Thousands of Utahns have joined millions of Americans in demonstrations demanding that democracy and the rule of law be restored as the governing principles of our country. This is as it should be. But if this movement is to truly succeed, Americans must focus their energy on specific changes that can be enacted and implemented. We must push for reforms that dismantle oligarchy and return governing authority to the people.

In Utah, that means restoring the people’s power to legislate through ballot initiatives — a right guaranteed in our state constitution. This right is under threat. The Legislature continues to pass statutes making it increasingly difficult, even impossible, for citizens to bring legislation to the ballot. When measures do pass, the legislature often reverses or ignores them. The 2018 Better Boundaries initiative is a stark example — passed by voters, then disregarded by lawmakers.

This pattern of legislative overreach is unfolding again. The Utah Cares Political Issue Committee spent years carefully crafting fiscally sound, sustainable reform for Utah’s health care system. Health care costs are skyrocketing — doubling every decade — and are among Utahns’ top concerns. Utah Cares responded with a comprehensive proposal: the Utah Cares Act. Polling shows Utahns are ready for significant reform, and economic studies project long-term savings. You can read more about these studies at www.utahcares.vote.

On April 9, 2025, Utah Cares filed an application with the lieutenant governor’s office to place the Utah Cares Act on the 2026 ballot. As is standard, the application was referred to the Office of the Legislative Fiscal Analyst (OLFA). On May 9, OLFA issued a terse fiscal impact statement, warning the Act “could” result in an $8 billion annual shortfall — a figure that contradicts all independent research commissioned by Utah Cares.

On May 13, the lieutenant governor’s office stated that the Utah Cares application was under active review despite the adverse fiscal impact statement and requested that the sponsors be patient. On May 29, the date of expiration for an appeal of the adverse fiscal impact statement, the lieutenant governor’s office stated that the fiscal impact statement required rejection of the application.

The OLFA analysis was released without transparency. Utah Cares followed proper channels to request the data behind this estimate and was denied. Instead of evaluating the $16 billion in projected annual savings, OLFA assumed no change in spending and projected a massive deficit. Their statement ignores the strong fiscal case for the Utah Cares proposal and misleads both voters and policymakers.

To challenge OLFA’s flawed analysis, Utah Cares would need to meet a “clear and convincing” legal standard in court — a bar far higher than most civil cases. The process is stacked against citizen initiatives.

Utah’s ballot initiative laws have been so undermined that the people no longer effectively hold their constitutional power to legislate. OLFA and the lieutenant governor’s office operate opaquely, and their treatment of the Utah Cares application feels like a foregone rejection, not an honest review.

Utahns who have been marching to restore democracy can take meaningful action by supporting Utah Cares in its fight to get on the ballot. Every citizen who cares about government accountability and health care reform can make a difference by contacting the Utah lieutenant governor’s office. Demand that she reverse her rejection of the Utah Cares Act and allow the people to move forward with collecting signatures.

This is a defining moment. Democracy isn’t only defended in the streets — it’s protected through persistence, transparency and action. Help us restore the power of the people in Utah.

Dr. Joseph Q. Jarvis is a public health physician, chair of the Utah Cares Political Issue Committee and author of several books, including “The Purple World: Healing the Harm in American Health Care” and “What the Single Eye Sees: Faith, Hope, Charity, and the Pursuit of Discipleship.

At 15, I went on a cross-country motorhome trip with my family, which stalled in a small Texas town when the engine froze. While we were stuck for a week, two unforgettable events shaped my perspective.

Early in the week, my father gave me cash and sent me with my brothers to get haircuts. I found a barbershop and waited, but after several others were served first, I asked when our turn would come. The senior barber, a Black man, gently told me he couldn’t cut my hair because of segregation laws. He directed us to the white barbershop. Coming from a predominantly white Phoenix suburb, I had never faced such discrimination. It was an eye-opening moment.

Later that week, my family gathered around a motel TV to watch the first moon landing. Seeing the American flag planted on the lunar surface filled me with pride and optimism about what our country could achieve together.

Today, just like back then, there are deep societal divides in my country — not just by race, but by gender, wealth, education, faith and political alignment. Americans are ridiculed and rejected for who they are and what they believe. Hatred has replaced compromise. But now government is not expected to help because it is seen as the enemy rather than a solution.

