Health Care Reform: A Practical Path to Affordable Coverage

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Health care should be a top priority for the incoming 120th Congress, which has recently announced priorities. Sweeping health care reform likely won’t happen, mainly because any legislation is likely to be vetoed. Much could be accomplished administratively, if executive departments are open to incremental changes.

Health care affects everyone, but not everyone experiences the system in the same way. Some Americans receive insurance through their employers. Others buy individual policies, are self-employed, rely on Medicare or Medicaid, receive veterans’ or military health benefits, or have no insurance.

Person in a wheelchair in a carpeted hallway of a care facility

Citizens may never have enrolled in Medicare or Medicaid, but they still have a stake in how those programs work. They pay taxes, support family members who rely on public programs, and experience the same rising health care costs that affect everyone else.

According to the U.S. Census Bureau’s 2025 report, employer-sponsored insurance remains the largest source of coverage, reaching 53.5 percent of the population. Medicare covers 20.1 percent, Medicaid 17.1 percent, and individually purchased insurance 10.5 percent. Veterans and military health programs cover additional populations. Approximately 26.7 million Americans went the entire year without health insurance.

These categories overlap, but they show the many ways Americans obtain health care coverage.

We also need to clear up a misconception about Medicare for All. Publicly financed health care isn’t necessarily socialized medicine. The government doesn’t own most hospitals or employ most doctors who treat Medicare patients. Medicare pays independent physicians, private hospitals, clinics, laboratories, and other health care providers for the services they deliver. Medicaid also relies heavily on private and community-based providers, alongside public facilities.

In other words, government financing and private health care delivery already coexist. Expanding coverage doesn’t automatically mean eliminating private hospitals, independent doctors, or the health care businesses that serve patients.

There is a distinction between preserving private health care delivery and preserving the existing insurance business model. Some Medicare for All proposals would replace much of the private insurance market for covered services. Insurance companies could lose some of their current business, although other models could retain them in administrative, supplemental, or other roles. Hospitals and physicians would continue delivering care, but payment arrangements and reimbursement rates could change.

The overall goal should be affordable, accessible health care, not winning an ideological argument about whether to finance it through socialism vs. capitalism. Rather than making the debate about government versus the private sector, Democrats can start with common-sense objectives that people across the political spectrum can recognize:

  • Lower prescription drug prices and out-of-pocket medication costs. The current administration is already doing this.
  • Reduce insurance premiums, deductibles, and unexpected medical bills. Many states, like Colorado, have approved “No Surprises” legislation. Premiums and deductibles are the sticking points.
  • Protect rural hospitals and expand community health centers. The “Big Beautiful Bill” provided for some assistance.
  • Improve access to primary care, mental health services, and addiction treatment.
  • Make health insurance more portable so people don’t risk losing coverage when they change jobs. Employers may still provide one plan for their workers, but the aggregate premium may be lower if employees assume part of the premium payment. Under Medicare, recipients pay around $200 per month.
  • Simplify the paperwork and administrative costs that burden patients, providers, and employers. I’ve seen my health insurance provider do this to better manage care and gather patient feedback to improve service delivery.
  • Thanks to Obamacare, people with preexisting conditions are still covered under most plans, as are dependents under 26. Medicare offers Medigap insurance to cover gaps. Medicare for All would likely include supplemental coverage policies.

I believe in an incremental approach. We don’t have to settle every argument about Medicare for All, single-payer insurance, or the role of private companies before we begin improving the system. We can build on existing programs, identify what works, address what doesn’t, and expand access as we go.

Unless you study Medicare and Medicaid—or rely on one yourself—you may not realize Medicare already offers a model that combines public financing with private insurance.

The Clinton administration and Congress established Medicare Part C through the bipartisan Balanced Budget Act of 1997. Originally called Medicare+Choice, it allowed beneficiaries to receive their Medicare benefits through private insurance plans rather than traditional fee-for-service Medicare. The program began in 1999 and was renamed Medicare Advantage in 2003.

