The Problem Isn’t Which Card You Carry
Congress let the ACA subsidies expire on January 1. Millions of people already lost affordable coverage — not because they got healthier or richer, but because a budget line item ran out. That’s the whole problem in one sentence: your healthcare depends on which program survives the next vote.
If you’re working, your coverage depends on your boss. If you’re retired, Medicare premiums eat your COLA. If you’re uninsured, one ER visit can bankrupt you. If you’re a veteran in a rural county, good luck getting to the VA.
Medicare is just the ACA in different clothing. Both are insurance schemes — they broker access to care instead of delivering it. The VA is different. Salaried doctors. No billing department trying to deny your claim. The mission is care, not profit. It’s the one system that works the way healthcare should work.
I’m on Medicare. I thought it would be better than the ACA. In many ways, it’s the same or worse. I run every prescription through three different options to find the best price. The expensive ones go to the VA — I’m lucky I have that option. Even so, my medication costs top $1,000 a year.
FL-3 Isn’t Short on Capacity
UF Health Shands. The Malcom Randall VA Medical Center — one of the five busiest in the country. HCA’s new $231 million hospital. Palms Medical Group’s 12 rural clinics serving everyone on a sliding scale.
The capacity is here. The connection isn’t. What happens if you need an ER at 2 a.m. in Horseshoe Beach? The nearest emergency room is Doctors’ Memorial Hospital in Perry — 64 miles and an hour and fifteen minutes away. There is no hospital, no ER, no urgent care, and no pharmacy anywhere in Dixie County. Four ambulances cover 17,000 people spread across 864 square miles — and when one of those ambulances transports a patient to Perry, it’s gone for hours. Only two primary care clinics serve the entire county: the Cross City FQHC and UF Health in Old Town. Dixie County is a federally designated Health Professional Shortage Area.
Mobile units are the start. They bring basic care, prescriptions, and telehealth connections to places that have nothing. Over time, local doctors get credentialed, choices increase, and drive times drop. Mobile units won’t solve the 2 a.m. ER problem alone — but they’re the foundation that grows into something permanent.
You don’t have to be in the middle of nowhere to be in a medical desert. Waldo has zero medical facilities — no clinic, no pharmacy, nothing. Archer has a nurse-led clinic only, no pharmacy in town. Micanopy’s only practice is cash-pay and subscription — not accessible to Medicaid or Medicare patients. Hawthorne is the best-served of the bunch with an Aza Health FQHC, but still no urgent care or ER.
In east Gainesville, the closest FQHC — Palms Medical — is on the wrong side of town, seven to eight miles from the east side. Bus Route 11 runs once an hour, weekdays only. ZIP codes 32641 and 32609 are identified as primary health disparity areas. County Commissioner Goston has said residents have been “deprived of services for over 50 years.”
In west Ocala (ZIP 34475), 47% of residents live in poverty. The area has been a federally designated Health Professional Shortage Area since 1986 — forty years. The FQHC satellite at Beacon Point is open one day a week — Wednesdays. SunTran has no Sunday service. Before the Estella Byrd Whitman Wellness Center opened in 2018, the nearest care was an emergency room.
A hospital five miles away that you can’t reach is functionally as far as one 64 miles away.
The Gainesville Paradox: Proximity Isn’t Access
Alachua County ranks #3 in Florida for clinical care quality — but 31st in health outcomes. West Gainesville has 29 clinics. East Gainesville has two. A world-class hospital 10 minutes away that you can’t afford is functionally as distant as one 60 miles away. The presence of the hospital masks the absence of accessible care.
31,000 Alachua County residents carry $30 million in medical debt — in a county with a world-class hospital. A Shands custodian — someone who works at the hospital — accumulated $30,000 in medical debt after a car accident. That $30 million in community medical debt could be erased for $150,000 — half a penny per dollar — through the nonprofit Undue Medical Debt.
In Marion County, two hospital systems generating $1.1 billion or more in combined revenue provide only $3 million combined in indigent charity care.
