What It Looks Like When It Works
People are already figuring this out. A physician drops his family’s insurance because $2,000 a month for catastrophic-only coverage makes no sense. A mom discovers her prescriptions cost $8 without insurance and $50 with it. Someone avoids calling 911 because the ambulance bill scares them more than the chest pain. Families are doing the math and realizing the system costs more than the care.
I’ve seen what it looks like when it works.
On active duty, I walked into Sick Call, got treated, walked out. No bill. No prior authorization. No explanation of benefits arriving three weeks later telling me what they decided to cover. I was sick or hurt — they fixed it. That was it.
That peace of mind meant I could focus on my job. I didn’t stress about whether I could afford to get treated. I just got treated. That’s what healthcare should feel like — not just for veterans, but for all of us.
Now I’m on Medicare and the VA. Why both? Medicare lets me see any doctor, anywhere — that flexibility matters. The VA covers what Medicare won’t, especially medication. But Medicare still runs through UnitedHealthcare and it’s still expensive. Between Part B, Plan G, and medication, my monthly bill averages $500. The expensive prescriptions go to the VA — thank goodness, because my Part D wouldn’t cover them. I’m not a doctor and I’m not an insurance lawyer. But Medicare requires me to think like both.
Three systems. Only one feels like healthcare.
The question isn’t whether we redesign healthcare from scratch. It’s whether we can take what already works and make progress toward offering it to more people. That’s an investment in all of us — healthier people do better work, build stronger families, and put less strain on everything around them.
What the ACA Got Right
The ACA was an improvement. Before it, insurance companies could cap our lifetime benefits — meaning they could simply stop paying when we got too expensive. The ACA ended that. It strengthened employer-offered coverage. It extended coverage to millions of people who had nothing before. Those were real gains for real families.
It wasn’t nothing. And it deserves to be said plainly.
But the ACA is still an insurance scheme. It brokers access to care instead of delivering it. The coverage depends on which program survives the next budget vote. Congress let the ACA subsidies expire on January 1 — millions of people lost affordable coverage not because they got healthier or richer, but because a line item ran out.
Insurance still isn’t care. The insurance card and the treatment in the room are two different things, and the distance between them is where people fall through.
And the one thing insurance does cover — the catastrophic event, the car accident, the cancer diagnosis — turns out to be an expensive lottery ticket. We pay hundreds or thousands a month for the chance that if something terrible happens, we might be covered. Most of us will never hit the jackpot, and the ticket costs too much for most families to keep buying. So the biggest thing we’re left with isn’t coverage. It’s worry and stress.
The VA covers catastrophic too — same system, same card, whether it’s a checkup or a crisis. No separate tier, no surprise bill, no finding out after the fact what they decided to cover. That’s what a real system looks like: routine and catastrophic under the same roof, without the lottery ticket.
Right Here in FL-03
UF Health Shands. The Malcolm Randall VA — one of the five busiest in the country. HCA’s new $231 million hospital. The capacity is here. The connection isn’t.
When I was driving out to my store in Old Town on SR26, I’d regularly have to pull over to let an ambulance pass heading toward Gainesville. I never knew where it came from — Old Town? Trenton? Fanning Springs? Bell? Somewhere further out? All I knew was that ambulance had a long drive ahead, and wherever it came from had one fewer ambulance until it got back. Mobile clinics are a step toward making sure fewer of those trips are necessary.
East Gainesville has been identified as a primary health disparity area for over 50 years. A clinic recently opened on Hawthorne Road — a step in the right direction after decades of waiting. But one clinic doesn’t undo 50 years, especially in a city with a world-class hospital on the other side of town.
That’s the Gainesville Paradox: Alachua County ranks #3 in Florida for clinical care quality and 31st in health outcomes. A hospital five miles away that we can’t reach — by cost, by transit, or by schedule — is functionally as far as one 60 miles away. The capacity exists. The connection doesn’t. That’s the gap mobile clinics close.