Under Part C, Medicare pays approved private insurance companies a fixed monthly amount for each enrollee. The insurers assume financial risk for providing covered care. Most plans offer additional benefits, such as dental and vision coverage, along with copayments and annual out-of-pocket limits.

This isn’t socialized medicine. The government finances and regulates coverage, but private insurance companies administer the plans, while hospitals, physicians, and other health care providers deliver care.

Why not consider using this existing public-private model as a starting point for expanding affordable health coverage? Advantage plans also offer “dual coverage” for those on Medicaid and Medicare. Advantage plans offer Medicare for All. A universal system could borrow features of Medicare Advantage, extending access to regulated private plans and comprehensive benefits beyond today’s Medicare population.

We don’t have to settle the entire Medicare for All debate before making meaningful progress. We can start with what already works, address what doesn’t, and build toward affordable, accessible health care for everyone.

People with employer-sponsored insurance shouldn’t feel that universal health care means their doctors, hospitals, or insurance choices will automatically disappear. Medicare beneficiaries shouldn’t have to defend a system that works well enough for them. Veterans shouldn’t worry about losing specialized care. Small-business owners shouldn’t have to choose between providing health benefits and keeping their businesses afloat. People without insurance shouldn’t have to wait until a medical emergency to receive care.

Finding common threads starts by recognizing that Americans don’t have to agree on the ultimate design of the health care system to agree that getting sick shouldn’t threaten their financial security.

Democrats’ Path to a Lasting Majority: Common Threads

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My mother’s Stitch and Bitch club might have a few lessons for the next Congress.

My mother belonged to a handwork club called the “Stitch and Bitch.” The name pretty much said it all. Women gathered around their handiwork, shared stories, exchanged opinions and, I imagine, solved a few of the world’s problems along the way.

I’ve been thinking about that club while watching the political aftermath of the 2026 midterm elections. My mom’s sewing circle picked a theme, and each member gave their interpretation. They disagreed, but accepted each other’s version as long as it fit the underlying theme.

It occurred to me that Democrats could learn a lesson from a group of women sitting around a table with needles, thread, and different ideas about what they wanted to make.

If Democrats want to turn the 2026 blue wave into a lasting governing majority, they need a bigger hoop going into the first 100 days of 2027.

To be honest, the new majority won’t be able to do much if President Trump keeps his word and vetoes any legislation that comes to his desk.

Regardless, the November 2026 general election delivered Democrats an opportunity. It didn’t deliver a mandate for a uniformly progressive agenda. The blue wave swept through some traditionally conservative states and districts, bringing along voters who don’t necessarily share the Democratic Party’s most progressive positions.

That’s an important distinction.

Democrats have spent considerable time arguing among themselves about their own members’ political leanings. Pennsylvania Senator John Fetterman, former West Virginia Senator Joe Manchin, and former Arizona Senator Kyrsten Sinema all drew criticism from Democrats when they broke with the party on particular issues.

Their critics treated those disagreements as evidence of political disloyalty. Elected representatives have a responsibility to represent the people who sent them to Washington.

In 2009, incumbent Representative Marilyn Musgrave of Congressional District 4 focused on culture wars and aligned herself with an unpopular president.

Sound familiar? CD 4 is now the home of Lauren Boebert.

A newcomer, Betsy Markey, soundly defeated Musgrave. The Democrats coerced her into voting for Obamacare. Two years later, she lost by 12 points to Republican Corey Gardner. Markey’s loss created a domino effect. In 2014, Gardner upset incumbent Democrat Mark Udall and became an integral member of the so-called “Make America Great Again” coalition.

The moral of the story? A Democrat representing a conservative constituency faces different political realities than a Democrat representing Boulder, Manhattan, or San Francisco.

The incoming Congress will include more Democrats representing places where progressive politics don’t resonate, like South Carolina, Mississippi, and Texas. If party leaders expect those members to vote as though they represent the same constituency, they risk turning an electoral victory into a political liability.

Look what happened in 2026.

Democrats don’t have to abandon their principles or move wholesale to the right. A successful political coalition needs room for different opinions.