I believe that at the heart of our crisis is the absence of care and compassion — like that shown by that Black barber who wanted to help me but couldn’t. We are collectively failing to live up to Abraham Lincoln’s admonition, delivered upon the occasion of his second inauguration, just as the Civil War was ending: “With malice toward none, with charity for all, with firmness in the right as God gives us to see the right, let us strive on to finish the work we are in to bind up the nation’s wounds, to care for him who shall have borne the battle and for his widow and his orphan — to do all which may achieve and cherish a just and lasting peace among ourselves and with all nations.”

American society is ruled now with bipartisan force and harshness. We are on the left hand of God. We have not strengthened the diseased, healed the sick, bound up the broken or sought out the hungry, thirsty, estranged, unclothed or imprisoned. We are not enjoying the blessing of mercy in our collective lives because we are not merciful.

We need a return to kindness, to truly caring for one another. Nowhere is this more evident than in our broken healthcare system, where hundreds of thousands die prematurely each year because they cannot afford care.

Though we pay more for healthcare than any other country, too many are left to suffer. This neglect fuels resentment and division. When people see others getting care while their loved ones are abandoned, anger grows, and society fractures. If we want healing, we must start by helping those in need — just as that barber tried to help me years ago. Join us in making a difference at www.utahcares.vote.

Dr. Joseph Q. Jarvis is the chair of Utah Cares, a political issue committee planning to put health care reform on the ballot in Utah in 2026. He is a public health physician, author and film producer.

I believe most Americans have some notion that health care costs are a problem in the United States. This is because millions of Americans owe medical debt; 14 million Americans owe more than $1,000 in medical debt.

This means that each of us likely knows someone who owes medical debt.

Fewer Americans are aware that U.S. health care costs are far higher than anywhere else in the world. Americans spend just less than $15,000 per person on health care, nearly twice as much on average as other developed countries.

Health care costs are rising faster than GDP growth, meaning that an ever-increasing part of our total economic output goes to the health care system, a trend that is clearly unsustainable. The vast majority of health care expenditures are paid by direct taxation or written off through federal or state tax policy. Americans pay more taxes to support health care than do the citizens of any other country.

These facts present an alarming scenario for all of us to consider. Our economy cannot continue indefinitely to sustain health care costs growing faster than the gross domestic product. Nearly ten years ago, Warren Buffett called the growing share of GDP going to health care the “tapeworm” that is sapping American industrial competitiveness.

It is unlikely that the American economy will survive if we don’t stop the growth of GDP share going to health care before it reaches 25%. The USSR collapsed when its military grew to consume 20% of its GDP. We either fix our health care system or watch our economy implode.

But health care costs leading to debt are not just a problem for individual American families or the overall American economy. Health care debt has become the biggest driver of federal government debt. Here is the opening paragraph of a recent report on federal debt by the Peter G. Peterson Foundation:

“As the recent long-term projections from the Congressional Budget Office (CBO) show, the national debt is on an unsustainable path. Under current law, the nation’s debt trajectory will rise from nearly 100 percent of gross domestic product (GDP) in 2024 to 166 percent in 2054. One of the largest drivers of that rising debt is federal spending on major healthcare programs, such as Medicare and Medicaid. Such spending is projected to rise by 73 percent over the next decade and will exceed all other categories of federal spending in 2028. By 2054, such spending will account for 30 percent of total federal outlays, exceeding the total amount spent on discretionary programs, such as defense and education, by 51 percent.”

In effect, this report is saying that if we Americans don’t reform how we do health care business, and instead continue to allow health care costs to grow faster than the gross domestic product, not only will millions more American families be bankrupted by medical debt, but so will the federal government. We will lose our competitive edge as a nation and perhaps drop out of first world status. Or worse, we could implode, as did the Soviet Union.

Real and sustainable health care system reform is not optional for us. We either change the way we do health care business, or we will not thrive as a nation. We can’t kick this can down the road even another decade.

There are improvements in health care system functions that can lead to substantial reductions in the growth of health care costs, even to reducing the portion of gross domestic product going to health care. The two most important among these measures would be reducing the overhead or inefficiency of U.S. health financing and improving the quality of the health care we all receive.

Inefficiencies in American health care financing, mostly due to the high overhead of private, for-profit health insurance, cost us more than $500 billion in waste every year. A similar amount of waste occurs each year because the American health care system features suboptimal quality care. Efficient and high-quality health care will cost less and save both lives and our economy.

Dr. Joseph Q. Jarvis is a public health physician, chair of the Utah Cares Political Issue Committee and author of several books, including “The Purple World: Healing the Harm in American Health Care” and “What the Single Eye Sees: Faith, Hope, Charity, and the Pursuit of Discipleship.”

“If they would rather die,” said Scrooge, “they had better do it, and decrease the surplus population.”

