The Whole Health Plan
*NOTE: Since the COVID-19 pandemic, I have made one change in my position on health care. Because the specter of the virus is likely to be with us for the rest of our lives, I believe a Medicare-for-All type system will be necessary in order to adequately handle our health care needs.
Today’s healthcare system puts an unbalanced focus on treating the symptoms of illness at the expense of treating their cause. Until we ask why so many of us experience chronic illness to begin with – far more than do the citizens of comparably wealthy countries – then we will continue to experience unsatisfactory results in health care. The WHOLE HEALTH PLAN expands the health care debate, tackling not only how to pay for health care but also how to provide greater opportunities for health. The problem in America is not just that our current healthcare system fails to adequately treat sickness. The problem is also that our current economic system, based as it is on an inordinate focus on short-term profit, actually increases the probability of sickness.
Healthy food, healthy water, and healthy air are regularly sacrificed at the altar of short term profits of food, big agricultural and chemical companies. A stress-free lifestyle is sacrificed at the altar of corporate greed, making the average American have to work harder and longer for less money, with too little time and energy for health-enhancing activities. Social determinants such as food and income contribute heavily to the physical condition of our bodies, and cannot be ignored in any serious discussion of creating a healthier America.
The factors mentioned above are the root causes of illness, and will be addressed by a Williamson administration through vigorous regulatory procedures. We will begin with a concerted effort to remove toxins in our water, food and air that increase the probability of illness. The Food and Drug Administration as well as the Centers for Disease Control will regain their rightful power and authority to protect Americans from overreach by corporate forces that would sacrifice our health in favor of short term profits. No longer will government agencies cover up for, cozy up to, or in any way serve the entities whose overreach they were established to protect us from.
Under the Whole Health Plan, we will:
- Address unhealthy water and air, higher toxin exposures such as lead, and limited opportunities to purchase healthy food because of low availability and high cost, all factors which impact health.
- Improve food quality. Poor diet is one of the leading causes of premature death and chronic disease, and in my administration we will fund research regarding which foods can help us be healthier and live longer.¹
- Move beyond the current disease care system, and build a true healthcare system. Health and wellness will be proactively supported. We will promote healthy eating through nutrition education, encourage active lifestyles by building more parks with walking paths and physical recreation equipment, and provide greater access to bicycles. We will provide refundable tax credits for gym memberships, supporting people in putting healthy eating and regular exercise into their lives. We will support "food recovery", the distribution of unused fresh healthy food to underserved communities, rather than dumping that abundance in landfills due to lack of distribution ability, so as to benefit health, children's developmental capabilities, and the environment. Centers providing stress-reduction benefits like yoga and meditation, and community centers promoting connections that help us care for ourselves and each other, will be government subsidized. We will act on the knowledge that stress suppresses the immune system, and reducing stress will improve our health. The reduction of cost not only in terms of health, but also in terms of our economy, will be enormous. Health promotion and disease prevention can save billions of dollars. We will also provide health coaches to serve people in making the kinds of lifestyle changes that most benefit their health.
- Reduce toxins in our environment and our food. We must reduce toxins in our environment that can lead to illness. I will appoint a world class environmentalist to head EPA and scientists to lead USDA and FDA, to conduct research untainted by corporate interests. I will appoint an inter-agency work group to assess ways to reduce the negative impact of these toxins on our health. We will encourage and incentivize regenerative agriculture and reduce the use of pesticides. We will enforce consumer protections by more regular and serious food inspections.
- Support the strong recommendation of the CDC to phase out the practice of using antibiotics to promote growth in farm animals, and end the inhumane practice of animal factory farming. Overuse of antibiotics in animals leads to increased risk of antibiotic-resistant infections in humans, according to the Centers for Disease Control and Prevention. "Up to half of antibiotic use in humans and much of antibiotic use in animals is unnecessary and inappropriate and makes everyone less safe,” the CDC stated. “Stopping even some of the inappropriate and unnecessary use of antibiotics in people and animals would help greatly in slowing down the spread of resistant bacteria.”
