We already know universal healthcare works

My bottom line

Every American deserves quality, affordable healthcare, and where you live or what you earn shouldn't decide whether you get it. We already spend more on healthcare than any country on earth, roughly twice what comparable nations spend, and we still rank dead last among them on results, with four in ten adults carrying medical debt to show for it. That is not a money problem. It is a broken-system problem. People act like universal coverage is some impossible idea. It isn't. We already run a version of it, and plenty of the best ideas for finishing the job are already written into American law. They were either never carried all the way out or quietly strangled. My plan is not to blow up what works and start over. It's to build on the parts that already work, fix the parts that were broken on purpose, and be straight with you about what it costs.

This is not a government takeover of your care. It still runs through private doctors and community hospitals. We bring costs down the way you'd actually want it done: with real competition, by breaking up the monopoly middlemen, and by cutting the hundreds of billions we waste on paperwork. That isn't a slogan. It's the whole design.

What I mean when I say TRICARE

When I say we already have a version of universal healthcare, I mean TRICARE, the health program for our military families. And if you've worn the uniform, this part matters: I do not mean the base clinic, and I do not mean the VA. I mean the side of TRICARE where the public pays the bill and the care comes from private doctors and community hospitals, in your own town, not a government clinic.

That's not a small corner of the program. More than two-thirds of TRICARE's care isn't delivered at a military facility at all. The Defense Department buys it from civilian doctors and hospitals in your community, with public dollars covering the bill. In some regions a nonprofit like Johns Hopkins runs the whole thing through its own network of local providers. That's the model worth building on: public financing delivered through private, community-based care. It is not perfect, and the government-run side has real, documented strain that I won't paper over. But the part I'm talking about proves the core idea works, and it has for decades.

Finish what the ACA started

The Affordable Care Act got a lot right, and Washington keeps strangling the best of it. The fastest way to help millions of people is to finish the job.

The honest truth about paying for it

My fiscally conservative neighbors always ask the fair question: how are you going to pay for it? Here's the honest answer, and it starts with a number nobody in Washington wants to say out loud. About one of every four dollars we spend on healthcare in this country, somewhere between 760 and 935 billion dollars a year, is waste. The single biggest chunk isn't anyone's paycheck or profit. It's administrative red tape: needless, conflicting paperwork that runs to roughly 265 billion dollars a year on its own. So this isn't about punishing anyone for making a living. It's about the waste.

The status quo is not free either. We already spend tens of billions in public money treating uninsured people in the emergency room, at the most expensive possible moment, instead of keeping them well. So a real plan gets measured against that bill, not against zero. Independent analysts have found that a well-built universal system can lower what the country spends overall. But I won't sell you a fairy tale: it also moves more of the cost onto the federal budget, and that has to be funded with honest revenue. That's exactly why the first thing I'll do is the homework Washington keeps dodging: commission real, independent studies on how a plan like this scales, and what it does to hospitals, insurers, and drug companies, so we build something that can pass and survive, not just poll well. Cutting Pentagon waste and ending unnecessary wars is part of the answer, not the whole answer, and I'm not going to pretend otherwise.

Break up the middlemen driving up your costs

Americans pay nearly three times what other wealthy countries pay for the same medicines, and more than four times for brand-name drugs. More than four in ten of us have skipped a prescription or cut pills in half to save money. That isn't a free market working; it's a rigged one, and if you want to know why, look at the middlemen. They're called pharmacy benefit managers, and just three of them handle about eight in ten prescriptions in America. Here's the catch: each one is owned by a giant that also owns an insurance company and a chain of pharmacies. So the same parent sets the price, owns the pharmacy that fills it, and owns the insurer that decides whether to pay. Federal investigators found exactly what you'd expect from that setup: inflated drug costs, patients steered to the company's own pharmacies, and independent hometown druggists squeezed out.

None of this is about punishing profit. It's about self-dealing and red tape, not capitalism. The fix is more competition, not less: break up the conflict of interest so the company that sets the price can't also own the pharmacy and the insurer. There's already a bipartisan bill to do it, and the same giants are increasingly buying up the doctors' offices too, which deserves its own hard look. Bust the monopoly in the middle, and prices come down without the government running your pharmacy.