Letting people die, or at least not supporting what they need to live, is business as usual in American health care. Tens of thousands of Americans die each year simply because they can not afford the care they need, either because they are uninsured or because their deductibles, co-payments, and co-insurance make them functionally uninsured.

Hundreds of thousands more Americans die each year due to preventable injuries suffered while hospitalized, making patient injury the third leading cause of death in the United States.

Scrooge would have loved business as usual in American health care, especially modern American health insurance, at least before he had a change of heart.

That this is playing out here in Utah can be seen in a recently published article in The Salt Lake Tribune, which indicated that up to two-thirds of Utahns are not getting the care they need because of cost.

In fact, Utah rates an “F” on health care affordability, which means that, when it comes to health care, the Beehive state is one of the Scroogiest.

Let’s be honest with ourselves, like Scrooge, we Utahns need a change of heart.

I recently tried to persuade a wealthy friend of mine that he should donate to Utah Cares, the non-profit which I chair which will place single payer health system reform on the Beehive ballot in 2026. I explained to him the Common Sense proposal, which we have named “UtahCares,” would replace profit and greed as the driving factors in health care delivery and instead focus care on what patients need, leaving no Utah resident behind.

Put simply, we propose that every patient receive better care, more simply financed, from any physician they choose in Utah, with no out of pocket payment at the time of service. My friend’s response was pure Scrooge: He argued that the business of insurance companies has priority over the lives of the people they cover.

That harsh business-over-life mindset has transformed health care during the several decades of my medical and public health career. As a medical student, I watched the first CT scans be used in Utah and, as I recall, every patient who needed a scan got one. I saw how a brand-new kind of medicine, Cimetidine, could revolutionize the treatment of peptic ulcer disease, because every patient who needed it could acquire it.

Today, new medical devices and medications are too costly for vast numbers of Americans to afford them. American health care prices, as opposed to everywhere else in the developed world, are ridiculously high.

Tens of thousands of Americans die every year because they cannot afford life saving treatment. Meanwhile, the medical industrial complex keeps a “tight-fisted hand at the grindstone,” “squeezing, wrenching, grasping, scraping, clutching” and coveting its way to better and better profits.

As our society abandons patients, we create the conditions which lead to anger and division. If we don’t learn to care for each other, our nation will fall apart from the inside.

An initial economic analysis of UtahCares has demonstrated that we can afford to pay for medically necessary care for every Utah resident. If we can have a change of heart about health care, we can care for all of our fellow Utahns and begin to heal the hurt and anger that so divides us from each other.

Merry Christmas, happy Hanukkah and joyous Kwanzaa from Utah Cares.

Dr. Joseph Jarvis, is a public health physician, author and chair of the board of directors of Utah Cares, a 501c4 non-profit organization planning to bring real and sustainable health system reform to the Utah electorate by ballot initiative in 2026.

Not far from its end where it pours into the Hudson River, the Mohawk River makes a crescent bend that is crossed by a bridge carrying New York State Highway 9 between Saratoga Springs and Albany.

Right there on the east side of the bridge and north side of the river, I recently stood next to a display of flowers and candles which have been tended now for four and a half years by friends of a young man, Danny Desnoyers, who died at that site on April 9, 2019.

The Mohawk River, which at this point approaches the size of the Colorado River as it passes through the Grand Canyon, drains the valley between the Catskill and Adirondack mountains, and in early spring, when Danny died, carries a massive flow of water.

The Mohawk served the purpose of water source for the Erie Canal builders back in the early 19th century. It’s likely that Joseph Smith, the founding prophet of The Church of Jesus Christ of Latter-day Saints, passed by this site as he moved with his family from Vermont to western New York, traversing the Mohawk Valley to Palmyra, which sits on the Erie Canal.

The flower and candle display, like many to be seen spontaneously arising along the byways of the American landscape, is not particularly remarkable. It sits between the river’s edge, a drop-off of about 5 feet, and a line of large boulders traversing the area from the bridge to a rise further to the east.

The boulders have been placed there by the local government in response to the incident that killed Danny Desnoyers. Danny died when his truck plummeted into the Mohawk River and the boulders keep other vehicles from following that same path of demise.

A week prior to dying in the Mohawk River in his truck, Danny was doing well and going about his business. He went to his local pharmacy to pick up his antidepressant medication — which had helped him rise above a chronic mental health condition, major depression — only to discover that he had been kicked off his Medicaid managed-care benefit because he had forgotten to make a $20 copayment.

