Healthcare is a deeply personal issue for me. My daughter was first diagnosed with brain cancer at the age of 4, but the quality care that the American people provided my family through the military gave her a chance to beat the disease. When Alex’s cancer came back last year, more than a decade later, we were fortunate to have the same medical heroes who had saved her once, save her again — including a doctor who came out of retirement to perform the intricate brain surgery. I’m running for President so that one day soon all Americans will be able to feel the same sense of gratitude and good fortune my family feels when we think of my daughter’s care and treatment. We must finally make healthcare a right, not a privilege.
As a Congressman, I was proud to vote for the Patient Protection and Affordable Care Act (ACA) in order to increase access to quality care, reform the broken health insurance industry, and save lives. By every metric, the ACA was successful at providing more and better healthcare coverage and in lowering costs: more than 20 million previously uninsured Americans now have insurance; average health insurance premiums per family have been reduced by $4,000 per year; insurance companies must now cover pre-existing conditions; parents can keep their children on their health plan until age 26; and overall healthcare spending has kept below pre-ACA projections by a staggering $2.3 trillion dollars over just the first seven years of the program.
Yet not all Americans benefit from the successes of the ACA, for a variety of reasons. Employees are now covering more of the costs of their own insurance (their share of premium costs has gone up some 32% since 2012), many Americans can only afford high-deductible plans, and the costs of prescription drugs and copays continue to climb. In the run-up to the final passage of the ACA I was also proud to vote for a public health insurance option, though unfortunately it was removed from the bill in the Senate and the ultimate law was weaker for it. A public option would further reduce costs across the board. It would create competition in local markets where one or two health insurance companies enjoy a monopoly. And it would allow the government to negotiate with hospitals and pharmaceutical companies to save patients money. I support immediately creating a public option plan to expand access to many more uninsured people and cut costs for everyone.
I believe that the public option is one part of a transition of choice to a national healthcare system. Creating such a system will not be easy, but I believe our country can rise to the challenge. I know from my experiences visiting our wounded warriors at Veterans Health Administration (VHA) facilities across the country that a national healthcare system can work — indeed, it already exists for veterans. The VHA directly provides high-quality medical services to over 9 million people at some 1,250 facilities, employing over 300,000 healthcare professionals. It is the country’s largest integrated healthcare system, providing comprehensive care to its patients whether they walk in to a Vet Center in Fairbanks, Alaska, or a VA hospital in San Juan, Puerto Rico. And it provides medical education and training to over 100,000 people every year, including more than 37,000 medical residents, or 30% of all residents trained across the country each year.
There have been a few unfortunate scandals at the VA, but overall wait times have been significantly reduced — to the point where for primary care services and at least three specialties, VHA wait times are now shorter than wait times for private doctors (according to a 2019 study published by no less an authority than the Journal of the American Medical Association). Furthermore, when compared to the subsidized healthcare the general public receives through Medicaid, studies find the VHA provides better services with better outcomes. It is not a perfect system (and I offer some solutions to the challenges it faces in the Veterans section), but it is remarkably effective at providing care for millions of Americans — and I believe it can serve as one model for any implementation of national healthcare system for all Americans.
I recognize that such a dramatic change in our healthcare system must take into consideration the 255 million Americans who are currently supported by private health insurance today. Many people are happy with their coverage, and are justifiably skeptical of any proposed shift to a national healthcare system. I believe we must study every conceivable option to see how to best achieve this ambitious goal and build as close to a national consensus as possible before deciding the exact contours of any plan. I am optimistic that the success of the public option will increase public confidence in the government’s ability to deliver on such an important issue that can lead to the transition of choice to a nationwide system benefitting all Americans.
While the ACA has gone a long way toward stabilizing costs, the overall cost of healthcare remains a burden for millions of American families and individuals. I believe Congress and the President should take immediate action to lower costs further. One solution to skyrocketing costs of prescription drugs is to allow the importation of cheaper drugs from Canada where our own pharmaceutical firms often sell the same drugs for lower prices. For years the state of Maine permitted citizens to reimport drugs from Canada — often saving individuals thousands of dollars each year — until a federal court struck down their law in 2013. Now Vermont has passed a law to allow wholesalers to import drugs from Canada, but it is still arguing for the approval of federal government and so has yet to come into effect. To give just one example, Canadians pay just $29 per month on a Nasonex prescription, while in the US we pay $105.
