Healthcare

I support Medicare for All. Single-payer. The Bernie Sanders and Pramila Jayapal version, with no carve-outs and no compromises sold as pragmatism by the people lobbying against it.

Every other developed country figured this out decades ago. We are the only major country in the world that ties health insurance to employment, that allows medical bankruptcy, that lets pharmaceutical companies set their own prices, that lets insurance companies decide what care a doctor is allowed to provide. We pay roughly twice what other developed countries pay per capita. Our outcomes are worse. Our life expectancy is lower. Our infant mortality is higher.

This is not a problem with American medicine. American doctors and American nurses are excellent. The problem is the layers of for-profit middlemen extracting wealth between the patient and the care they need. Medicare for All removes those middlemen.

The transition is the hard part. We need a clear timeline, real protections for workers in the insurance industry who will need to transition into other roles, and a public education campaign that does not let the insurance industry write the talking points. The pushback will be enormous. The current system funds both political parties. That is the entire reason we have not done this yet.

Pharmaceutical companies in this country charge whatever they want for drugs that cost pennies to manufacture. The same insulin that costs $30 in Canada costs ten times that here. The same generic chemotherapy that costs $50 in Europe costs orders of magnitude more in the United States. The justification, every single time, is that high prices fund research and development. The data does not support that. Pharmaceutical companies spend more on marketing and stock buybacks than they spend on R&D, and most of the meaningful basic research happens at universities funded by taxpayers.

We need Medicare to negotiate prices on every prescription drug, not just the handful that the Inflation Reduction Act allowed. We need to break up the patent abuse schemes pharmaceutical companies use to keep generics off the market. We need a clear rule that any drug developed with public funding is sold at a fair price domestically, or the patent goes back to the public.

Mental health parity has been federal law since 2008. Insurance companies are required to cover mental health care at the same level as physical health care. They are still systematically violating that law. Networks for mental health are inadequate. Reimbursement rates are lower. Prior authorization requirements are stricter. The result is that people who need mental health care cannot find a provider who takes their insurance, and the ones who can are out of pocket.

Veteran suicide is at epidemic levels. Civilian suicide is rising. Anxiety and depression among young people are at the highest rates ever recorded. We do not have a mental health crisis because we do not have enough therapists. We have a mental health crisis because the system is designed to ration care.

We need real enforcement of mental health parity, with serious penalties for insurance companies that violate it. We need a federal investment in mental health workforce development, with loan forgiveness for therapists, social workers, and psychiatrists who practice in underserved areas. We need crisis response systems that are not the police.

Most long-term care in this country is paid for by Medicaid, which means most families have to spend their savings down to nothing before they qualify. The cost of assisted living is staggering. The cost of nursing home care is worse. Family caregivers, most of them women, provide an estimated $600 billion of unpaid care every year while losing their own income, retirement savings, and careers.

My mother is in assisted living. I know what this looks like from inside the family. The system is broken in ways that most policy debates do not name, because the people who profit from it are not the ones the cameras point at.

We need to expand Medicare to cover long-term care, not force families to bankrupt themselves into Medicaid. We need to support family caregivers with tax credits, paid leave, and workforce reentry programs. We need to invest in home and community-based services as alternatives to institutional care. And we need real labor standards in the long-term care workforce, because the people doing this work are paid poverty wages while the corporations running these facilities post record profits.

I have been a VA patient for over fifteen years. I have spent more time fighting that bureaucracy than most members of Congress have spent fighting any institution. The PACT Act was a real step forward. Implementation has been uneven, the backlog is still enormous, and the privatization-by-attrition strategy that successive administrations have pursued is doing real damage.

The VA is not a market problem. It is a budget problem. It is understaffed because Congress has refused to fund it adequately. It outsources work to private providers because Congress has refused to hire enough VA staff. The waiting times are not because the VA is incompetent. The waiting times exist because Congress has been letting the VA quietly fail while pretending to support the troops.

We need full funding for the VA, not piecemeal additions tied to political cycles. We need to bring more healthcare in-house, not less, because the data on quality of care strongly favors VA over private community care. We need accountability for the contractors who profit from VA outsourcing while veterans wait. And we need the VA’s mission expanded to include the full set of services veterans actually need, including long-term care, family support, and addiction recovery.