His parents, Scott and Anna Desnoyers, with whom I visited the Mohawk River site, could not raise the several hundred-dollar cost of the prescription. Danny’s appeal to the managed care organization after he paid the $20 fee on the day he discovered that his Medicaid benefit had lapsed was to no avail. They wouldn’t reinstate him until the next billing cycle a month later.

Sudden withdrawal from antidepressant medication is dangerous. Patients who stop cold turkey when taking these medications commonly develop nausea, vomiting and other flu-like symptoms. Their underlying mental health condition flares, with anxiety and depression.

They suffer insomnia, vivid dreams, severe headaches and other pain, and can become suicidal. Danny spent a week in that kind of hell, and then he decided that he could go on no longer.

He drove his truck to the crescent bend of the Mohawk River, super-glued his seat belt shut, posted a suicide note on Facebook, backed his truck up and accelerated into the river swollen with spring snowmelt.

Scott and Anna took me to the site at my request. They rarely visit the place; it’s too painful.

They have dealt with this loss by sublimating their grief into a general call for all of us to change the health care system that denies medically necessary care to patients who can’t afford their treatment. Scott stood up at Danny’s funeral and vowed that he would look into the eyes of every elected politician all across the U.S. and tell them that they must change how we Americans do health care business.

Scott’s passion brought him to the attention of a filmmaker who was organizing a documentary about the agony of American health care and what can be done about it. I was the executive producer of that film — “Healing US.”

I stood on the banks of the Mohawk River with a grieving mother and father and felt how sacred that site is. Not because I could place the site in the context of my LDS faith, but because the place where we lost the life of Danny Desnoyers, like the tens of thousands of similar places of premature mortality due to the dereliction of our health system, will serve as a monument to our collective commitment to rid our nation of the horror of for-profit health insurance.

Joseph Q. Jarvis, MD, MSPH, is the chairman of the Board of Directors for Utah Cares, a 501c4 non-profit organization planning to bring real and sustainable health system reform to the Utah electorate by ballot initiative in 2026.

I recently heard a friend comment that he saw no need for significant reform of our health care system. After all, he and his family always had outstanding care meeting his every expectation. To which I should have replied, “Yes, but you donated enough to your hospital system that they have named a wing of the place after you.”

Another acquaintance, a business leader, expressed a similar feeling about American health care, calling it “pretty dang good.”

Years ago, before I began my medical training at the University of Utah School of Medicine, I too had a sanguine view of business as usual in U.S. health care. I felt that, as a newly accepted medical student, I was joining the leading profession in the country that led the world in caring for patients.

But then the sad realities of for-profit health care began to be evident. I wrote about my transition to single payer activist in my books “The Purple World: Healing the Harm in American Health Care” and “For the Hurt of My People: Original Conservatism and Better, Simpler Health Care.”

After my transition to single payer health reform advocate, I produced a documentary film about the awful situation many American patients confront as they desperately try to get needed care for themselves and their families.

The film, “Healing US,” begins with the story of patient neglect in an emergency room leading to the death of a young woman because she had no health insurance. This kind of death is commonplace in America — it happens 68,000 times each year.

Nicholas Kristof recently asked a question in the New York Times: “How do we fix the scandal that is American health care?”

Here, in part, is how he described the scandal: “It’s not just that life expectancy in Mississippi (71.9) now appears to be a hair shorter than in Bangladesh (72.4). Nor that an infant is some 70% more likely to die in the United States than in other wealthy countries.

Nor even that for the first time in probably a century, the likelihood that an American child will live to the age of 20 has dropped … America’s dismal health care outcomes are a disgrace. They shame us.

Partly because of diabetes and other preventable conditions, Americans suffer unnecessarily and often die young. It is unconscionable that newborns in India, Rwanda and Venezuela have a longer life expectancy than Native American newborns (65) in the United States. And Native American males have a life expectancy of just 61.5 years — shorter than the overall life expectancy in Haiti.”

Every other developed nation is better at preventing deaths that are caused by treatable conditions than the U.S. No other developed nation has personal and family bankruptcy due to the cost of illness and injury care while 500,000 such financial disasters happen in America each year, mostly to people who had insurance when they became sick or injured.

No other nation comes close to spending as much as we Americans do for health care. Most of that spending is public money appropriated for health care. Those growing health care appropriations are crowding out the funding of other needed services such as education, public safety and hygiene and our infrastructure.

We spend more on health care because we have a poor quality health care system that is inefficiently financed, both of which are problems which can be fixed.