14.3% of Floridians delay care due to cost. For those earning under $25,000, the rate is eight times higher than for higher earners. An uninsured vaginal delivery in Florida costs $31,984. A C-section: $41,299. EMTALA requires the delivery — then you get the bill and zero postpartum care.
The Plan: Mobile Clinics for Everyone in FL-3
This isn’t a new idea that needs inventing. Mobile clinics already operate across the country. North Florida Medical Centers already runs one in parts of our region. The funding comes from multiple sources: FQHC grants, HRSA (Health Resources and Services Administration) rural health dollars, state funds, and VA community care partnerships under 38 USC 8153. FQHCs already provide sliding-scale care across the district. The MISSION Act says if you’re more than 30 minutes from a VA facility, you’re entitled to community care.
The legal authority exists. The funding programs exist. The operating model is proven. What’s missing is someone who writes the proposals, brokers the partnerships, and gets the mobile units on the road — and a congressman in Washington making sure nothing falls through the cracks between the VA, the FQHCs, and the grant offices. These things can stall quietly if nobody’s following up.
The pieces are all here. Nobody’s connected them.
What’s on the mobile unit
Each unit is a motorhome-style vehicle with slide-outs that expand — like origami — into real clinical space when parked: exam room, basic lab capability, pharmacy dispensing for common prescriptions, and a telehealth station connecting to specialists at UF Health or the VA. When more capacity is needed, the unit tows a trailer for additional equipment or supplies. The motorhome-style design also means ADA-compliant wheelchair lifts rated for heavier patients and stretcher access — something standard vans can’t accommodate, and critical in rural areas where patients with mobility issues have the fewest alternatives. Not a screening booth — a real clinic visit, same day.
What it covers
- Primary care — family medicine, chronic disease management, labs, behavioral health screening. Same place, same day, every week on a reliable schedule.
- Women’s health and maternal care — prenatal care, postpartum follow-up,
well-woman exams, staffed by providers trained in women’s health.
Eighteen of Florida’s 21 rural hospitals have shut down OB units —
86% no longer deliver babies. Five FL-3 counties are maternity care deserts:
Lafayette, Dixie, Gilchrist, Union, and Hamilton. And 53% of maternal deaths
happen postpartum — after discharge, when women in these counties
have no follow-up care at all.
But this isn’t just a rural problem. Black women die in childbirth at 3.15 times the rate of white women — 44.8 per 100,000 vs 14.2 (CDC 2024). That disparity persists even at well-resourced hospitals. It’s not just access — it’s treatment. Symptoms dismissed, treatment delayed. College-educated Black women have worse maternal outcomes than white women who didn’t finish high school. This isn’t an income problem. Preeclampsia kills Black women at 4–5 times the rate — yet standardized treatment protocols cut those deaths by 60%.
UF launched an OB/GYN Mobile Outreach Clinic in February 2025 — the model we’re proposing already exists.
Nobody should skip prenatal care because there’s no clinic in the county. And nobody should die because their symptoms were dismissed.
- Behavioral health and crisis support — counseling, substance abuse screening, and suicide prevention resources. No referral runaround.
- Physical therapy — when the mobile unit stops at a college extension or host site with a gym or dedicated room, PT equipment like weights and resistance bands can be stored on-site — no need to haul it in the motorhome. The doctor sees patients while the physical therapist works with theirs simultaneously. PT students and even undergrads considering the field can staff these rotations, the same way programs like Kinetix in Gainesville use UF students today.
- Veterans get priority appointments under existing VA sharing authority. Then the schedule opens to the general public — uninsured, underinsured, Medicaid patients, and rural residents broadly. Everyone on a sliding scale through FQHC partnership. No one turned away.
How it’s staffed
Each mobile unit route needs 6–8 people: a nurse practitioner or PA, a community health worker, a driver/logistics coordinator, and support staff. The staffing model is part-time by design — compatible with school schedules, second jobs, and caregiving. Think AmeriCorps, not hospital shift work. Service Corps members from the jobs program fill support roles, getting real clinical experience while the community gets care.