- Keep weed killer out of our food. Many weed killers like Monsanto’s Roundup have the herbicide glyphosate in them, which ends up in our food. This herbicide has been linked with cancer by the World Health Organization and the state of California. Glyphosate is the world’s most commonly used weed killer. Some foods including commonly used cereals have it. It is primarily used as a weed killer, but is also used to harvest crops like oats, wheat and barley.⁴ A recent study by researchers from the University of Washington shows that exposure to glyphosate raises the cancer risk by 41%. After being sued for selling Monsanto’s Roundup without adequate cancer warnings, the retailer Costco has stopped selling the product.⁵ We need strong action to keep dangerous herbicides and pesticides out of our food.
- Prevent and even reverse many diseases through lifestyle changes: This has been demonstrated in medical research to be effective. The European Prospective Investigation into Cancer and Nutrition study showed that changes in nutrition and lifestyle factors could potentially prevent 93% of diabetes, 81% of heart attacks, 50% of strokes and 36% of all cancers. This trend is backed up also in studies conducted by Dr. Dean Ornish (see his book UnDo It!: How Simple Lifestyle Changes Can Reverse Most Chronic Diseases); the National Institutes of Health and the Centers for Disease Control and Prevention in their joint Diabetes Prevention Program, and others. Dr. Dariush Mozaffarian, dean of the Tufts Friedman School of Nutrition Science and Dan Glickman, secretary of agriculture from 1995 to 2001, show similar benefits in their article “Our Food Is Killing Too Many of Us.” (New York Times, 8/26/2019).
Addressing these factors is so essential to good health that under my plan, programs that are proven to be effective at helping people adopt these approaches will be covered as a health expense. My administration will provide major funding for research and education around how health is impacted by nutrition, exercise, stress, community and toxins in our food and environment. It will also support effective leading-edge approaches like Integrative and Functional medicine—which take a whole body systems approach to cultivating health and healing disease.
- Support full inclusion of people with disabilities. As many as 60 million Americans have some kind of disability. My administration will work to provide services that enable these folks to live as independently as possible, that protect their civil rights, and that promote their full inclusion in society. This includes quality healthcare as well as closing disparities in employment, housing, transportation, and education. I will work to pass the Disability Integration Act that would require all healthcare insurers to cover home healthcare, and to fully fund the Individuals with Disabilities Act. (See my plan for Disability Justice)
- Treat gun violence as an issue of public health. My administration will restore research on gun safety as a health issue, which was blocked by the National Rifle Association, and allow medical professionals to discuss gun safety with patients. (See my plan for gun safety.)
HIGHLIGHTS: WHAT THIS PLAN ACHIEVES
My plan for a thriving, universal, affordable Whole Health Care System actively supports health and wellness, improves care, and reduces costs by focusing on preventing illness, value and competitive pricing.
- It adds coverage for programs that promote health by improving diet, increasing exercise, managing stress and providing social supports in ways that are scientifically shown to prevent and even reverse disease.
- It reduces costs of prescription drugs by restoring the government’s right to negotiate prices. If pharmaceutical companies do not bring prices down to reasonable levels, my administration will exercise its March In rights under the Bayh Dole legislation which allows the government to give patent rights for drugs developed with government funds to another company that will offer lower prices.
- It will have future drug development conducted by NIH to eliminate the profit incentive and give the government the patents to produce the drugs if prices are high.
- It restores and expands funding for comparative effectiveness research to find the most effective treatment options to improve health. Studies will include nutrition, exercise, and complementary medicines along with other treatments. These approaches can lead to both better health and dramatic cost savings.
- It requires health professionals to inform patients of different options for treatment. Just as financial professionals who are fiduciaries are required to recommend investments which they believe are best for the client (not what brings the advisor the most commission), health professionals will be required to recommend treatments which they know are shown to be effective. For example, someone with high cholesterol can be told that one treatment is drugs with side effects, and another treatment is changes in diet and exercise.
- It provides more public education around good nutrition and supports for integrating optimal nutrition into our lives. The USDA nutrition guidelines will reflect the best research not influenced by corporate interests.
- It requires all insurance companies that offer health insurance on the exchanges to be non-profit organizations, with all funds directed to better care and lower costs. All companies selling health insurance must offer Essential Health Benefit plans with defined core benefits.
- It gives people added choices with multiple public options on the insurance exchange. For the first time, any American can buy the same health insurance plan offered to members of Congress. Medicare is offered to people younger than age 65.