So to my friend and acquaintance, both of whom grossly misunderstand the dereliction of American for-profit health care, U.S. health care is pretty dang bad. Take the blinders off and look around. Our society needs better quality care, efficiently financed, that funds all medically necessary care for all of our citizens.

Here in Utah we are mobilizing to solve this most urgent of domestic issues. Join us at Utah Cares, and let’s learn to care for each other.

Joseph Q. Jarvis, MD, MSPH, is the chairman of the Board of Directors for Utah Cares, a 501c4 non-profit organization planning to bring real and sustainable health system reform to the Utah electorate by ballot initiative in 2026.

According to a study recently conducted by the newly announced health reform group Utah Cares (https://utahcares.vote), $28 billion will be spent on health care in Utah this year. 

Health care spending in Utah is growing fast, doubling every decade, a rate faster than that of all but one other state. The Utah Foundation has for years consistently found that Utahns rate health care costs at the top of their list of concerns.  In 2020, the Utah Foundation noted that during the decade from 2008 to 2018, health insurance premium rose 50% and deductibles for health insurance rose 74%, causing Utahns to have the 8^th highest out of pocket costs for health care in the nation. 

On average, every Utahn will spend $2800 annually out of pocket for health care, and that’s after paying (along with all Americans) the world’s highest taxes for health care.  Unlike the rest of the developed world, however, only in America will people go without health care because they cannot afford it.  In 2018, an estimated 429,000 Utahns were unable to get needed health care because they could not pay the out-of-pocket costs.

My own recent health care experience helps to illustrate why Americans are increasingly priced out of needed care.  A few months ago, I began to have right sided pain that reminded me of how it felt when I passed a kidney stone about a decade ago.  I notified my urologist, who arranged for me to have a CT Scan. 

As it turned out, the pain I was experiencing was not due to another stone. Rather, I had developed a very large cyst on my right kidney.  The cyst, which was about the size of my liver, was impinging on nearby anatomic structures and causing pain and obstruction of blood flow.  My urologist and I concluded that the cyst had to be removed.

I was scheduled for same day surgery at Salt Lake Regional Medical Center.  The 90-minute surgery went well, and I was released to go home after about 4 hours in the recovery room.  I removed my own surgical drain a few days later.  I have enjoyed a satisfactory return to health and no longer have the pain and other discomfort associated with the cyst. 

Just recently, I have begun receiving notification of the billing associated with my surgery.  I have Medicare with a supplemental insurance plan, so I receive claims information from both sources of payment.  The supplemental insurance plan recently notified me that for the several hours of relatively uncomplicated surgical care rendered at Salt Lake Regional Medical Center, Medicare was billed $30,902.64.  Apparently, that bill was paid without question. 

Lest anyone consider my experience to be an isolated case, a friend recently told me about his own uncomplicated hospitalization (his was overnight) for which the hospital received more than $55,000 from Medicare.

Let’s face it, the prices for hospital care in the United States are ridiculously high.  Hospitals set these prices without any attempt to base them on what providing needed care really costs.  These prices are invented out of whole cloth and are generating windfall profits at the expense of American patients and their families.  There is no justification for pricing middle class Americans out of needed health care after they pay the world’s highest taxes for that very care.

With very few exceptions, every American family is health insecure, meaning their next major health problem could bankrupt them, or they could simply be priced out of the care they need.  Meanwhile, our hospitals, nursing homes, dialysis centers, pharmaceutical firms, and medical device manufacturers are making enormous profits.  Business as usual in American health care is killing Americans.  It is time for real and sustainable reform.

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Joseph Q. Jarvis, M.D., is a public health physician and the author of two books about American health system reform: “The Purple World: Healing the Harm in American Health Care” and “For the Hurt of My People: Original Conservatism and Better, Simpler Health Care.” He is also the executive producer of a soon-to-be released documentary film: “Healing US.”

Not much was overtly said about health system reform during the several hours of election coverage I watched on Election Day. None-the-less, American voters know that how we do health system business is unsustainable.

We can’t keep forking over trillions of dollars every year (mostly through our taxes) to support health care delivery that is poor quality, highly inefficient and leaves our patients in debt. The election news coverage often mentioned inflation and abortion as issues motivating many voters. Both of those, of course, are health care problems.

American consumers have seen health care prices rise into the stratosphere for years, while health care benefits have eroded wage increases. Health care in the U.S. is an economic kitchen table issue because it is mostly funded by the taxpayer, and therefore, like all such issues, will be on every ballot.

