It’s old news that accessing healthcare in the US is a problem for millions of Americans — even Trump has campaigned on making healthcare more affordable.

During last night’s Democratic debates, only two candidates said they would get rid of private health insurance to lessen the US’s healthcare inequality gap: Senator Elizabeth Warren and New York City mayor Bill DeBlasio. Such a complex and pressing issue would have benefited from more time for debate.

Like many of the Democratic candidates said last night, and like many non-Americans, I have long been baffled by the exorbitant prices people in the US pay for medical services and medications. And that’s not just my opinion. In a follow-up to a well-known 2003 study researchers found that, in terms of per capita spending, the US spends more money on healthcare than any other Member State of the OECD — but Americans get far less care for that money than citizens from other OECD countries.

Thanks to important coverage provisions going into effect in 2014 from the Affordable Care Act (also known as Obamacare), in 2013 the number of uninsured Americans dropped from 44 million to less than 27 million in 2016. But that number began to rise again in 2017, when over 700,000 more Americans reported they didn’t have health insurance.

This gap in care is precisely why the health tourism industry is growing in Mexico. My colleagues and I regularly comment on the growing number of Americans looking for preventative care and surgery in Mexican hospitals because of the quality and affordability.

As a family we’ve also experienced the pitfalls of the current US healthcare model. Last summer, my wife and daughter were in Colorado when my then one-year-old baby began to have asthma attacks. My wife took her to a local hospital and after a doctor listened to her chest with a stethoscope and checked her blood oxygen levels, she left with a $700 bill. That is more than I charge for some of the surgical procedures I perform as a urologist. No one should have to pay that much money for a doctor to merely listen to their child’s lungs, regardless of whether they can afford it or not.

Democratic debate: Tim Ryan If you go to guantanamo bay there are terrorists who get better healthcare than those kids'

That is the kind of situation the more progressive candidates want to avoid with the Medicare-for-All program, which is often misunderstood. Basically, a Medicare-for-All plan would eliminate private healthcare coverage, and instead provide government plans for nearly all health coverage.

Considering how difficult it was for Obama to pass the Affordable Care Act, I find it hard to believe a more rigid plan would be popular. But there’s still another option: a more flexible system similar to the one we have in Mexico that permits private care, but with a government-funded public system that reaches all sectors of the population.

In Mexico, for example, high-quality medicine and research is accessible in the private sector as well as in government hospitals, which are divided to give attention to different types of populations, such as bureaucrats, teachers, members of the military, and state workers, for annual fees paid by their employers, as well as federal-level hospitals that provide care to patients and are directly operated by the Secretary of Health.

That’s right – millions of patients still pay into the system for their health coverage, but that coverage is then provided by the program the patient has paid into. There are cracks in the system, but that is essentially how it works.

We also have a public policy program called Popular Insurance, or Seguro Popular, which was established in 2003. It arose from the need to provide medical care to the “open population” — that is, to people who are unaffiliated with any other health system — and to provide care to people in the informal labor market. This system is financed directly by the federal government. Through the Popular Insurance Program, the Mexican government has managed to cover about 52.7 million people who otherwise would have gone without healthcare.