- It creates a care delivery system better matched to our society’s needs by targeting federal health training investment toward those specialties in short supply, especially preventive care, primary care and mental/behavioral health, and will require residency programs to fill those training slots prior to filling any other openings. It incentivizes health professionals to practice in underserved areas. Doctors trained in residency programs that receive funding from Medicare, Medicaid, or the Veterans Administration will not be allowed to refuse to treat patients covered by Essential Health Benefit plans.
What the plan doesn’t change is also important: It allows employers to offer health benefits to their employees; people still buy health insurance with required essential benefits on the insurance exchange, now with public options added; pre-existing conditions are covered; all while physicians, hospitals and other providers remain in the private sector.
GOALS of The Whole Health Plan
- Universal Coverage – Everyone participates by getting some form of an Essential Health Benefits plan which covers all core benefits and may have additional coverage. Plans may be provided by employers or purchased on an insurance exchange. To improve chronic disease preventive care, we will lower or eliminate cost sharing such deductibles, coinsurance, or co-pays for a broader range of preventive services.
- Expand Essential Health Benefits - All Essential Health Benefit plans must include coverage for preventive care, expanded health and wellness, vision, dental, and hearing, behavioral/mental health (including psychiatry, psychology, clinical social workers, and more evidence-based holistic approaches like mindfulness meditation) and addiction treatment services.
- Affordability –We make access to Essential Health Benefits plans affordable to everyone by sliding scale premium subsidies. Co-pays and deductibles are reduced or eliminated to increase affordability. Competition, value-based payment that emphasizes efficiency and regulation will be used to reduce costs.
- Diversity of Choice and Innovation – Essential Health Benefit plans on exchanges will include both public and private options, thus avoiding a “one-size-fits-all” limitation and foster ongoing innovation in healthcare. Medicare, Medicaid, the Congressional Health Plan and a Veterans Administration plan will be available on federal and state insurance exchanges – with expanded coverage as described above.
- Health Services Availability – This plan focuses federal training dollars on professionals in preventive care, primary care, behavior/mental health, nursing and allied health providers such as nutritionists and health and wellness coaches needed to serve the full population of the U.S. It will assure that the training includes sufficient depth of knowledge in issues of health and wellness to promote health in patients. It incentivizes health care professionals to practice in underserved areas. Providers will be required to accept patients covered by all Essential Health Benefit Plans to avoid patients being denied care due to the source of the benefit coverage.
- Areas Beyond Traditional Healthcare – There are other areas that affect health not normally considered in health policy such as financial stress, gun violence, and exposure to environmental toxins. For example, some toxic exposures such as lead cause tremendous morbidity in children leading to learning disabilities and cost the system large amounts of dollars. We address these in companion policies.
STRUCTURE OF SYSTEM:
- We have serious challenges in our healthcare system. More than half of Americans suffer from one or more major diseases like heart disease, diabetes, Alzheimer’s, or cancer. Treatment of the seven most common chronic diseases, coupled with productivity losses will cost the U.S. economy well over $1 trillion dollars annually. Prescription drugs can be so expensive that some people can’t afford the medicine that could save their lives. Too often, insurance companies deny needed coverage, treatment is too expensive, or people lack any health insurance at all. Illness is a leading cause of why people go bankrupt, as wages stop when they’re too sick to work, and the cost of treatment depletes savings or are out of reach, so many people are one emergency away from bankruptcy. As a society, healthcare costs will continue to rise as 10,000 people a day turn 65 years old and our aging population requires more health services.
- The Affordable Care Act (ACA) made improvements by expanding access to affordable health coverage to millions of people. The ACA also added important consumer protections like coverage of pre-existing conditions. But far more needs to be done. In particular, we want to keep people healthy so that they enjoy their lives and so costs are reduced. My Whole Health Plan builds on the ACA while improving health and managing costs.
