Background

In 2019, healthcare spending in the United States reached a whopping $3.8 trillion – or $11,582 per person. Our healthcare system now comprises nearly 18% of our nation’s Gross Domestic Product (GDP) – an extraordinary amount fueled by the expansive profit motive of insurance and pharmaceutical companies; a burdensome and costly healthcare administrative state; frivolous malpractice suits; and an overwhelming focus on disease treatment as opposed to prevention.

The data demonstrate how broken our system is. Compared to other wealthy nations, the United States spends by far the highest per capita on healthcare – more than twice the average of wealthy countries. We spend 5.4 times the amount of other OECD countries just on healthcare administrative costs – which are expenditures like private insurance overhead, physician billing costs, hospital administration, licensing and credentialing, and so forth. In fact, nearly one third of our healthcare dollars go to administrative expenses alone!

Further, our overly-litigious approach to physician liability means that our doctors are forced to continuously practice defensive medicine – a dangerous trend whereby physicians feel compelled to perform unnecessary treatments or procedures as a safeguard against lawsuits. North of a third of all physicians have dealt with a malpractice claim against them at some point in their career. A new study found that medical malpractice and defensive medicine accounts for 2.4% of total healthcare spending - or nearly $56 billion annually. 

But make no mistake – the healthcare administrative state is designed to maximize profits for insurance companies, not safeguard and improve the public’s health. From 2017 to 2018, net earnings across all health insurance companies reached an astronomical $23.4 billion – a 45% increase from just the prior year. During the COVID-19 pandemic, while 5.4 million Americans lost their employer-based healthcare coverage, the largest healthcare companies including Humana, Anthem, and UnitedHealth Group posted second-quarter earnings that were twice what they made the prior year. In short – these companies have directly profited off the death, despair, and loss of millions of Americans.

Meanwhile, pharmaceutical companies have sharpened their skills in price gouging while the American people have been stuck footing the bill. Per person spending on pharmaceuticals in the United States is as much as 209% higher than other wealthy countries as Big Pharma exploits the growing divide in payments between public and private payers. One research study found that across 132 brand-name drugs for conditions ranging from high cholesterol to insulin deficiency to Hepatitis C to type 2 diabetes, median cost increases were 76% between January 2012 and December 2017.

Take the cost of insulin, for example. When Eli Lilly and Company first released Humalog in 1995, the cost of a vial was $21. Fast forward to 2019, it is 1200% higher – at $275 a vial. Yet Eli Lilly has not changed a single component of the drug formula; in other words, it is just as effective as it was 25 years ago, but the company still decided to increase its price exponentially.

Treating healthcare as a business rather than an inherent human right undergirds why the focus is on treatment (which yields profit) rather than prevention (which yields health). We must build healthy, vibrant communities that ensure everyone has the resources necessary to thrive. But we can’t do that when less than 3% of health spending is directed towards public health and prevention. That chronic neglect of health promotion and disease prevention contributes directly to our lower population health outcomes across metrics such as life expectancy, infant mortality, and rates of chronic disease like diabetes and cancer. Yet public health is as much about cost-efficiency as it is about improving health. Numerous studies have shown that every $1 invested in community-driven physical activity, improved nutrition, and commercial tobacco cessation programs yield $5.60 return on investment (ROI). This is significant, given that according to the CDC a staggering 90% of our annual health expenditures are for preventable chronic and mental health conditions. We need to create systems and environments that inspire health - by fully addressing the social determinants of health, abolishing systemic racism, and ensuring working class Americans and communities of color have permanent housing, strong public education, living-wage jobs, and the dignity to live without the threat of state-sponsored violence. 

Our healthcare system has been broken for a long time. It is broken because our lawmakers have opted to tinker around the edges with incremental changes that benefit the industry rather than the patient; and have failed to champion bold, transformative solutions that put the American people first, and recognize healthcare as an inherent human right. This must change. 

VISION

The health, economic, and social devastation triggered by the COVID-19 pandemic - which as of January 2021 has infected 21 million Americans and killed over 356,000 and counting - lays bare the failures of our crumbling public health infrastructure and broken healthcare system, and further exposes the systemic and generational racial health inequities built into our unjust system. That is why our 21st Century Public Health System policy outlines:

Enact Medicare for All with a federal jobs/wages guarantee.

