PROVIDENCE – Our health care system has come a long way under the Affordable Care Act. Rhode Island’s health insurance exchange is a national model and our uninsured rate is among the lowest in the country. Nonetheless, many Rhode Island families and small business owners spend far too much on health care.

This challenge isn’t unique to Rhode Island. America’s health care system is dizzyingly complex and inefficient. One consequence of that complexity is that the United States spends far more on health care than other developed nations, and in many cases, our outcomes aren’t as good. While we spend more per capita than any other industrialized nation on health care, our average life expectancy is on par with the Czech Republic. Many countries that perform better have a national health care system.

One of my top priorities in the Senate is to lower health care costs while improving the quality of care for Rhode Islanders. That’s why I believe it’s time we had a real conversation about moving toward a national health plan. One approach is the Medicare for All Act, which I am proud to have cosponsored. This proposal signals where the American health care system needs to go – a place where every American has quality, affordable health insurance coverage and where no one goes without the care they need when they need it.

The transition will require careful planning to make this shift successful.

Prioritize health care for veterans
First, we must carefully prioritize health care for our veterans. Veterans have made enormous sacrifices for our nation, and we owe them the best health care. The Providence VA is a national leader, and the Rhode Island veterans who like the care they receive there should not be forced to make changes. While the current Medicare for All proposal does not touch the VA health care system, we still need to make sure veterans are on board and know they will be protected.

We must consider the many seniors who get Medicare coverage through private insurers under Medicare Advantage. Medicare Advantage plans take extra steps to help seniors coordinate their care and typically provide more benefits than traditional Medicare. Ninety percent of seniors with Medicare Advantage plans are happy with their coverage, according to one survey. I believe Medicare Advantage should continue to play a role within Medicare for All.

Medicare Advantage provides a model for employer-based coverage as well. There are effective models in other developed countries where government backstops the sick and allows the “insurer” to focus on quality of care, customer satisfaction, and lowered cost. Among other benefits, this would reduce the burden of present “trench warfare” between insurers and doctors over payment claims. Existing Accountable Care Organizations are a microcosm of what this could look like, as are Neighborhood Health Plan and Blue Cross Medicare Advantage.

Unions have fought hard for decades to secure robust, affordable health insurance coverage for their members. They have deep experience building benefit packages that work for their members and must be strategic partners in an effort to build a single-payer plan. They need to be on board with a result that works for them.

State Medicaid programs have been tailored to the needs of the communities they serve. For example, beginning this year Rhode Island will receive federal matching funds for home visitation services to provide extra care for pregnant women and children on Medicaid. Federal matching funds will also support a state program to provide peer-mentoring services for children and families facing behavioral health challenges. Medicare for All ought to preserve local flexibility to innovate.

A national network that covers everyone
Congress must consider each of these areas carefully in order to realize the promise of Medicare for All: a national health care network that covers everyone. While some have tried to characterize Medicare for All as unaffordable, it actually costs more to support the existing system. Overall health spending for the entire country would go down by $2 trillion over the first decade, according to one estimate.

As we work toward Medicare for All, there are improvements we should make to our health care system right now. That’s why I’ve introduced legislation to add a public option to every health insurance exchange. This would give everyone shopping for health insurance on the individual market the option to buy a government plan that they can trust is there to protect their health.

It is a national shame that we are not yet providing every American with quality, affordable health insurance coverage. In this shining city upon a hill, we can, and must, do better.