1. UNIVERSAL COVERAGE: Everyone participates in an Essential Health Benefit plan that provides financial coverage for a core set of services.
a. Plan participation can be through an employer benefit, or by purchasing a private non-profit plan or public option on an insurance exchange. A non-participation fee (tax) will be assessed for those who are not covered by an Essential Health Benefit plan to encourage participation.
b. Anyone can purchase a certified Essential Health Benefits plan on the federal health insurance exchange or their State's insurance exchange.
c. Both private non-profit and public options for Essential Health Benefit plans can be offered on the health insurance exchanges.
d. Essential Health Benefits in all plans will include focus on prevention, health & wellness, primary care, behavioral health and addiction treatment services.
2. EXPAND ESSENTIAL HEALTH BENEFITS - All Essential Health Benefit plans must include coverage for preventive care, health and wellness, vision, dental, and hearing, behavioral health and addiction treatment services.
- The best health care is preventing people from getting sick. The definition of “health care” will be expanded to include access to health and wellness services that have been scientifically proven to promote health and mitigate disease; namely, nutrition education and counseling, exercise, stress reduction and community supports. These services will be reimbursed in all Essential Health Benefit plans. We need to actively support health by expanding preventive care and adopting complementary medicine that’s scientifically proven to be effective, like Integrative and Lifestyle medicine. In this century, research is showing ever more clearly that most illnesses can be prevented or mitigated by eating a good diet, getting exercise, reducing stress levels and maintaining healthy relationships. We need much more robust data about diets and better research. This needs to be publicly financed research which has dried up considerably, leaving much of the medical research to be sponsored by companies which often have a vested interest in the outcome.
- Dr. Dean Ornish, professor at the University of California at San Francisco Medical School, identified the main causes underlying many diseases such as inflammation, stress and microbiome. He addresses these causes in a program he summarizes as “eat well, move more, stress less, love more.” It offers a new paradigm of health care that research leads to better health and lower costs. As an example, Robert Treuherz, MD, had a massive heart attack and was awaiting a donor heart for a heart transplant. He enrolled in the lifestyle medicine program to get in shape for surgery: he improved so dramatically that he no longer needed a heart transplant. It should be noted that while diet, exercise and stress reduction help virtually all chronic diseases, some chronic diseases are not going to be reversed by lifestyle modifications.
- Reproductive rights and access to birth control would be required as a benefit in all Essential Health Benefit plans.
3. AFFORDABILITY: We will provide subsidies and cost limits to make Essential Health Benefits plans affordable.
a. Persons with low income.
i) Low Income Persons will be eligible for a sliding-scale premium for purchasing their Essential Health Benefit plan or, if income is low enough, they will be eligible for Medicaid.
b. Minimizing Out-of-Pocket Costs
i) Out-of-Pocket Cost Limits - All certified Essential Health Benefit plans will have defined limits for out of pocket expenses. Comparable structures will be required for copays & deductibles to allow easy-to-understand cost comparison of plans. Sliding scale coverage will also be available so that anyone below income thresholds will not have any out of pocket expenses or deductibles.
ii) No Surprise Bills - All Essential Health Benefits plans must include all providers needed to deliver covered services. This will eliminate surprise bills. Currently not all of the physicians or providers who are needed for covered services have contracts with the insurance company. For example, a surgeon may have a contract, but the anesthesiologist may not, even though both are needed for surgery; this means some patients get billed for needed services like anesthesia. Essential Health Benefit Plans must contract with the full complement of providers needed to provide the covered benefits.
Focus Investment on Care – Adding lifestyle services, competition, value-based purchasing and regulation will all be used to maximize the care available to people while minimizing cost.
- Healthcare Providers Remain in the Private Sector - Physicians, hospitals and other providers do not become government employees but remain in the private sector.
- Negotiate Drug & Service Prices - All Essential Health Benefit plans, including Medicare, Medicaid and Veterans Administration options, will negotiate the prices that they pay for all drugs, medical supplies and services that they buy. We are not anti-drug; we are anti-greed. If pharmaceutical companies do not bring prices down to reasonable levels, my administration will exercise its March In rights under the Bayh Dole legislation, which allows the government to give patent rights for drugs developed with government funds to another company that will offer lower prices. Where appropriate, the government will set reasonable upper limits on benefit coverage.