Mobile Clinics: They Already Work
This isn’t a new idea. Mobile clinics operate across the country. North Florida Medical Centers already runs one in our region. Harvard’s Family Van documented $36 saved for every $1 invested compared to ER visits, over 30 years of operation.
The funding already exists: FQHC grants, HRSA rural health dollars, VA community care partnerships under existing law. FQHCs already provide sliding-scale care across the district. The legal authority is there. The operating model is proven. What’s missing is someone connecting the pieces and making sure nothing stalls quietly between the VA, the FQHCs, and the grant offices.
Each mobile unit is a real clinic visit — not a screening booth. Exam room, basic lab, pharmacy dispensing for common prescriptions, telehealth connection to specialists at UF Health or the VA. They anchor at places people already know: churches, fire stations, community centers, college campuses. Same place, same day, reliable schedule.
These units also double as emergency response. When a hurricane hits, they’re already on the road, already staffed, already mobile — able to deploy to disaster zones without waiting for a field hospital to be stood up.
The pieces are all here. Nobody’s connected them.
The VA Works
The VA runs its own hospitals, employs its own doctors, and buys drugs at government-negotiated prices. Salaried doctors. No billing department trying to deny a claim. The mission is care, not profit. It’s the one large system I’ve seen that works the way healthcare should work.
The VA has always been an innovation engine. Artificial limbs, the golden-hour protocol — developed for veterans, now part of everyday civilian medicine. Opening those doors wider isn’t asking the VA to learn something new. It’s letting what it already knows reach more people.
The direction I’m pointing is toward credentialing private doctors into the VA system — the doctor stays in their own office, their computer connects to the VA network, the VA pays the doctor directly. No insurance company in between. No claim denied, no prior authorization, no billing department deciding whether the care was “medically necessary” after the fact. The doctor and the patient — that’s it. Eventually, open that model to Medicaid patients and beyond. Not overnight. Not by decree. Built on infrastructure that already works, expanded as the capacity grows.
Veterans get head of the line. That doesn’t change. But the system they built — and what it knows — can serve as a foundation for the rest of us, too. For the full plan on serving those who made this system possible, see the veterans plan.
AI and the Paperwork Tax
For every hour a doctor spends with a patient, they spend two hours on documentation — clinical notes, diagnosis codes, prior authorizations, insurance appeals. That paperwork is part of why doctors burn out — and part of why a 15-minute appointment that costs $125 out of pocket gets billed at $300 through insurance.
AI can handle documentation in real time — capturing the encounter, generating clinical notes, assigning codes, routing payment — while the doctor is still in the room. The doctor’s job goes back to what it should be: talking to people and thinking about their health. Pair that with a single administrative system — like the VA — and the overhead collapses from both directions.
We Already Paid for It Once
A significant portion of approved drugs trace back to taxpayer-funded research. The NIH invests tens of billions each year in the basic science that discovers how diseases work. A 2018 study in the Proceedings of the National Academy of Sciences found that NIH-funded research contributed to the scientific foundation of every one of the 210 drugs approved by the FDA from 2010 to 2016.
We paid to discover it. Then we pay again to buy it. The public funds the research, private companies develop the drug, and then charge whatever the market will bear for something our tax dollars helped create.
The fix: negotiate directly, and use the lowest price any federal agency has already secured — VA, Medicare, Medicaid, whoever got the better deal. And if the market still won’t deliver affordable generics, the government makes them — same logic as the Postal Service. The VA already has the pharmacies and supply chains. That’s not building from scratch.
100% Federal Medicaid Funding
Right now, the federal government covers 90% of Medicaid expansion costs and states cover the remaining 10%. That 10% state match gives governors an excuse not to expand — and the result is healthcare deserts in rural communities across Florida. Pushing for 100% federal Medicaid funding is a concrete Day One ask: remove the excuse, close the coverage gap.
An Investment in Our Own Health
Healthcare isn’t a cost to be minimized. It’s an investment in our capacity to do everything else — work, raise families, build communities. When people aren’t stressed about whether they can afford to get treated, they function better. That’s not a political claim. It’s just how people work.