs/action-for-dental-health/er-referral

64 – https://www.kff.org/other/state-indicator/total-population/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D

65 – https://www.businessgrouphealth.org/news/nbgh-news/press-releases/press-release-details/?ID=361