Local nursing students from area programs can do their clinical rotations on the mobile units when they come through their town. It fits the part-time model, cuts transit costs because the students are already local, and gives them real rural clinical experience they can’t get in a hospital hallway. Patients may recognize a familiar face from their own community — and in healthcare, especially rural healthcare, trust matters.
How many, and where
The goal is a mobile unit route in every underserved corridor of the district. You start where the gaps are worst and scale from there. The route map gets built with local providers, not drawn from Gainesville. Where a local doctor already exists, we don’t duplicate — the mobile unit fills gaps, not competes.
The mobile units anchor at places people already know: churches, fire stations, community centers, college campuses. Santa Fe College, for instance, has thousands of students with no student health center — the mobile unit parks on campus and serves students and the surrounding community at the same time. Between visits, a small supply room on campus stocked with basic medical supplies and staffed by trained student peers keeps the connection alive — triage, supply pickup, help with paperwork, so the unit’s clinical time isn’t spent on things that can be handled in advance.
Host sites could also have a vending machine stocked with basic health supplies — braces, resistance bands, over-the-counter items — that people can buy between visits. A wireless relay tracks what gets purchased and tells the next visit what to restock. Small idea, but it shows the system is smart and self-maintaining.
Each mobile unit costs $250,000–$390,000 upfront (coverable by a single HRSA New Access Point grant) and roughly $275,000 per year to operate. Start with the first routes, prove the model, then expand.
Can this actually scale?
Used mobile health units are available — COVID surplus — at 30–60% of new cost, deliverable in weeks. North Florida Medical Centers already operates Health Force One — the proof of concept exists in FL-3. Harvard’s Family Van documented $36 saved for every $1 invested compared to ER visits, over 30+ years. A hybrid model — stationary trailers at anchor sites plus motorized units for circuit routes — keeps costs down. The vehicles are the easy part. Staffing is the real constraint, which is why the nursing student rotation pipeline matters.
The spare
The plan includes an extra mobile unit on standby for breakdowns and scheduled maintenance. In a pinch, it can be pressed into emergency service — but its primary job is keeping the regular routes running so communities never lose their scheduled clinic day.
The Phased Plan: What a Congressman Can Actually Do
This isn’t a wish list. It’s a realistic, multi-year plan built around what a freshman congressman can actually push, fund, and deliver.
Year 1-2: Get Mobile Units on the Road
FQHCs already have the authority. HRSA grants already fund this. VA sharing agreements already exist. This is actionable now — write the proposals, broker the partnerships, get the units rolling. Veterans get priority appointments, then the schedule opens to everyone. This is a Day One priority.
Year 2-3: Certify Outside Doctors Into the VA System
Instead of farming veterans out to corporate healthcare chains, credential individual private doctors into the VA system. The doctor stays in their own office. Their computer connects to the VA network. No corporate middleman. No duplicate billing infrastructure. I will go to every congressman and senator to build support for this. It expands capacity without building new facilities.
This also encourages doctors to venture out from clustering around hospitals. It works for rural towns like Branford AND underserved urban areas like east Gainesville. The mobile unit model creates infrastructure where the doctors are, instead of requiring patients to go where the hospitals are.
Year 3+: Expand the VA Model Beyond Veterans
Once certified doctors and mobile units are in place, push to let the VA treat Medicaid patients, then ACA patients. The infrastructure is already built. The doctors are already certified. The administrative pipeline is already running. You’re not creating a new system — you’re opening the doors wider on one that already works.
But veterans still get head of the line. As the program expands, designate local doctors who get extra training to be VA-qualified, growing capacity instead of splitting it. Think of it like Army and Air Force — separate branches, same department, shared infrastructure but distinct missions. Veterans don’t get diluted by the system.
Long-Term Vision
A healthcare system built FROM something we already have — the VA — not designed from scratch. The VA delivers care at 21% lower cost with 46% lower mortality (NBER). It pays 54% less for the same drugs (GAO). The question isn’t whether this model works. The question is why we only offer it to people who served in the military.