- Value-Based Purchasing – All certified Essential Health Benefit plans will be allowed to adopt value-based payment approaches. Value-based payment methodologies incentivize health care providers to provide the most clinically effective care by paying for outcomes or a full-course of treatment with one payment. This eliminates incentives to pad treatment protocols with unnecessary patient visits or tests because they are paid for each separate service. Value-based payment rewards evidence-based medicine, low cost approaches and coordinated, holistic approaches to health and well-being. One of the benefits of having organizations involved with value-based purchasing is that it makes them look at some of the social determinants impacting patients and work with community partners to improve health status.
- Insurance Regulation - Health and well-being are no longer a good fit for the “rarely occurring, individually unpredictable, one-time adverse events” which insurance is designed to address. When health insurance developed in the U.S., the main threats were debilitating infections like polio or unpredictable injuries. Today, health and well-being require predictable, ongoing investment in prevention, wellness and chronic condition management throughout one’s life in order to thrive in society.
- Essential Health Benefit Plans Must Be Not-for-Profit - Private insurers who offer certified Essential Health Benefit plans on insurance exchanges will be required to operate as not-for-profit organizations in recognition of the public good that they support and reinvest returns into additional health benefits and/or lower costs. Many health insurers such as Kaiser Permanente and many BlueCross/Blue Shield plans already operate as not-for-profit, so it is a proven viable model.
- Supplemental Health Benefit Plans - Private insurers will be able to offer supplemental insurance plans with any kind of benefit allowed under current law beyond the core Essential Health Benefits on a for-profit basis.
- All Future Drug Development Will Be Conducted by NIH – This assures that the government will have patent rights to all drugs and can produce them for patients at an affordable price if the market does not.
- Administrative Simplification – All Essential Health Benefit plans will be required to use uniform data elements and structure. They will be required to use electronic health records and participate in Health Information Exchanges (HIE) using inter-operable software to facilitate electronic information flow between participating health & wellness providers reducing the paper burden on patients and providers. The use of interoperable electronic health records and communication, along with uniform data sets and structure, will provide much of the administrative simplification that a single-payer system would achieve.
Improving Care. Medical practice is a combination of science and human judgement. There are many treatment protocols that have never been subjected to rigorous scientific research. Restoration of research funds for comparative effectiveness research to determine which treatments are most effective will both improve people’s health and reduce cost by avoiding spending on less effective treatments. Providers will have to certify education and training in the outcomes of these studies each year in order to make treatment recommendations for their patients. We also need to recognize that poor diet is one of the leading causes of premature death, and increase research funding related to nutrition so that people stay healthier longer.
DIVERSITY OF CHOICE AND INNOVATION – Multiple options avoid “one-size-fits-all” limitation and foster ongoing innovation in healthcare.
- Multiple Health Plan Options – This proposed U.S. healthcare system allows for multiple Essential Health Benefit plans to be offered on insurance exchanges. Both private plans and government sponsored public options would be available for individuals to select. The diversity among private and public plans will foster diverse benefits beyond the Essential Health Benefits requirements that can be tailored to important subgroups of our diverse population, promote cost-effectiveness, and allow for new health innovations. Employers will be able to offer their own plan to employees so long as it includes the required Essential Health Benefits. This allows further diversity of plans available. We would ensure that patient costs are controlled so they are not hit with high co-pays, deductibles, or out-of-pocket expenses.
- Medicare - Medicare will offer a certified Essential Health Benefit plan on all insurance exchanges, whether federal or state. It will be available to all people regardless of age. Medicare Part A and B will include drug coverage to eliminate the confusing Part D.
- Medicaid - States may choose to offer their Medicaid plan as a certified Essential Health Benefit plan on any state exchange for state residents who fall within their eligibility criteria.
- Congressional Health Benefit Plan– The Congressional health benefit plan will be available to everyone on all health exchanges. For the first time, citizens can have the same health plan as members of Congress.
- The Veterans’ Administration – The Veterans’ Administration may offer a certified Essential Health Benefit plan on the federal exchange or on any State exchange as a convenience for people who fall within their eligibility criteria.
- Employers may choose to offer a certified Essential Health Benefits plan for their employees. Employers may also offer supplemental health benefit plans. Ceilings will be set to prevent extraordinarily high deductibles.
- Employee Equal Benefits. Employers who provide health benefits will continue to be required to offer all eligible employees the same health benefit options. This means that lower-wage workers and executives get the same health benefit options.