The common thread: Getting through life with fewer financial burdens

If Democrats want to govern, they should begin with issues that matter to people regardless of their political affiliation.

They don’t have to agree on every policy detail. They need to identify problems that Americans share and find practical ways to address them.

Over the next few days, I’ll share some ideas on how the new Congressional majority can improve everyday life.

What could Democrats accomplish if they spent less time arguing over ideological purity and more time addressing shared concerns?

Here’s a teaser about six places to start:

  • Bring down prices. Help families manage the cost of groceries, utilities, housing, childcare, and other expenses that eat into their paychecks.
  • Provide less expensive healthcare. Lower prescription drug and insurance costs while protecting access to doctors, hospitals, mental health services, and addiction treatment.
  • Build more entry-level houses. Give younger families a realistic shot at homeownership and make rental housing more affordable for people at every stage of life.
  • Invest in jobs and practical education. Expand trade schools, apprenticeships, community colleges, and workforce training while continuing to support universities and research.
  • Make communities safer. Support effective local law enforcement, police accountability, responsible gun ownership, and practical efforts to reduce violence.
  1. Invest in jobs and practical education. Expand trade schools, apprenticeships, community colleges, and workforce training while continuing to support universities and research.Fix immigration. Secure the border, enforce immigration laws, maintain a workable legal immigration system, and create a fair process for people who have built their lives here.- Keep energy affordable and reliable in the age of AI. Modernize the electric grid, develop dependable energy sources, and address the enormous power and water demands of data centers.

None of these issues belong exclusively to one political party. Democrats don’t have to agree on every solution, but they should be able to find enough common thread to get something done. That’s what creating multiple designs in a bigger embroidery hoop is all about.

Helium Shortage: Wyoming, Semiconductors and Underdog

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I caught a TV soft news segment about the giant balloons being prepared for the Macy’s Thanksgiving Day Parade. The story featured Underdog, the blue-caped canine superhero whose balloon first appeared in the parade in 1965.

Black-and-white cartoon of a dog rushing out of Macy’s while a caped superhero dog flies past the entrance.

I have to admit, seeing Underdog brought back memories. The superhero, voiced by the late Wally Cox, didn’t need artificial intelligence, a streaming subscription, or a complicated origin story.

“There’s no need to fear. Underdog is here!”

He had a cape, a telephone booth, matched wits with the evil doer Simon Bar Sinister, and a good supply of helium.

Helium?

The same lighter-than-air gas that makes Underdog fly has a behind-the-scenes job regulating silicon wafer temperatures as they’re etched and processed. Think of it as the air conditioning system for the world’s most expensive microscopic assembly line.

That got me thinking. Why are we running short of helium?

In October, the U.S. Department of Energy added helium to its Critical Material List, recognizing its importance to semiconductor manufacturing, medical applications, and other essential technologies.

Helium has officially graduated from filling party and parade balloons to a national security concern.

If helium is such a high-demand commodity, why not recycle it?

One reason helium is wasted is that semiconductor manufacturers don’t routinely recover all the gas they use. During some manufacturing processes, helium flows behind silicon wafers to help regulate their temperature. Afterward, some of the gas enters the chamber exhaust, where it mixes with other process gases, including corrosive chemicals.

Recovering and purifying that mixture can be technically difficult and expensive. Engineers have developed ways to capture helium before it gets mixed with the exhaust, but recovery isn’t yet standard across the industry.

Recycling a valuable resource can interfere with profit margins.

The Thanksgiving Day balloons spewing helium into the post-parade air don’t help the cause either.

When the chips are down

According to the U.S. Geological Survey, in 2024, only 18 percent of American helium consumption went toward lifting gas, including balloons and airships.

Black-and-white cartoon of Acme Semiconductors executives watching a helium-powered superhero balloon float over a Macy’s Thanksgiving Day Parade, captioned “There goes our helium supply.”

The rest went toward running equipment and machines. About 15 percent of that total went to controlled atmospheres, fiber optics, and semiconductor manufacturing. Another 17 percent went to MRI machines, and 22 percent went to analytical, engineering, laboratory, scientific, and specialty gases.