Civilian medicine has the same trauma issues as veterans — not a war zone, but family strife, traffic accidents, violence. Same thing in different clothes. The VA built expertise treating combat PTSD, traumatic brain injury, amputations — those clinical skills transfer directly to civilian trauma. Opening the doors wider isn’t the VA learning something new. It’s applying what it already knows.
The VA has always been an innovation engine. Artificial limbs, the golden hour protocol — things the VA created for veterans that are now part of everyday civilian medicine. Opening the doors wider is veterans continuing to serve — their system’s legacy extending through expertise developed for them.
Other candidates will promise you more mobile units. I’m promising you won’t need them forever.
The Paperwork Tax: What Administrative Overhead Actually Costs
The safety net runs through more than fifteen programs across eight federal agencies — Medicaid, ACA marketplace plans, Social Security Disability, Medicare, VA healthcare, CHIP, SSI, SNAP, unemployment insurance, Section 8 housing assistance, TANF, WIC, and more — each with separate eligibility rules, separate databases, and separate processes. The total administrative overhead: $270–370 billion per year.
- $100–150 billion in direct agency administration (federal + state combined)
- $248 billion in excess healthcare billing and insurance overhead compared to peer nations
- $70+ billion in unclaimed benefits — people who qualify but can’t navigate the system
- 11.5 billion person-hours of paperwork annually just for benefits eligibility — that’s 45 hours per American adult per year
Individual programs look efficient in isolation: Social Security runs at ~1% overhead, Medicare at 1.3%. But the system as a whole is not. Hospitals spend 19% of their revenue on billing, coding, prior authorization, and insurance negotiations. Physicians spend 15%. A VA-style system would cut those to 12% and 9% respectively (CBO estimates).
Means-testing IS the overhead. The entire administrative apparatus exists primarily to determine who is “deserving.” Programs with universal eligibility — Social Security, Medicare Part A — have the lowest admin costs. The question isn’t whether we can afford universal coverage. It’s whether we can afford to keep deciding who deserves it.
What VA-Style Medicare Would Actually Cost
The VA runs its own hospitals, employs its own doctors, and buys drugs at government-negotiated prices. It costs 21% less per episode of care and achieves 46% lower mortality than private hospitals (NBER). It pays 54% less for the same drugs (GAO).
If we ran Medicare the way we run the VA:
Current Medicare: ~$1.1 trillion/year for 68 million beneficiaries ($17,786 per person)
Where savings come from
- Drug pricing (VA pays 54% less — GAO confirmed): $79 billion/year
- Provider admin reduction (hospitals from 19% to 12%, physicians from 15% to 9%): $53 billion
- Eliminate Medicare Advantage insurer middlemen (6% overpayment + admin): $41 billion
- Integrated care efficiency: $29 billion
Offsets
- Higher utilization (no deductibles/copays): +$64 billion
- Capital investment: +$15 billion
Net savings: $123 billion/year conservative, up to $250 billion optimistic.
VA-style Medicare cost: ~$950B–$995B vs current $1.118 trillion. While eliminating deductibles, copays, and the confusing Part A/B/D split.
Compared to $1.118 trillion, savings of $123–250 billion might seem like a wash. But the more people in the system, the lower the per-person cost becomes. And it lowers personal cost: not just the dollar amount, but the fuel for driving to distant clinics, the time spent traveling and waiting, and the stress of navigating a complex system. The savings compound at every level — federal budget, state budgets, and kitchen tables.
Nearly 9 out of 10 independent studies that have looked at single-payer healthcare found it saves money. By year 10, every model showed net savings.
That is not a radical idea. It is how we already provide healthcare to 9 million veterans. The question is why we only offer the efficient model to people who served in the military.
What VA-Style Medicare Would Actually Feel Like
When I was on active duty, I walked into the clinic, got treated, walked out. No bill, no paperwork, no confusion. The government figured out how to do this for active duty service members. Why can’t we do it for retirees who’ve been paying taxes for 40 years?
I talk to my neighbors and we’re all confused by Medicare. Medicare Advantage is denying procedures, dropping doctors mid-treatment, adding stress when we should be focused on our health, not our coverage.
