As the 2024 election cycle nears, clinicians anticipate the election’s impact on healthcare. While clinical teams—doctors, nurses, pharmacists— are largely responsible for healthcare delivery, the financial structure, policies, and regulations of the field are largely controlled by non-medical, elected officials who lack a medical background.
Despite the stakes, “physicians vote at rates nearly 20% lower than the general population, which is concerning given our unique role in influencing health policy,” says Dr. Alister Martin, emergency medicine physician and CEO of a Healthier Democracy.
Though some argue that medicine and politics should remain separate, healthcare related issues consistently appear on ballots. Therefore, clinicians expect many of their healthcare concerns to be addressed by the next wave of elected officials. “I’m most concerned that healthcare does not seem to be among the top priorities of the candidates currently,” says Dr. Scott Weiner, emergency medicine physician and health services researcher. The lack of emphasis on healthcare this election cycle is worrisome to clinicians who are witnessing the plethora of healthcare system struggles.
With these concerns in mind, here are the key healthcare issues that clinicians are urging elected officials to prioritize and address.
Key Healthcare Issues
Equitable Access to Healthcare
The fundamental priority of any healthcare system should be to ensure access to quality care. “Over 7% of Americans are uninsured and over 100 million face challenges accessing primary care,” says Dr. Regan Marsh, emergency medicine physician and health equity researcher. Marsh wants to undo the generational inequities in our healthcare system. “Black, Latino, and other communities of color face worse health outcomes across a range of conditions,” adds Marsh. While the U.S. spends the most on healthcare compared to other wealthy countries, “we have some of the worst health outcomes.”
Expanding Children’s Health Coverage
Similarly, a significant issue is the lack of universal healthcare access for children. “This is, in part, due to healthcare policies and economics,” says Dr. Rachel Fleishman, neonatologist and author. Research shows that Medicaid and the Children’s Health Insurance Program provide insurance for over half of all children in the United States. Fleishman adds that national organizations “again called to federalize Medicaid” to both ensure care is provided and services are adequately compensated. She warns that because of the large number of children with Medicaid and because of the disparities in compensation for pediatric services, as compared to the same services for adults, pediatric hospital services are closing and fewer doctors are becoming pediatricians.
Prior Authorizations
Prior authorization is a process when physicians seek approval from insurance companies for specific medications, diagnostics, and procedures. While intended to ensure responsible care, “the process has become a significant burden,” says Dr. Stephen Salzbrenner, psychiatrist who has researched this area. For instance, he often must provide evidence of past failed trials of preferred alternatives, which may not be accessible. As a result, he feels clinicians may hesitate to use newer, more costly medications or alter diagnoses to meet authorization criteria. “This inefficient system adversely affects public health by interfering with treatment” says Salzbrenner, who urges lawmakers to increase transparency in insurance formularies and restrict influence of large pharmaceutical companies.
Reforming Private Equity in Healthcare
In 2021, private equity investors spent over $200 billion on healthcare acquisitions. Many believe this shift compromises care quality and patient outcomes. Most concerning is when failed investments lead to abrupt hospital closures, leaving marginalized populations without care. For small business owners, selling their private practice to private equity may feel like the only solution to sustain operation. Critics, however, feel private equity-owned practices force clinicians to rush care and prioritize profits over patient and employee well-being. Dr. Marietta Angelotti notes that “the increased speed leads to errors in diagnosis, over-referrals to specialists, and over-treatment with antibiotics.” Reform of private equity in healthcare has faced challenge, leaving investors largely unregulated and unaccountable.
Food Access and Nutrition
Many health issues are related to the food we consume. “Access to healthy, fresh food is essential for improving health outcomes, particularly in marginalized communities that face significant barriers,” explains Dr. Fatima Cody Stanford, physician and obesity medicine advocate and researcher. Her research shows that targeted advertising for sugary beverages and processed foods towards Black and Hispanic youth leads to higher rates of obesity and related conditions. She argues that limited access to nutritious foods and the abundance of fast food options results from structural racism and worsen the problem. “To address these challenges, it is crucial to develop effective obesity policies that focus on reducing the consumption of unhealthy foods and increasing access to affordable, healthy options.