- Employer Health Tax for Low Income Employees Not Given Health Benefits. Employers who choose not to offer an Essential Health Benefit plan for their employees who work 30 hours or more will be assessed an employee health tax to cover the cost of subsidy for their employees who qualify for subsidies on the insurance exchange.
Innovation Encouraged - This proposed health care system allows private Essential Health Benefit plans and supplemental plans to be offered beyond the core requirements. This would allow for additional services or experimental treatments.
HEALTH SERVICE AVAILABILITY – Having health benefits coverage doesn’t help if there is no doctor or nurse available or willing to take care of you. We currently have shortages of certain types of health providers and in certain geographic areas. When these needs are not being met, society has a right and duty to correct the deficiencies.
Training the Clinicians We Need - The current system of physician training via medical residency programs has not met society’s need for preventive care, primary care or behavioral health providers, and nurses remain in chronically short supply. Further, physicians are not provided adequate training in nutrition, exercise physiology, stress reduction or social supports, all of which are needed to achieve a healthy life. Our plan will require hospitals and academic medical centers offering physician residency training programs that accept Medicare and Medicaid funds or use Veterans Administration facilities to give doctors serious training in understanding the relationship of health to food and nutrition, exercise, stress and social connection.
Additionally, they will be required to fill their training slots in those specialties deemed to be in short supply before filling other specialty training residency slots. Scholarships and student loan forgiveness programs will be expanded for nurses, nutritionists, clinical social workers and other allied health professionals deemed to be in short supply. Additionally, expanded supports from adjunct professionals like trained and certified health coaches will be promoted, which will provide patients greater support and ease the load on other health professionals.
- Doctors Trained in Government-subsidized Residency Programs Must Accept Essential Health Benefit Plan Patients - Doctors trained in residency programs that receive funding from Medicare, Medicaid, or the Veterans Administration will not be allowed to refuse to treat patients covered by Essential Health Benefit plans.
- Public Health Service and Student Loan Forgiveness Will Incentivize Practicing in Underserved Areas. The U.S. Uniformed Public Health Service which provides medical school scholarships for physicians and student loan forgiveness programs will be expanded to address the shortage of physicians, nurses, behavioral health and allied health professionals in underserved urban and rural areas. Many physicians are burdened with high student loans. Assistance with paying for medical school either through public health scholarships, or loan forgiveness in return for providing patient care in underserved areas will help them overcome this burden and address a need for more care providers in these areas. Similarly, scholarships and loan forgiveness for nurses and allied health providers will be expanded in return for service in underserved areas.
- Expand community health centers/urgent care facilities funded by the federal government. - Community health centers will provide affordable, comprehensive primary and urgent care, including coverage for dental, vision, hearing and behavioral/mental health services.
AREAS BEYOND TRADITIONAL HEALTHCARE
- Reduce toxins in our environment and our food. Many chemicals can cause illness. We must reduce toxins in our environment that can lead to illness. I will appoint a world class environmentalist to head EPA and scientists to lead USDA and FDA, not corporate cronies, but scientists dedicated to the health of the American people. Clean water and clean air are essential. There has been an erosion of environmental protection which is having a negative health impact currently. The access to potable water is an issue for many Native Americans and inner-city residents. The exposure to air pollutants is inversely tied to socioeconomic status. We will encourage regenerative agriculture and reduce the use of pesticides in food. We will enforce consumer protections by more regular and serious food inspections.
- Increase gun safety. Gun violence is an issue of public health. Repeal and prohibit laws that limit health providers ability to talk to patients about gun safety. My administration will restore research on gun safety as a health issue, which was blocked by the National Rifle Association. (See my plan for gun safety here: https://www.marianne2020.com/issues/gun-control)
8. See my plan for Disability Justice here: https://www.marianne2020.com/issues/disability-justice
9. See my plan for gun safety here: https://www.marianne2020.com/issues/gun-control
11. See https://www.nytimes.com/2019/11/13/opinion/diet-research-nutrition.html?action=click&module=Opinion&pgtype=Homepage
13. See my plans for widening the circle of prosperity here: https://www.marianne2020.com/issues/the-economy and https://www.marianne2020.com/issues/the-anti-poverty-plan