Too many moving parts — Part A, Part B, Part D, Medigap, Advantage plans, formularies, donut holes, network restrictions, prior authorizations. I’m not a doctor and I’m not an insurance company lawyer. Why do I need to be both to get healthcare?
One system, one card, your doctor stays your doctor. Take one more thing off our shoulders. I’m on Medicare myself. This isn’t theoretical for me — it’s personal.
AI Kills the Paperwork Tax
Right now, for every hour a doctor spends with a patient, they spend two hours on documentation — clinical notes, diagnosis codes, procedure codes, prior authorizations, insurance appeals. That paperwork is why rural practices close. It’s why doctors burn out. It’s why a 15-minute appointment costs $300.
AI can handle documentation in real time. While the doctor talks to you and examines you, the AI captures the encounter, generates the clinical notes, assigns the codes, and routes the payment. The doctor walks to the next patient instead of sitting down at a screen for 30 minutes.
Pair that with the VA’s single administrative system and the overhead collapses from both directions — AI eliminates the paperwork, and a single payer eliminates the insurance maze. The doctor’s job goes back to what it should be: talking to people and thinking about their health.
How Healthcare Grows From the Ground Up
You don’t build a $200 million hospital and hope people come. You grow healthcare the way towns actually grow — from a seed outward.
- Year 1: Mobile units reach underserved areas. A local doctor gets VA-certified. No construction needed. People who were driving 90 minutes now drive 10.
- Year 3: Patient volume grows. A second provider joins. The practice expands. Mobile units move on to the next gap.
- Year 5: The practice becomes urgent care — walk-ins, extended hours, basic labs on site.
- Year 10: Urgent care grows into an emergency room, then a community hospital. Built by demand, not by decree.
The mobile units fill the gaps in the meantime — serving places where there’s no doctor yet. But as certified providers take root, the units move on to the next gap, and what they leave behind is permanent.
No mandates. No overnight overhaul. The better model wins because it works — less paperwork, reliable payment, and a doctor who nets more per patient without an insurance company standing between them and the person sitting across from them.
The VA already proved that eliminating copays saves more in administrative costs than it loses in revenue — see our veterans plan.
Emergency Response
Mobile clinics are not just for routine care. When a hurricane hits or a disaster strikes, these units are already on the road, already staffed, already mobile. They can deploy to disaster zones immediately, coordinating with emergency management to deliver medical care where it’s needed most. No waiting for FEMA to set up a field hospital. The infrastructure is already rolling.
100% Federal Medicaid Funding
Right now, the federal government covers 90% of Medicaid expansion costs and states cover the remaining 10%. That 10% state match gives governors an excuse not to expand — and the result hollows out rural areas and creates healthcare deserts. Day One, I am pushing for 100% federal Medicaid funding. Remove the excuse. Close the coverage gap.
You Already Paid for It Once
When people say medication costs are too high, remember: a significant portion of approved drugs trace back to taxpayer-funded research. The NIH invests tens of billions of dollars a year in the basic science that discovers how diseases work and which molecules might treat them. A 2018 study in the Proceedings of the National Academy of Sciences found that NIH-funded research contributed to the scientific foundation of every one of the 210 drugs approved by the FDA from 2010 to 2016.
We paid to discover it. Then we pay again to buy it. The public funds the research, private companies develop the drug, and then they charge us whatever the market will bear for something our tax dollars helped create. That’s not a free market — it’s a subsidy with no return.
Two Things at Once
This plan does what most healthcare proposals don’t — it handles the emergency and fixes the system at the same time. Mobile clinics get care to people who need it today. VA credentialing and AI documentation repair the structural failures that created the shortage in the first place.
Everyone running for this seat can promise to put the train back on the track. I’m the one looking at why the tracks keep failing — and I have a plan to rebuild them so the derailment stops happening.
The VA already proves this model works — salaried doctors, no billing maze, lower costs, better outcomes. For our full plan on serving the veterans who made this system possible, see the veterans plan.