One of the problems with our politics is that it often demands 60-second sound bites or slogans to answer complex questions. There is perhaps no more complicated or more personal issue for Americans than health care. I know this from my own personal life, caring for my mother as she battled colon cancer. And I also know it from talking to so many Americans in this campaign — seniors and union members, young people and parents, workers and caregivers. No panicked parent should hold a sick child while worrying about an expensive hospital bill. No senior should have to cut their pill in half just to make ends meet.

Right now, the American health care system is a patchwork of plans, providers and costs that have left people frustrated, powerless and insurance companies in charge. And the bottom line is that health care just costs too much. So as a presidential candidate, here is where I stand to make transformative change for the better.

Stopping GOP Attacks on Americans’ Health Care

Insurance companies and drug companies have jacked up prices so much that Americans, on average, pay twice what people in other countries pay for health care. Even though we spend more, we have failed to insure nearly 30 million Americans, and the problem has gotten worse under Donald Trump.

Kamala Harris at a rally in California to save health care

Millions have lost their health insurance under his presidency, and 21 million risk losing coverage as this administration and their Republican allies try to overturn the Affordable Care Act in the courts. Between 2014 and 2017, 15,000 people died because Republican states decided not to expand Medicaid.

The first thing the next Democratic president must do is end these senseless attacks on Obamacare. As someone who fought tooth and nail as Attorney General and as Senator to prevent repeal, that’s exactly what I will continue to do.

But we are also at a crisis point for health care in America. Big corporations are still putting profits over people’s wellbeing, and Republicans are determined to destroy what progress we have made and put those same corporations back in charge of the system. The next Democratic president needs a clear, transformative, and achievable vision of how we finally change this broken system for good.

Addressing What Keeps People Up At Night

I look at this issue through a fairly simple prism: each night, millions of Americans wake up at 3 o’clock in the morning worried about some aspect of their health care. How am I going to afford a $5,000 deductible just for walking my child into the emergency room because their fever won’t go down? How will I pay that surprise medical bill because the ambulance that took me to the hospital was out-of-network? How am I going to continue to see my doctor when I get a new job and my new insurance plan doesn’t have them in their network?

In America, health care should be a right, not a privilege only for those who can afford it. It’s why we need Medicare for All.

Imagine changing a job and not having to worry about your health care coverage. Imagine going to the pharmacy and not having to worry about an outrageous price increase on the prescription drug you need. Imagine walking through those sliding glass doors at the emergency room or doctor’s office or hospital knowing that the first card you pull out will be a Medicare card, not a credit card.

We need comprehensive health insurance that covers every American.

How We Get To Medicare For All

Medicare works. It’s popular. Seniors transition into it every day, and people keep their doctors and get care at a lower cost. Let’s not lose sight that we have a Medicare system that’s already working.

Now, let’s expand it to all Americans and give everyone access to comprehensive health care. Medicare for All will cover all medically necessary services, including emergency room visits, doctor visits, vision, dental, hearing aids, mental health, and substance use disorder treatment, and comprehensive reproductive health care services. It will also allow the Secretary of Health and Human Services to negotiate for lower prescription drug prices.

Under my Medicare for All plan, we will also expand the program to include other benefits Americans desperately need that will save money in the long run such as an expanded mental health program including telehealth and easier access to early diagnosis and treatment, and innovative patient programs to help people identify the right doctor and understand how to navigate the health system.

And I’ll institute a serious audit of prescription drug costs to ensure pharmaceutical companies are not charging more than other comparable countries, a comprehensive maternal child health program to dramatically reduce deaths among women and infants of color, and meaningful rural health care reforms, such as increasing residency slots for rural areas with workforce shortages and loan forgiveness for rural health care professionals, to promote high-quality access for people regardless of their zip code.

But I am clear-eyed about the challenge of achieving this goal. It will not be easy, and it will not happen overnight. So here is my plan to get us there.

First, when we pass my plan, all Americans will immediately have the ability to buy into Medicare. This is similar to the immediate, introductory buy-in provided in Senator Sanders’ Medicare for All bill. Right away, it will lower costs and give us a baseline plan as we transition to Medicare for All.

Second, we will set up an expanded Medicare system, with a 10-year phase-in period. During this transition, we will automatically enroll newborns and the uninsured into this new and improved Medicare system, give all doctors time to get into the system, and provide a commonsense path for employers, employees, the underinsured, and others on federally-designated programs, such as Medicaid or the Affordable Care Act exchanges, to transition. This will expand the number of insured Americans and create a new viable public system that guarantees universal coverage at a lower cost. Expanding the transition window will also lower the overall cost of the program.