• A single-payer healthcare system would transform healthcare delivery to truly meet the needs of all Americans while dramatically reducing long-term healthcare costs and improving health outcomes. 

  • I am also in full support of AB1400 or CalCare here in California that would establish a comprehensive, zero-cost single-payer system for all Californians.

• Through Medicare for All, we would provide full, permanent, and ZERO-COST healthcare coverage that encapsulates medical, preventive, dental, vision, mental, behavioral, reproductive, pediatric, and long-term care services and benefits. 

• I fully support the Medicare for All plans put forth by Bernie Sanders and Pramila Jayapal - which would also abolish private health insurance.

• However, Congress must provide a federal jobs and/or wages guarantee to prevent the displacement of hundreds of thousands of people currently employed by medical billing, insurance, and pharmaceutical companies.

Triple the annual budget of the Centers for Disease Control and Prevention (CDC), with significant investments towards new climate change and emergency preparedness programs and technical assistance.

• When adjusted for inflation, CDC’s budget has increased only nominally since FY 2008. Over the past decade, CDC’s operating budget for emergency preparedness and response efforts have been more than halved, creating the vacuum for a catastrophic pandemic like COVID-19 to take root. Similarly, the Trump Administration has gutted the limited climate-change specific grant programs available through CDC. 

Repeal the Hyde Amendment, and double Title X funding to better meet the family planning, medical, and public health needs of low-income women and families.

• The disastrous Hyde Amendment has been included in every annual appropriations package for over four decades, and it directly restricts women - especially low-income women of color - from accessing the family planning and abortion services they need. 

• A woman’s right to choose is an inalienable human right - and no law should be infringing on bodily autonomy. In addition, separation of church and state is foundational to individual liberty. 

• Furthermore, the Title X program currently serves about a fifth of all women who use publicly funded family planning services, and has a network of over 4,000 health centers nationwide. Over two-thirds of women served at Title X clinics live at or below the federal poverty level, and are disproportionately women of color. Doubling funding for Title X would significantly expand access to this life-saving program, and help ensure that women receive the healthcare services they deserve.

Employ a public health approach to gun violence and gun safety by enacting the following:

• Invest $250 million annually into CDC to conduct research into the root causes of gun violence, and develop public health grant programs for gun violence prevention, mitigation, and response;

• Repeal the Protection of Lawful Commerce in Arms Act, which protects firearms manufacturers and dealers from liability if their products are used to commit a crime; 

• Require universal background checks and: 

  • Close the “gun show” loophole that allows private gun sales without background checks.

  • Close the “Charleston” loophole which permits a gun sale if a background check isn’t completed in 3 days.

  • Close the “boyfriend” loophole by expanding the definition of “intimate partner” to include anyone who has been convicted of domestic violence or abuse, and prohibit anyone who has been convicted of stalking or has a restraining order against them from purchasing a gun. 

• Establish national licensing standards to include mandatory gun safety trainings prior to eligibility to purchase a firearm;

• Raise the minimum age for gun possession to 21;  

• Pass a permanent national ban on the sale and distribution of assault weapons.

Impose stronger regulations on medical devices and close the 510(K) loophole.

• The 510(K) loophole is a moniker that references the section of the Federal Food, Drug, and Cosmetic Act that authorizes medical device manufacturers to fast track FDA approval of a medical device - without showing clinical trial data, rigorous scientific review, or the basic tenets of safe human research - simply because the device is substantially similar to one already on the market from that manufacturer.

• The problem is, even when devices have been directly linked to injuries and even death, many of them remain on the market. Examples include some automated external defibrillators (used to treat cardiac     arrest) and vaginal mesh products, which have led to thousands of deaths and permanent injuries for countless women. Yet those products remained on the market for years (mesh products were still on the market until 2020). And worst of all, manufacturers were still able to file for 510(K) waivers for “new” products based on those same faulty and deadly products.

Invest $100 billion annually towards constructing, upgrading, and modernizing America’s hospitals, clinics, community health centers, and health stations.