Women’s Health Rights
“Studies have shown states with abortion bans have higher maternal and infant mortality” says Dr. Karen Tang, board-certified gynecologist and women’s health advocate. Tang is concerned about states with strict abortion bans driving clinicians out of the area, “in part due to their fear of prosecution and physical safety”. These “maternity deserts,” she clarifies, decrease access for all women, even for issues not related to pregnancy such as pap smears and management of fibroids and endometriosis. Who is elected to office is of great significance as “the next president may appoint two Supreme Court justices, determining reproductive health and other law for generations,” she adds.
LGBTQIA+ Health Rights
Major health organizations, like the American Medical Association and the American Academy of Pediatrics, advocate for accessible care for LGBTQIA+ individuals. Dr. Alex S. Keuroghlian, psychiatrist and advocate for LGBTQIA+ people, believes the federal government has defended LGBTQIA+ health rights. However they clarify that some state governments have “violated their biomedical ethics principle of respect for autonomy.” Keuroghlian shares that “more than half of U.S. state governments have proposed or advanced legislation restricting health rights and freedoms of LGBTQIA+ people, particularly regarding access for transgender and gender-diverse individuals.” Political decisions about LGBTQIA+ rights should begin with evidence-based discussions that include the voices of physicians, patients, and relevant healthcare organizations.
Gun Safety Policies
Dr. Cedric Dark, an emergency medicine physician and author, emphasizes the urgent need for effective gun safety measures to combat the epidemic of gun violence. He advocates for “background checks on every firearm sale, national safe storage laws to prevent minors from accessing firearms, raising the legal purchase age to 21, allowing law enforcement to remove firearms from individuals with domestic violence restraining orders, banning high-capacity ammunition magazines, and prohibiting concealed carry without a state permit.” As both a physician and gun owner, Dark seeks political leadership that prioritizes safety and public health, ensuring these measures are evidence-based.
Emergency Department Boarding
In emergency departments across the nation, patients are designated as “boarders” — a status for admitted patients who are physically located in the ED for prolonged windows. “Boarding leads to care delays, patient safety concerns, and negatively impacts experiences for both patients and staff,” says Dr. Marcus Baymon, emergency medicine physician and medical director. Studies show patients who board longer in the ED often face more discrimination, particularly among historically marginalized groups, and report increased dissatisfaction with their care. Baymon wants elected officials to, “focus on educating patients about capacity challenges, invest in the healthcare workforce, fund alternatives to hospital admissions, expand virtual care options, and incentivize hospitals to improve patient flow.”
Climate Change and Healthcare
“U.S. healthcare is responsible for 8.5% of our total greenhouse gas emissions,” says Dr. Sheetal Khedkar Rao, physician and expert in climate and health. She shared that healthcare pollution occurs through single-use plastics or excessive surgical waste, for example. There is movement to reduce impact through voluntary initiatives with the Joint Commission and Centers for Medicaid and Medicare Services. However, “many in the healthcare sector have called for rapid, concrete action that involves mandatory industry-wide greenhouse gas reporting standards.” Roa adds.
Another way climate change affects health is through, “extreme weather events like heat, flooding and hurricanes.” Rao states. Natural disasters have exposed how climate change can impact supply changes in our sector.
“It’s important for both candidates to consider directing preparedness resources in a more intentional way to avoid critical shortages during disasters; IV fluids being the latest example after the hurricanes.” says Bryan Hayes PharmD Clinical Pharmacist at Massachusetts General Hospital. He adds that shortages of critical medicine, such as IV fluids, is still a large and persistent problem, exacerbated when production factories and distribution centers are closed unexpectedly. “Some work has been done at the national level to encourage earlier reporting when companies are anticipating a shortage,” he adds. However there is still work to be done on both prevention and management of shortages.
Burnout and Attrition
As in any scenario where employees feel unheard, unsupported, and unable to provide quality work — burnout and attrition rates increase. “In the last 5 years, I have seen so many amazing physicians—often the most compassionate and dedicated—quit clinical practice,” says Dr. Michelle P. Lin, physician and researcher. Though COVID caused a degree of attrition, she also feels the pandemic “unmasked systemic causes of burnout and dissatisfaction that still haven’t been addressed.” Her list of stressors that need resolution speak to the growing administrative demands, declining reimbursement, workforce shortages, and various causes of gender inequity.
Martin notes, “communities with high rates of civic engagement are healthier.” Given this link, it’s concerning that only 162 million Americans are registered to vote. Now is the time for physicians, patients, hospital administrators, private-equity investors, and elected officials — to vote and unite and create evidence-based solutions that benefit patients, the workforce, and the field.