Abortion is, by its very nature, a medical procedure and, in many circumstances, such as ectopic pregnancy, an urgent and lifesaving one. Providing for physicians and patients to have the legal protections necessary to make clinical decisions freely will therefore also be on every ballot. But the recently completed election had at least two health reform votes openly on the ballot — one was in the U.S. Senate race in Pennsylvania and the other was a ballot measure in South Dakota.

John Fetterman, the Pennsylvania lieutenant governor who flipped that state’s open U.S. Senate seat from red to blue, overtly put health system reform on the ballot. His campaign website reads: “I believe that health care is a basic, fundamental human right, not a privilege. But health care in America is far too expensive and convoluted. In the richest nation on earth, I believe we have a moral duty to guarantee quality health care coverage for every American and end the disgusting practice of corporations profiting from people’s health and well-being.”

Fetterman proves that politicians in swing states can win while embracing comprehensive health system reform, because that is what the American voters, whether red or blue, know must happen.

Even in red states there is an underlying urge to find a way to fund health care for everyone. Prior to this year, six red states had seen the question of Medicaid expansion come to the vote through ballot initiative. In every one of those states — Idaho, Maine, Missouri, Nebraska, Oklahoma and Utah — the electorate chose to expand Medicaid even though the respective legislatures had already voted it down.

This year a seventh state, South Dakota, saw a similar ballot initiative go to the voters. And again, red state voters passed the Medicaid expansion. Together, these ballot measures will bring a total of about 900,000 low-income people onto the Medicaid rolls across the nation.

Why are these ballot measures succeeding? One analyst suggested three reasons: hearing from neighbors who will benefit, bringing federal tax dollars back to the state and protecting the solvency of rural hospitals and health clinics. Assuming that those reasons reflect the reality of health care ballot measures, I would suggest that more comprehensive reforms of the business of health care can also be accomplished with ballot initiatives.

American taxpayers have been trying to give the gift of universal health care to themselves and their neighbors for 75 years. We want our neighbors to have the care they need. We all want our fair share of federal taxation spent with purpose on improving our lives and those around us.

We see the failure of corporate medicine in rural America and we know that we can’t leave any person or any part of America behind. American voters won’t be done with health care issues until we find a way to deliver better, simpler, and therefore less expensive care to every American citizen.

Joseph Q. Jarvis, M.D., is a public health physician and the author of two books about American health system reform: “The Purple World: Healing the Harm in American Health Care” and “For the Hurt of My People: Original Conservatism and Better, Simpler Health Care.” He is also the executive producer of a soon-to-be released documentary film: “Healing US.”

On September 6, 2022, the Gold Room at the Utah State Capitol filled with the glitterati of Utah health care delivery.

Hospitals, health systems, advocacy organizations, and business leaders were there to attend the kick-off of the One Utah Health Collaborative, the nonprofit, private-sector, volunteer initiative organized by Gov. Spencer Cox because, as he put it, if Utahns don’t solve our health system woes, then they will be solved for us by federal intervention.

It was all very solemn and I’m sure well meant, but, in my opinion, not very compelling.

It’s just that I’ve been at similar meetings, with similar solemnity, many times over. I moved back to Utah in 1997 and every governor since then has had health system reform at the top of the gubernatorial agenda. Gov. Mike Leavitt ran on health system reform. He pushed for and passed Health Print, including 10 major pieces of legislation creating Medicaid managed care and a health policy agency.

I had several personal conversations with Gov. Jon Huntsman about health system reform, both when he was a candidate and after he took office. During his tenure as governor, the Salt Lake Chamber and other business organizations convened ahigh-level, blue-ribbon room full of leaders to recommend legislation.

Gov. Gary Herbert also talked seriously (or so it seemed) about health system reform.

I tried to help each of these governors with their health system initiatives. Both Leavitt and Herbert interviewed me as a finalist for the position of executive director of the State Department of Health before choosing someone else.

Despite all this gubernatorial attention over 25 years, Utahns are no better off today when it comes to finding and paying for health care than they were in 1997. Americans pay far more for health care than do the citizens of any other country and we mostly pay for it through the world’s highest health care taxes. Despite paying on average more than $12,000 for every man, woman and child, when Americans need health care, they often can’t afford it. Most Americans filing bankruptcy do so because of debt due to illness and injury costs, usually debts owed by people who had health insurance at the time they needed care.

American health care delivery is fraught with ridiculously wasteful overhead, costing $500 billion more each year than more efficient health financing in other first world health systems. American health care is least able in the developed world to prevent mortality which should be amenable to known clinical interventions. In American hospitals, patients often sufferpreventable injury, leading to 240,000 premature deaths per year.