• According to the American Hospital Association, the average age of American hospitals is nearly 11.5 years, with the vast majority of America’s public hospitals having been constructed in the 1970’s and 1980’s. Many of these hospitals are ill-equipped to effectively utilize modern medical technologies for things like electronic medical records, use of telehealth equipment, and modern medical devices. 

• Further, the over 1,400 community health centers in the United States provide care to nearly 29 million people, but many of those facilities are rapidly ageing with limited capacity and services. Similarly, migration from rural areas has led to disturbing closures of rural hospitals across the country, leaving millions without access to care.

Invest billions annually towards constructing high-speed rail and modernizing and electrifying public transit through 100% renewable energy.

• In cities like Los Angeles, freeway expansion projects and redlining policies worked hand in glove to violently displace low-income Black and brown neighborhoods for decades. The result has been massive urban sprawl, high-density traffic, air pollution, and worsening poverty in low-income neighborhoods.

• LA has the worst ozone pollution in the country, much of it driven by a transportation sector heavily reliant on petroleum-based fossil fuels. Nearly a third of greenhouse gas emissions nationally come from the transportation sector. It’s essential that we invest billions into constructing high-speed rail and electrifying public transit. According to Data for Progress, electrification could reduce 21.5 million metric tons of CO2, lead to over 4,000 fewer deaths nationally, and save over $100 billion in associated health costs.

Provide $1.5 billion annually in block grants to state, Tribal, territorial, and local governments and nonprofits for a new comprehensive federal harm reduction initiative and eliminate all legal barriers to implementation.

• Put simply, harm reduction is the philosophy of practical strategies to reduce the adverse effects of drug use for individuals, families, and communities. For decades, cultural stigma and discrimination against drug users fueled by the economically and socially destructive, morally corrosive, and inherently racist War on Drugs, has stifled the availability of harm reduction programs. 

• While some harm reduction principles like use of the opioid overdose reversal drug Naloxone and Good Samaritan laws have grown in prominence, they continue to operate on the sidelines of public health. Even more troublesome is that more transformative programs like syringe exchange, supervised drug consumption sites, widespread use of drug checking (e.g. fentanyl testing strips) continue to face significant legal and social barriers despite their demonstrated value in reducing drug-related harms, deaths, and also consumption rates. 

• It is long past due for harm reduction to become a staple of public health practice. We can achieve that goal by removing legal barriers towards establishment of supervised consumption sites, and providing meaningful funding for harm reduction programming. 

Cancel student loan debt and make public colleges and universities tuition free, and create a pipeline for youth to enter the healthcare and public health workforce as the next generation of health leaders.

• Economic health is public health. When an entire generation of young people face crippling student loan debts that stifle their socioeconomic mobility, it results in long-term adverse health impacts. 

• Further, because of the astronomical costs of medical and nurse practitioner school programs, it acts as a major disincentive for youth to enter the healthcare field. Congress can solve this problem by cancelling student loan debt for all, and making public colleges and universities - including medical schools - tuition free. 

  • And through marked investments into health training classes and programs in K-12 schools, it can inspire a generation of young people to enter the health workforce. This would ensure the long-term stability of the health system, and address long-standing physician, public health, and nursing vacancies 

Fund the Health Resources and Services Administration (HRSA) to work with colleges and universities to establish comprehensive training curriculums for mid-level and paraprofessional health providers to reduce the national shortage of healthcare practitioners.

• In tandem with creating a pipeline for fully trained medical and public health practitioners, Congress should empower HRSA to partner with colleges and universities to strengthen existing and create new training programs for mid-level providers like community health aides.

• Similarly, Congress should fully fund the expansion of innovative and revolutionary mid-level provider programs developed by Tribal Nations like community health aides, dental health aides, and behavioral health aides. These mid-range providers - which are from and serve their communities - would dramatically increase availability of care for low-income and rural populations. 

Establish a new Center within CDC committed to studying and funding solutions to address the public health impacts of mass incarceration and police brutality.

• At their core, mass incarceration and police brutality - both of which are fueled by systemic racism - are public health crises on a massive scale that disproportionately impact Black, Indigenous, and Latinx communities of color. However, very little funding and focus has been directed towards studying the intergenerational impacts of mass incarceration on community and individual health. 