Third, in setting up this plan, we will allow private insurers to offer Medicare plans as a part of this system that adhere to strict Medicare requirements on costs and benefits. This would function similar to how private Medicare plans work today, which cover about a third of Medicare seniors, and operate within the Medicare system. Medicare will set the rules of the road for these plans, including price and quality, and private insurance companies will play by those rules, not the other way around. This preserves the options that seniors have today and expands options to all Americans, while also telling insurance companies they don’t run the show.

Kamala Harris with a caucus-goer in Iowa

Unlike the current system, private plans in the new Medicare system will be held to stricter consumer protection standards than they are today, such as getting reimbursed less than what the Medicare plan will cost to operate, to ensure that they are delivering meaningful value and unable to profit off of gaming consumers or the government. People will also be able to purchase supplemental insurance covering services not included in Medicare, such as medical insurance for traveling abroad, or cosmetic surgery.

Essentially, we would allow private insurance to offer a plan in the Medicare system, but they will be subject to strict requirements to ensure it lowers costs and expands services. If they want to play by our rules, they can be in the system. If not, they have to get out.

Throughout this entire period, I would also ensure the new system of Medicare for All meets clear benchmarks before asking people to join the plan. Has the public Medicare plan fulfilled its promise of high-quality coverage without unaffordable cost-sharing? Have we meaningfully expanded coverage to the uninsured? Have we reduced costs for middle-class Americans and working people?

This isn’t about pursuing an ideology. This is about delivering for the American people.

Data matters and should inform our transition. Health care is personal to people and we should make sure we get it right.

These benchmarks are also key as we fight back against the lies pushed by Big Pharma and their allies that this plan would “end Medicare as we know it,” or other misleading attacks. Seniors will be able to keep their Medicare and have dental, vision, and hearing aids covered immediately. Medicare Advantage plans would continue uninterrupted by the transition. Under my plan, no one will lose access to insurance during a transition. Period.

At the end of the ten-year transition, every American will be a part of this new Medicare system. They will get insurance either through the new public Medicare plan or a Medicare plan offered by a private insurer within that system. Seniors will see stronger Medicare benefits than they have now. We will cover millions more people who don’t have health insurance today. And we will reduce costs, save our country money, and ensure that no American has to sacrifice getting the care they need just because the cost is a barrier.

We Can’t Afford NOT to Change the System

Right now, the U.S. spends $3.5 trillion a year on health care. If we do nothing over the next decade, that number will skyrocket to an estimated $6 trillion a year. So the real question is: how can we afford not to act?

By extending the phase-in period to ten years, we will decrease the overall cost of the program compared to the Sanders proposal, and we can save additional money by accelerating delivery system reforms and value-based care that rewards meaningful outcomes. More than 200 economists have said we will dramatically save money over the long run if we expand the Medicare program to include everyone and limit profits for drug companies and insurance companies.

Senator Sanders, for example, has put forward a number of ways to help pay for his Medicare for All plan, including an income-based premium paid by employers, higher taxes on the top 1%, taxing capital gains at the same rate as ordinary income, among others. I think these are good options, especially making the top 1% and corporations pay their fair share through a more progressive income, payroll, and estate tax.

However, one of Senator Sanders’ options is to tax households making above $29,000 an additional 4% income-based premium. I believe this hits the middle class too hard.

That’s why I propose that we exempt households making below $100,000, along with a higher income threshold for middle-class families living in high-cost areas.

To pay for this specific change, I would tax Wall Street stock trades at 0.2%, bond trades at 0.1%, and derivative transactions at 0.002%. Think of it like this: that’s a $2 fee on a $1,000 trade by investors and big banks. I would also end foreign tax shelters by taxing offshore corporate income at the same rate as domestic corporate income. Together, these proposals would raise well over $2 trillion over ten years, more than enough to make up the difference from raising the middle-class income threshold.

In total, this plan will reduce our country’s health care costs and lower Americans’ out-of-pocket costs, all while extending health insurance coverage to every American.

So that’s my plan: stop the attacks on Americans’ health care coming from this administration and their Republican and special interest allies, expand on the progress made under Obamacare, immediately offer an improved Medicare buy-in to all Americans, put in place an expanded Medicare system that everyone is in, expand coverage, reduce costs, increase options for care, and establish a reasonable phase-in period with clear benchmarks to ensure a smooth transition to Medicare for All.

And what will the result be? Health insurance for every American. Expansive coverage for nearly all medical benefits. Continuity of care. Lower health care costs for American consumers and our country overall. Improved health, well-being, and productivity for the American people.

Learn more about my plan at kamalaharris.org/medicare-for-all.