I could go on cataloguing the failings of American health care, but I am tired of listing the failures and waste of our healthcare system. And I am tired of listening to health care leaders and politicians talk about how we in Utah can lead the nation and solve the health care conundrum.

The health care glitterati and the governor may mean well, but the Gold Room at the Utah Capitol is not where sustainable health system reform will get done. There is only one means for really changing something as big as the health care system: the ballot box.

If you, like me, are tired of struggling to pay for or even find good health care, then educate yourself about who will be on your ballot this November. Incumbents have already had a chance to reform the health care system and have failed. I suggest you ignore party affiliation when you vote and simply vote for new leadership. If you want change, then change who represents you in Congress and in the Legislature.

Joseph Q. Jarvis, M.D., is a public health physician and the author of two books about American health system reform: “The Purple World: Healing the Harm in American Health Care” and “For the Hurt of My People: Original Conservatism and Better, Simpler Health Care.”

By Joseph Q. Jarvis and Kindra Celani | Special to The Tribune  | Published: Aug. 25, 2022

The burden of care in hospitals falls mostly on nurses. They are the eyes of health care at the bedside and the arms offering comfort. It is on the shoulders of nurses that recovering patients lean as they begin post-operative recovery.

Doctors may write the orders for patients, but nurses deliver the IV fluids, insert the needles, count the pills and bring the relief. Patient safety and hygiene are mostly in the hands of nurses. Health care is a labor-intensive enterprise and nurses are its backbone.

Modern hospital management, however, has come to see the cost of nursing as a major obstacle to optimal profits. Under the guise of efficiency, fewer nurses are deployed throughout the hospital each shift. The ratio of registered nurses (RNs) to patients has been steadily falling for several years. These efficiencies, however, come at a cost.

When RNs have too many patients in their care, patients experience increased risk for medical errors, complications, falls and other injuries, pressure sores, increased hospital length of stay and readmission after discharge. For each added surgical patient in an RN’s workload beyond the established ratio of 1:4, the likelihood of patient death within 30 days of surgery increases by 7%.

A 2006 study demonstrated that increasing RN staffing nationwide to match the best-staffed hospitals across the country would reduce in-hospital deaths by 5,000 per year and prevent 60,000 adverse outcome each year. American hospital patients need better nursing.

Recently, Dr. Marc Harrison announced that he would be resigning his position at Intermountain Health Care as CEO. The news articles that covered his announcement received hundreds of comments, many referring to nurse staffing ratios. For example, one commenter at KSL.com stated:

“[Dr. Harrison has been] sacrificing quality of care for the sake of more money. He changed staffing ratios so that the nurses and CNAs have to take on a MUCH heavier patient load as well as being short staffed. . .Intermountain Healthcare used to be a company that really took care of their employees. I worked for them for 13 years. But over the last 6 years, they have really gone downhill in employee satisfaction and patient experience.”

Given the enormous burden of nursing in the care of hospitalized patients, it should not be surprising to find hospital employees recognizing the relationship between the support they receive from their employer (or lack of it) and the care delivered to patients at the bedside.

RN staffing ratios are but one way of characterizing how well hospital employees are supported by health care managers. Another would be offering nurses a protected pathway for providing comment about unsafe practices observed at the workplace. Optimal care of patients requires best practices in managing the corporate environment in which nurses work. It appears that IHC has been failing Utah patients by failing to support our nurses.

If nurses aren’t safe, then patients aren’t safe. Nurses who work too many hours and are assigned to care for too many patients may boost the corporate bottom line, but they are not safe, and neither are their patients.

Nurses at IHC often feel that they cannot report the unsafe behaviors they observe while at work because they fear push back from colleagues, physicians or management. Nurses may, through their silence, foster an appearance that all is well, but no nurse or patient is safe under those circumstances.

Nurses are at high risk of developing PTSD as they are exposed to ongoing and unpredictable trauma at the bedsides of sick and dying patients. This is compounded by a hostile and retaliatory work environment where it is unsafe to speak up for positive changes to the system or to report errors for fear of scapegoating, retaliation and threats to the license and livelihood of already severely underpaid nurses.

Utah patients need safe and supported nurses. IHC is at a crossroads as it chooses new leadership. It is time to place nurse safety and patient safety before any other concern. Choose a new corporate leader wisely or expect a ground-up nursing movement like unionization to improve patient safety through advocacy for nurses.