• This new Center within CDC would be empowered to study, develop policy, and fund grants to governmental and nonprofit partners to address how mass incarceration and police brutality impact mental and behavioral health outcomes, substance use, recidivism rates, maternal and child health outcomes, chronic disease outcomes, and other public health issues impacted by their destructive effects. 

Modernize federal, state, Tribal, territorial, and local public health disease surveillance and real-time reporting systems to better track, measure, respond to, and mitigate future public health challenges.

• Our nation’s public health data systems and surveillance infrastructure is ill-equipped to address 21st century public health problems. The COVID-19 pandemic has directly exposed the deficiencies of our disease tracking systems and reporting capabilities. This is best exemplified by the dozens of states that continue to lack full racial and demographic data on thousands of COVID-19 cases. 

• Further, racial misclassification and undersampling of Indigenous peoples in particular directly contributes to the invisibility of disease within Tribal and urban Native populations. Many state and local health departments don’t even include “American Indian or Alaska Native” demographic indicators on disease or death forms, instead misclassifying thousands as “other” “hispanic” or “white.” 

Provide universal free child care and pre-kindergarten.

• Child care and pre-kindergarten services are essential for public health, because early childhood education is essential to public health. Low-income Black, Indigenous and Latinx communities are most severely impacted by lack of early care and education (ECE) coverage in particular. 

• Multiple studies have demonstrated how intensive, high-quality, and full ECE positively impacts the educational, social, and behavioral outcomes of children later in life.

• Further, ECE is linked with lower rates of smoking, cardiovascular and metabolic disease, and higher nutritional outcomes. 

Double annual funding for the Community Mental Health Services Block Grant (MHBG) and Substance Abuse Prevention and Treatment Block Grant (SABG).

• Operated by the Substance Abuse and Mental Health Services Administration (SAMHSA), the MHBG and SABG provide annual funding to states for mental and behavioral prevention, treatment, education, and response efforts. However, program funds have stagnated for years when adjusted for inflation, while mental and behavioral health outcomes such as rates of suicide, depression, substance use disorders, and drug overdose continue to increase unabated. 

  • However, Congress must include structural changes to funding formulas to more meaningfully address the needs of houseless communities and better account for the Cost of Services Index (COSI). Congress must also ensure block grant eligibility for Tribal governments. 

Provide full, permanent, and entitlement-based funding for the Indian Health Service.

• The United States has treaty and trust obligations to provide full healthcare and public health services for all Tribal Nations and Native Peoples. For decades, the Indian Health Service (IHS) has been funded at less than 15% of need, directly contributing to the fact that Native People live on average 5.5 years less than the national average, and are disproportionately impacted by chronic and infectious disease disparities. 

• Congress should fully fund IHS as an entitlement program at the spending levels outlined by the IHS National Tribal Budget Formulation workgroup. 

Pass the Black Maternal Health Momnibus Act of 2020.

• Introduced by Rep. Underwood (D-IL) and Senator Harris (D-CA), the Black Maternal Health Momnibus Act of 2020 was a package of bills targeted towards addressing the disproportionately higher rates of maternal and child mortality and disease within Black, Indigenous, and Latinx communities.

• With marked investments into the maternal care of incarcerated women, grant funding for state, Tribal, and local governments to expand prenatal, perinatal, and postpartum care, and the commissioning of federal reports on the impacts of structural racism and discrimination on maternal health, the Momnibus Act of 2020 is a critical piece of legislation to address maternal health. 

Defund our military-industrial complex and endless wars and fully fund public health.

• Our $740 billion annual defense budget eclipses the military spending of the next ten countries combined. Due to the profligate greed of the defense industry aided and abetted by hawkish bipartisan neoconservatism, the United States continues to fund endless, morally vacuous, brutal, and destructive foreign wars. 

• Modern-day imperialism and colonialism takes the form of federal financing of anti-democratic and anti-humanitarian political factions that create more destabilization, abuse, death, and social and economic turmoil - all of which are antithetical to public health. In a modern and just world, there is zero room for endless wars and destruction.