Welding, aerospace, leak detection, and deep-sea diving account for much of the remaining consumption.

That’s a lot of important work for a gas most of us associate with floating birthday balloons.

Much of the world’s helium comes from a relatively small number of sources. Qatar produced nearly 40 percent of the world’s helium in 2024. Disruptions to its natural gas infrastructure during the 2026 Middle East conflict have put additional pressure on global supplies and technology supply chains.

Why does Qatar matter when we have helium here at home?

Wyoming is a helium heavyweight. The natural gas fields around LaBarge and Big Piney in southwest Wyoming account for an estimated 20 to 25 percent of the world’s helium supply.

The LaBarge facility alone has an estimated 80 years of production remaining at current rates. A new project near LaBarge, approved by the Bureau of Land Management in December 2025, could add more than 800 million cubic feet of helium production annually when it begins operating, currently expected in 2028.

That’s nothing to sneeze at.

It’s time we paid a little more attention to what the Cowboy State has underground.

Underdog might want to keep his cape handy. Wyoming could help keep him airborne for the next eight decades.

Does Underdog get priority?

Here’s a question for the folks managing our national resources.

When helium supplies get tight, who gets priority?

MRI machines? Scientific laboratories? Semiconductor factories making chips for artificial intelligence? The people responsible for keeping Underdog airborne?

Underdog has some serious competition.

I’m not suggesting we ground my favorite dog who had cosmic vision and spoke in rhyme like a 1960s hip-hop dog. Heaven knows we could use a superhero right about now.

The parade has its own history with wartime shortages. Macy’s suspended the parade during World War II, from 1942 through 1944. Materials that would have gone into the celebration, including rubber for the balloons, went to the war effort.

Underdog could do his patriotic duty and volunteer to walk the parade route instead, although that might disappoint the children and the adults who still remember him from Saturday morning cartoons.

The Creating Helpful Incentives to Produce Semiconductors (CHIPS) Science Act

At first, this story started out as a jokey connection between two seemingly unrelated uses for helium.

After I got to digging, there’s a serious economic policy question here.

In September 2023, the Biden administration announced a funding opportunity for smaller semiconductor supply-chain businesses. The program included manufacturers of chemicals, gases, equipment, and other materials American chip manufacturers need.

The Commerce Department has since reopened and amended that funding opportunity. Its current program accepts proposals for facilities producing semiconductor materials, including gases, with concept plans accepted through 2027.

There’s a principle here.

If taxpayers subsidize the construction of semiconductor factories to protect American economic and national security, shouldn’t those same taxpayers expect the companies to help strengthen the domestic supply of helium?

We don’t have to prohibit imports. We don’t have to pick a fight with Qatar, an important American security partner in the Middle East.

We can reward companies that invest in American suppliers, including those in Wyoming.

Here are my three ideas:

  • Domestic purchasing preference: Companies receiving federal semiconductor subsidies should demonstrate that they prioritize American helium when it meets quality, availability, and competitive-price requirements.
  • Long-term purchase agreements: Offer tax credits or other incentives to chip manufacturers that sign multiyear contracts with domestic helium producers. This gives producers the confidence to invest in additional extraction and purification capacity.
  • Helium recovery requirements: Require federally subsidized semiconductor facilities to evaluate and install helium recovery systems when technically and economically practical.

A helium-filled Underdog parade balloon isnisn’tsponsible for computer chip shortages. The quantities and uses are different.

The connection between the two raises an interesting question about our priorities.

We spend billions encouraging sophisticated technologies that depend on a gas that, when inhaled, makes a grown man’s voice sound like a Munchkin.

This Thanksgiving, when Underdog makes his return to the parade after a 42-year absence, I’ll be cheering for him to stay afloat.

Let’s hope nobody gets the bright idea to substitute hydrogen. An exploding Underdog would be a terrible way to celebrate the parade’s centennial.

Get that dog a fire extinguisher!