Jim is a medical doctor and he views the U.S. health care system from the perspective of the physician and his patient, rather than from that of the health industry. Before being elected to Congress, Jim treated a wide array of patients as a practicing psychiatrist, including Vietnam veterans, inmates of the King County jail, and State Department officials serving in sub-Saharan Africa, among others. In the course of this work, he experienced firsthand the limitations of the U.S. health care system, and this, in part, motivated him to become a member of Congress, where he could work to improve the system.
During his service in the Washington State Legislature, Jim crafted the Washington Basic Health Plan – the first state program in the country to provide low-cost health insurance for low- and moderate-income people who were not insured but ineligible for Medicaid. As a member of the U.S. Congress, Jim has long-focused on providing Americans with universal access to affordable, high-quality health care, which he believes is a right in a just, democratic society. Jim continues to push for a simpler health care system that provides better care and outcomes at a reasonable cost. In 2013, the Democrats on the House Ways and Means Committee chose Jim to be the ranking member of the Subcommittee on Health, which has jurisdiction over the Medicare program.
Universal Health Care
Jim strongly supported the Affordable Care Act, the pioneering health care reform bill that President Obama signed into law in 2010; in 2014 this program will bring health insurance to 30 million uninsured Americans. While the Affordable Care Act is a momentous achievement, Jim recognizes that still more needs to be done to control costs, improve care, and cover everyone. Jim believes that a single publicly financed universal health care system, rather than one based in the private insurance industry, is the only approach the will ultimately enable the U.S. to deliver high quality health care to all Americans in an affordable manner.
Publicly financed and managed health care systems in many other industrialized nations achieve better health outcomes at lower cost than ours here in the United States. Based on these models, Jim has introduced the "American Health Security Act," which establishes a nationwide framework under which each state would provide publicly financed universal health coverage. Until universal health care is established at a federal level, Jim also supports allowing states that seek to establish a single-payer system on their own – like Vermont – to receive a more expansive waiver than is allowed under the 2010 health care law.
Rebalancing the Health Care Workforce
The U.S. health care system desperately needs more primary care doctors, as well as more advanced nurse practitioners, physician assistants, nurses, and other non-M.D. health professionals. These primary care providers are in the best position to evaluate and manage patients holistically. Unfortunately, our health care system pays doctors for each procedure they perform, rather than for keeping patients healthy. As a result, specialty practices are far more lucrative than primary care and disproportionately attract the best talent from our medical schools. This largely explains why there is an abundance of expensive, and often counterproductive, procedures carried out and not enough basic prevention and care coordination. While we certainly will always need excellent specialists, rebalancing our physician workforce will lower costs and improve patient outcomes. Most other developed nations have about 50 percent primary-care doctors, compared with about 30 percent here in the United States.
One way to encourage new medical students to become primary-care doctors is to equalize the financial disparity between specialists and primary-care doctors. To help accomplish this, Jim has introduced the “Medicare Physician Payment Transparency and Assessment Act,” which seeks to end the disproportionate influence that specialty doctors exert on setting Medicare (and, by extension, most other) reimbursement rates. Allowing a neutral intermediary to play a role in setting reimbursement rates will help even the playing field between primary care and specialty practices. Jim has also developed a program called "RDOCS," under which new medical students at state institutions would receive federally-funded medical education in exchange for a commitment to serve for five years in the U.S. Public Health Service as a primary care doctor after graduation.
Fighting the HIV/AIDS epidemic has been one of Jim’s priorities since he arrived in Congress in 1989. Jim’s experience as a Regional Medical Officer in Zaire (now the Democratic Republic of Congo) brought him into contact with the AIDS epidemic in its infancy, and this experience fueled his desire to fight HIV/AIDS as a lawmaker. One of Jim’s first legislative accomplishments in Congress was authoring the Housing Opportunities for Persons with AIDS (HOPWA) program in 1990, which was included in the Cranston-Gonzalez National Affordable Housing Act that President George H.W. Bush signed into law. Under HOPWA, the Department of Housing and Urban Development distributes grant funds to states and localities nationwide to provide housing assistance for financially vulnerable people living with HIV/AIDS.
Jim also launched the Congressional HIV/AIDS Task Force in 1992 and has since served as its co-chair. Jim remains committed to enlarging the United States’ position as the global leader in destigmatizing, containing, and ultimately finding a vaccine and cure for this disease both at home and abroad. Jim recently re-launched the Task Force as the Congressional HIV/AIDS Caucus with Congresswoman Barbara Lee (D-CA) and Congressman Trent Franks (R-AZ), marking the first time that the group has had bipartisan support.