Long-term care: the bill Medicare won't touch

Most families don't learn this until they're already in a crisis: Medicare does not pay for long-term care, not the nursing home, not the home aide, not the daily help an aging parent or a disabled family member needs. And the costs are staggering. A private nursing-home room now runs about $128,000 a year, and a home health aide close to $78,000, more than a typical retiree makes in a year. You can't really plan around it, either: barely 3 in 100 older adults carry long-term-care insurance, because that market all but collapsed, and even 1 in 10 of the wealthiest retirees can expect to pay more than $250,000 out of pocket. So people who did everything right, who saved and planned and stayed solvent, still get wiped out, spending down a lifetime of work until they finally qualify for Medicaid. About half the people in nursing homes on Medicaid were not poor when they arrived. This is not a poverty problem. It's a middle-class cliff.

About seven in ten of us who reach 65 will need long-term care, and most would rather get it at home than in an institution. But the help to stay home is rationed: hundreds of thousands of people sit on Medicaid waiting lists, many for more than a year. Today, 38 million unpaid family caregivers already provide about $600 billion in care a year, more than the country spends out of pocket on healthcare, and too often they burn out doing it alone. I'll fight to fund care at home so people can age in their own communities, cut those waiting lists, and finally give family caregivers real support. This is a piece almost nobody in this race is talking about, and it's coming for nearly every Montana family.

Coverage means nothing if there's no doctor

You can hand someone the best insurance card in the world, and it's worthless if the nearest doctor is a hundred miles away. Part of why rural Montana keeps losing providers is that we bury young doctors in debt. They finish training owing a median of about $205,000, so they're pushed toward the highest-paying specialties in the biggest cities, not primary care in a small town. The country is on track to be short as many as 86,000 doctors by 2036, and rural Montana feels that first.

So we grow our own. Wipe out medical-school debt for doctors, nurses, and dentists who commit to serving rural and underserved Montana, and expand the national programs that already do this. And train more of them: the cap on federally funded residency slots has been frozen since the 1990s, choking the pipeline while the country ages. Lift it, and build residencies and partnerships with our own universities and tribal colleges so the people who train here are the people who stay here.

What a U.S. Senator can actually do

No senator flips a switch and remakes American healthcare overnight, and anyone who promises that is selling something. What a senator can do is take the winnable fights now and build toward the bigger goal honestly: restore the tax credits that just expired, break up the drug middlemen, fund care at home, and train more doctors, while doing the real work to stand up universal coverage the right way. Plans like this die the moment the insurance and drug lobbies go to work, so we account for them, do the math, and build something that lasts. That's how you actually change people's lives, instead of just giving a good speech about it.

Universal healthcare isn't a fantasy. We already know it works. The job now is to finish what we started, pay for it honestly, and stop letting the middlemen and the paperwork rob us blind.