Joseph Q. Jarvis, M.D., MSPH, is the author of “The Purple World: Healing the Harm in American Health Care,” and his new book “For the Hurt of My People.” He is a public health physician, former family doctor, and one-time academic occupational medicine specialist.

Kindra Celani, St. George, is a nurse practitioner caring for advanced heart failure patients, former assistant professor of nursing, experienced ICU and ER nurse, advocate for nurses and patients, founder of Latter Day Survivors podcast and survivor living with complex post traumatic stress disorder. She has a doctor of nursing practice degree from Rocky Mountain University of Health Professions.

By Joseph Q. Jarvis | Special to the Salt Lake Tribune | Published: February 17, 2022

Over my 30 years of health system reform advocacy, I have met with dozens of state and federal legislators and their staff members, offered testimony before many legislative committees in Nevada, Colorado and Utah and spoken to both Democratic and Republican platform committees, delegates and interest groups.

These many encounters have taught me that politics, meaning the alignment with party and special interests, is more important to elected officials than any human experience or set of facts. Those of us who are trying to change how Americans do health care business must recognize that health system reform is about politics. No amount of education or marching to the draw attention to the plight of American patients will change the grip of the medical industrial complex on business as usual in American health care. Health system reform is first a very heavy political lift, meaning it is a power grab, meaning someone’s ox must be gored.

To that end I announce the formation of a new Super PAC, or political action committee, which will be called The American Health Security Project. The project will be a political platform for a grass roots effort to hammer home the message first articulated in Congress by the late Sen. John McCain. In 2017, after he received the diagnosis of terminal brain cancer, he returned to Congress to vote on the “skinny” repeal of Obamacare, which meant repeal but not replace.

Republicans, then holding a slim majority in the United States Senate, had waited for his return before scheduling the vote, because two Republican Senators, Lisa Murkowski of Alaska and and Susan Collins pf Maine, had already declared their intent to vote against the “skinny” reform measure. But, if McCain voted for it, a fifty-fifty tie could be realized, which would then be broken in favor of passage by then-Vice President Mike Pence. With the voting held open on the Senate floor, McCain was personally lobbied by Pence and then took a call from then-President Donald Trump in the cloakroom of the Senate.

Despite those efforts, he returned to the floor of the Senate and voted against the bill, later stating: “Our health care insurance system is a mess. We all know it, those who support Obamacare and those who oppose it. Something must be done.”

That will be the message of the American Health Security Project. American health care is a mess. Everyone knows it. Something beyond politics must be done.

All Americans are health insecure. None of us know whether members of our families will have the funding and care that might be needed to save lives and livelihoods. Democrats and Republicans alike have been successfully exploiting our health insecurities to drive us apart and then win elections which allow each party in turn to govern us with force and harshness, denying us the care that we need.

It is time to stop placing our time, efforts, and resources at the behest of either major political party, when what we get in return is the indifference and posturing that I have seen on Capitol Hill for 30 years.

I invite all Americans to change political habits. If you routinely identify with either major party in the United States, instead of helping them, from now on bring the dollars and the doing that you usually donate to candidates and political causes to The American Health Security Project.

You can find The American Health Security Project online at https://americanhealthsecurityproject.org.

Joseph Q. Jarvis, M.D., MSPH, is the author of “The Purple World: Healing the Harm in American Health Care,” and the forthcoming book “For the Hurt of My People.” He is a public health physician, former family doctor, and one-time academic occupational medicine specialist.

Show Notes from the podcast channel “Medicare for All Explained”

This is episode 70, “How a Conservative Came to Support Single-payer Healthcare.”

My guest, Joseph Q Jarvis, MD, MSPH, received his medical and public health training at the University of Utah School of Medicine. His career includes time as a family doctor at a community health center, the state health officer for Nevada, a public health physician for state and federal agencies, a physician consultant with a national practice, and a specialist in occupational lung disease at a tertiary care center.  Dr. Jarvis has seen American health care across the entire spectrum of care.

Thirty years ago Dr. Jarvis came to the realization that American health care fails to deliver quality care at a reasonable price, and that Americans are suffering from society wide health insecurity.  Since then he has done everything he could think of to help all Americans realize how our health system is failing us and what we can do about it.  He shares his conclusions with anyone who will listen, or read his book “The Purple World: Healing the Harm in American Health Care.”  

Do not miss this episode as Dr. Jarvis explains how and why he came to support Medicare for All.

Please note that there was a connection problem that may have affected sound quality.

Learn more about Dr. Jarvis here.

His book, “The Purple World: Healing the Harm in American Health Care,” can be purchased here. 

A review of his book can be found here.