Healthcare costs keep rising, yet access to care remains uneven—even here in Coronado and across San Diego County. Many residents experience long waits for primary care, difficulty securing specialist appointments, or insurance networks that limit access to major systems like Scripps, Sharp, or UC San Diego Health. These are not isolated frustrations—they reflect structural inefficiencies built into how care is financed and delivered.
A major driver is the growing role of intermediaries, from private insurance layers like Medicare Advantage too tightly controlled systems that restrict where patients can go. These arrangements add administrative cost, reduce transparency, and often place barriers between patients and their physicians. If we want a system that is more affordable and accessible, we need to simplify it—starting with reducing the role of these middle layers.
California has already taken meaningful steps through Medi-Cal expansion and public coverage programs, but more can be done. Strengthening these efforts while introducing a state-administered public option would help close remaining coverage gaps and stabilize premiums. At the same time, adopting all-payer rate setting could address one of the largest drivers of healthcare spending: wide and often unjustified price variation between hospitals and systems.
Reform does not require eliminating choice. A hybrid model can preserve private insurance and concierge care for those who prefer it, while establishing a strong public foundation that guarantees access and affordability for all. Proven systems such as the Veterans Health Administration and TRICARE show that publicly financed, directly administered care can deliver high-quality outcomes with lower administrative overhead.
Equally important is the healthcare workforce. High educational debt continues to push physicians, nurses, and other providers away from primary care and underserved areas—even in high-demand regions like San Diego County. Loan forgiveness, tuition support, expanded residency positions, and income-based repayment programs should be treated as essential infrastructure. Without addressing workforce constraints, expanded coverage will not translate into timely access to care.
California has a real opportunity to lead. By strengthening public programs, reducing reliance on costly intermediaries, and investing in the next generation of providers, the state can build a system that delivers better care at lower cost. The goal is not to eliminate innovation or choice, but to restore balance in a system that has grown unnecessarily complex and expensive. Fixing healthcare starts with a simple principle: put patients and providers first, not the layers in between.
VOL. 116, NO. 24 – June 17, 2026