Sources

1. TRICARE covers roughly 9.6 million beneficiaries; the majority receive care through civilian provider networks rather than military treatment facilities (about 28% have a primary care manager at a military facility). Congressional Research Service; Military Officers Association of America, citing Defense Department enrollment data.
2. The Uniformed Services Family Health Plan delivers the full TRICARE Prime benefit through nonprofit "designated providers," including Johns Hopkins, using civilian networks. TRICARE (tricare.mil); Johns Hopkins Medicine.
3. Enhanced ACA premium tax credits expired January 1, 2026; average marketplace premium payments are estimated to rise about 114% (roughly $1,000 more per year for a typical subsidized enrollee), with effectuated enrollment projected to fall from about 22.3 million to roughly 17.5 million. KFF; Center on Budget and Policy Priorities.
4. Medicaid has been expanded in 40 states and the District of Columbia; the remaining coverage gap is concentrated in a small number of non-expansion states. AJMC; healthinsurance.org.
5. The Supreme Court upheld the ACA's no-cost preventive services requirement in Kennedy v. Braidwood Management (6-3, June 2025), while giving the Secretary of Health and Human Services greater control over it. KFF.
6. An estimated 25% of U.S. health spending, about $760 billion to $935 billion a year, is waste; administrative complexity is the largest category, roughly $265 billion. Shrank et al., JAMA (2019).
7. The Congressional Budget Office estimated that a single-payer system could change national health spending in 2030 by anywhere from a decrease of about $0.7 trillion to an increase of about $0.3 trillion, while federal subsidies for health care would rise by roughly $1.5 to $3.0 trillion, depending on design. Congressional Budget Office; Health Affairs.
8. The value of uncompensated care for the uninsured is estimated at roughly $35 billion a year, most of it borne by government, much of it delivered as emergency care. KFF; National Academies.
9. The three largest pharmacy benefit managers (OptumRx, owned by UnitedHealth Group; CVS Caremark, owned by CVS Health, which also owns Aetna; and Express Scripts, owned by Cigna) handle about 80% of U.S. prescriptions; the six largest handle about 95%. A 2024 Federal Trade Commission staff report found they inflate drug costs, steer patients to affiliated pharmacies, and squeeze independent pharmacies. Federal Trade Commission (2024).
10. The bipartisan Patients Before Monopolies Act would require structural separation of pharmacy benefit managers from pharmacy ownership. The FTC sued the three largest PBMs over insulin pricing in 2024 and reached a settlement with Express Scripts in February 2026.
11. Medicare does not cover most long-term custodial care; Medicaid is the primary payer, covering roughly two-thirds of home-care spending. More than 700,000 people are on Medicaid home- and community-based services waiting lists, with median waits exceeding a year in many states. KFF.
12. Median annual long-term-care costs in 2024: about $127,750 for a private nursing-home room and $77,792 for a home health aide, against a median household income of roughly $60,000 for those 65 and older. Genworth/CareScout Cost of Care Survey (2024).
13. Only about 3 to 4% of adults over 50 hold long-term-care insurance, and private coverage pays under 9% of long-term-care costs; roughly 1 in 10 of the highest-income retirees can expect out-of-pocket long-term-care costs above $250,000, and about half of Medicaid nursing-home residents were not poor before they spent down. HHS ASPE; AARP Public Policy Institute.
14. The cap on Medicare-funded physician residency slots has been largely frozen since 1997, a factor in the physician shortage; the National Health Service Corps provides loan repayment for clinicians who serve in underserved areas.
15. The United States spends more on health care per person than any other country, roughly twice the average of comparable nations, yet ranks last among wealthy countries on health-system performance and has a lower life expectancy. Commonwealth Fund, Mirror Mirror (2024); Peterson-KFF Health System Tracker (2024).
16. About 41% of U.S. adults carry medical or dental debt, and about 43% report not taking a medication as prescribed in the past year because of cost. KFF.
17. U.S. prescription drug prices average 2.78 times those in 33 comparison countries, and 4.22 times for brand-name drugs. RAND (2024).
18. The Defense Department purchases more than 65% of TRICARE care from the private sector; the FY2025 Defense Health Program budget includes $20.6 billion for private-sector care versus $10.8 billion for military-facility care. DoD Annual Evaluation of the TRICARE Program; Congressional Research Service.
19. About 70% of adults who reach age 65 will develop severe long-term-care needs, and roughly 48% will receive some paid care. HHS Office of the Assistant Secretary for Planning and Evaluation (ASPE).
20. An estimated 38 million unpaid family caregivers provide care valued at about $600 billion a year, more than total U.S. out-of-pocket health spending. AARP, Valuing the Invaluable (2023).
21. The median education debt for 2024 medical-school graduates was about $205,000; the AAMC projects a shortage of up to 86,000 physicians by 2036, worse without expanded graduate medical education. Association of American Medical Colleges.
22. About 12% of Montanans are uninsured, and Montana hospitals absorbed roughly $370 million in uncompensated care in 2024, a growing strain on low-margin rural hospitals. Montana Healthcare Foundation; Daily Montanan (2026).