The Democrat challengers to Trump in 2020 Show all 25 1 /25 The Democrat challengers to Trump in 2020 The Democrat challengers to Trump in 2020 Bernie Sanders The Vermont senator has launched a second bid for president after losing out to Hilary Clinton in the 2016 Democratic primaries. He is running on a similar platform of democratic socialist reform Getty The Democrat challengers to Trump in 2020 Joe Biden The former vice president recently faced scrutiny for inappropriate touching of women, but was thought to deal with the criticism well and has since maintained a front runner status in national polling EPA The Democrat challengers to Trump in 2020 Elizabeth Warren The Massachusetts senator is a progressive Democrat, and a major supporter of regulating Wall Street Reuters The Democrat challengers to Trump in 2020 Amy Klobuchar Klobuchar is a Minnesota senator who earned praise for her contribution to the Brett Kavanaugh hearings Getty The Democrat challengers to Trump in 2020 Michael Bloomberg Michael Bloomberg, a late addition to the 2020 race, announced his candidacy after months of speculation in November. He has launched a massive ad-buying campaign and issued an apology for the controversial "stop and frisk" programme that adversely impacted minority communities in New York City when he was mayor Getty Images The Democrat challengers to Trump in 2020 Tulsi Gabbard The Hawaii congresswoman announced her candidacy in January, but has faced tough questions on her past comments on LGBT+ rights and her stance on Syrian President Bashar al-Assad Getty The Democrat challengers to Trump in 2020 DROPPED OUT: Pete Buttigieg The centrist Indiana mayor and war veteran would be the first openly LGBT+ president in American history Getty The Democrat challengers to Trump in 2020 DROPPED OUT: Deval Patrick The former Massachusetts governor launched a late 2020 candidacy and received very little reception. With just a few short months until the first voters flock to the polls, the former governor is running as a centrist and believes he can unite the party's various voting blocs AFP/Getty The Democrat challengers to Trump in 2020 DROPPED OUT: Beto O'Rourke The former Texas congressman formally launched his bid for the presidency in March. He ran on a progressive platform, stating that the US is driven by "gross differences in opportunity and outcome" AP The Democrat challengers to Trump in 2020 DROPPED OUT: Kamala Harris The former California attorney general was introduced to the national stage during Jeff Sessions’ testimony. She has endorsed Medicare-for-all and proposed a major tax-credit for the middle class AFP/Getty The Democrat challengers to Trump in 2020 DROPPED OUT: Bill De Blasio The New York mayor announced his bid on 16 May 2019. He emerged in 2013 as a leading voice in the left wing of his party but struggled to build a national profile and has suffered a number of political setbacks in his time as mayor AFP/Getty The Democrat challengers to Trump in 2020 DROPPED OUT: Steve Bullock The Montana governor announced his bid on 14 May. He stated "We need to defeat Donald Trump in 2020 and defeat the corrupt system that lets campaign money drown out the people's voice, so we can finally make good on the promise of a fair shot for everyone." He also highlighted the fact that he won the governor's seat in a red [Republican] state Reuters The Democrat challengers to Trump in 2020 DROPPED OUT: Cory Booker The New Jersey Senator has focused on restoring kindness and civility in American politics throughout his campaign, though he has failed to secure the same level of support and fundraising as several other senators running for the White House in 2020 Getty The Democrat challengers to Trump in 2020 DROPPED OUT: Wayne Messam Mayor of the city of Miramar in the Miami metropolitan area, Wayne Messam said he intended to run on a progressive platform against the "broken" federal government. He favours gun regulations and was a signatory to a letter from some 400 mayors condemning President Trump's withdrawal from the Paris Climate Accord Vice News The Democrat challengers to Trump in 2020 DROPPED OUT: Kirsten Gillibrand The New York Senator formally announced her presidential bid in January, saying that “healthcare should be a right, not a privilege” Getty The Democrat challengers to Trump in 2020 DROPPED OUT: John Delaney The Maryland congressman was the first to launch his bid for presidency, making the announcement in 2017 AP The Democrat challengers to Trump in 2020 DROPPED OUT: Andrew Yang The entrepreneur announced his presidential candidacy by pledging that he would introduce a universal basic income of $1,000 a month to every American over the age of 18 Getty The Democrat challengers to Trump in 2020 DROPPED OUT: Julian Castro The former San Antonio mayor announced his candidacy in January and said that his running has a “special meaning” for the Latino community in the US Getty The Democrat challengers to Trump in 2020 DROPPED OUT: Marianne Williamson The author and spiritual adviser has announced her intention to run for president. She had previously run for congress as an independent in 2014 but was unsuccessful Getty The Democrat challengers to Trump in 2020 DROPPED OUT: Eric Swalwell One of the younger candidates, Swalwell has served on multiple committees in the House of Representatives. He intended to make gun control central to his campaign but dropped out after his team said it was clear there was no path to victory Getty The Democrat challengers to Trump in 2020 DROPPED OUT: Seth Moulton A Massachusetts congressman, Moulton is a former US soldier who is best known for trying to stop Nancy Pelosi from becoming speaker of the house. He dropped out of the race after not polling well in key states Getty The Democrat challengers to Trump in 2020 DROPPED OUT: Jay Inslee Inslee has been governor of Washington since 2013. His bid was centred around climate change AFP/Getty The Democrat challengers to Trump in 2020 DROPPED OUT: John Hickenlooper The former governor of Colorado aimed to sell himself as an effective leader who was open to compromise, but failed to make a splash on the national stage Getty The Democrat challengers to Trump in 2020 DROPPED OUT: Tim Ryan Ohio representative Tim Ryan ran on a campaign that hinged on his working class roots, though his messaging did not appear to resonate with voters Getty The Democrat challengers to Trump in 2020 DROPPED OUT: Tom Steyer Democratic presidential hopeful billionaire and philanthropist Tom Steyer is a longtime Democratic donor AFP/Getty

I won’t lie – the public healthcare model we have here is far from perfect. Patients and doctors will tell you that there are often long waits and bureaucratic obstacles to get appointments or to schedule non-urgent surgeries in the state and federal healthcare clinics and hospitals. This is why a growing percentage of the population also pays for private health insurance. Then there is the challenge of dealing with chronic diseases like diabetes, cardiovascular disease and cancer – which present an added strain for public healthcare systems. It’s not easy, but it does work.

A flexible public and private model like the one we have in Mexico is surely applicable in the United States; there is no doubt that the country has the wealth to accomplish it. The real question remains as to whether ensuring access to healthcare is a priority for the next president, whomever that might be.