The pharmaceutical companies argue that they need to charge as much as possible to pursue critical research, but I cannot accept that argument when the same drug companies spent $27 billion a year on marketing drugs. That’s enough to buy more than 5,000 Super Bowl ads. Meanwhile, Americans pay more for insulin than people in any other country — $6000 per year — and that price inexplicably doubled between 2012 and 2016. Such profiteering by drug companies must end. One way to force drug prices down is to allow Medicare to bargain directly with drug makers — as Medicate and the VA already do, saving over $15 billion every year. Another is stopping the “pay-for-delay” practice that costs $3.5 billion annually by allowing pharmaceutical firms to pay generic drug manufacturers not to go to market after their brand-name drug patent expires. If these efforts fail to control the costs of drugs, I would be open to the creation of an entity in the United States akin to Canada’s Patented Medicine Prices Review Board, which has authority to determine maximum prices for patented prescription drugs in Canada, and is part of the reason why Canadians pay so much less than we do.
Finally, we must shore up our entire medical system by taking action against the increasingly dangerous shortage of doctors and nurses in our country. The Association of American Medical Colleges projects that by 2030 we could face a doctor shortage of 120,000, with roughly one-third of them primary care physicians. Especially as we move toward an integrated national healthcare system, primary care physicians play a critical role in our health system as the gatekeepers to specialist care. We can redistribute the $13 billion America’s teaching hospitals receive in federal subsidies toward more primary care residencies, with financial incentives for rural area follow-on assignments, and generally fund additional residency slots. We must also strengthen federal incentives and programs like the National Health Service Corps, the Conrad 30 Waiver Program, Public Service Loan Forgiveness, and Title VII/VIII workforce development and diversity programs which aim to recruit a diverse medical workforce and stimulate doctors to take up specialties with particular doctor shortages and to practice in underserved communities. The nursing shortage can be addressed by increasing training and educational opportunities (such as through fellowships and loan forgiveness for future nurse educators who commit to teaching in underserved communities), and by incentivizing healthcare organizations to conduct internal reviews about policies regarding nursing staff and implement solutions to prevent burnout and turnover.
Focus on Mental Health & Addiction
Too often mental health is considered an issue apart from our broader healthcare system. But we know that mental health is critical to overall health and well being. We also know that our mental health system is failing. While some 43 million Americans suffer from a mental health condition, only 43% of them have received some form of treatment, according to a report from Mental Health America (MHA). The same report found that over 76% of youth with severe depression — some 1.7 million kids — do not get the treatment they need. It’s no wonder that both suicidal ideation and major depressive episodes among our youth are increasing.
Shockingly, nearly half of all psychiatrists refuse to accept Medicare or Medicaid patients, or even patients with private health insurance, instead preferring to see only cash-paying patients. While this is their right, it is incumbent on policymakers at the state and federal level to provide incentives to mental health professionals to do the right thing and take on the patients who need their help the most. We must also increase the number of hospital beds available for inpatient psychiatric treatment, currently at the same level as it was in the 1850s.
The federal government is already required to play a role in assuring that mental health and addiction are covered by health insurers under the Mental Health Parity and Addiction Equity Act (MHPAE)— which requires that restrictions and insurer’s requirements for coverage of mental health and substance use disorders are no more restrictive or onerous than those set for other medical and surgical benefits — but the Act is largely unenforced. Unfortunately it was written without a mechanism to monitor and evaluate its effective implementation, so it must be amended and updated as soon as possible. The ACA did improve coverage for behavioral health patients, but the parity protections of the MHPAE do not extend to Medicare, traditional Medicaid, or certain bare-bones catastrophic coverage plans currently offered. We should extend parity protections so that people in such plans are also able to access mental health and substance abuse treatment.
Finally, we must mobilize as a nation to address the crisis of opiate addiction. According to the data published by the Department of Health and Human Services, some 11.4 million people misused prescription opioids in 2016. Some 2.1 million people had an opioid use disorder. Tragically, nearly 50,000 people died from an opioid overdose. The federal government should be leading a multi-pronged approach to dealing with opioid addiction. We need states to rework their Medicaid programs to boost reimbursements paid to providers of addiction treatment services — as Virginia has implemented with their Addiction and Recovery Treatment Services program — because addiction treatment providers are generally underpaid by health insurers. We also need prisons to improve access to addiction treatment, including all available medications, and we need to increase funding for training programs to help doctors better understand the complexities of addiction care. We should also change federal law to allow doctors and scientists to expand research into the potential of certain psychedelic drugs to complement traditional substance abuse and other mental health treatment. Anti-drug laws should never be an impediment to sound scientific research, but especially not during a public health crisis such as this one.