The upcoming presidential election hinges on health care. The candidates are sparring over what’s been cast as their dramatically different visions for the public option, Medicare for All and individual mandates.

Californians—and all Americans—deserve a different conversation about health. 

Policymakers’ discussions, no matter the party, map back to the same tired health blueprint that Americans have been using for the past 80 years. The challenges of health care cost and access are important topics but our leaders need to have a broader, bolder vision for health. 

Our current system simply doesn’t work. Health care costs are out of control. According to the Organisation for Economic Co-operation and Development, an international public policy organization, the U.S. spent $3.5 trillion on health care in 2018—just over $10,000 per capita. That’s about twice as much as other high-income countries.

The spending doesn’t result in better health outcomes. In California, the burden of ailments like drug addiction, diabetes, Alzheimer’s and chronic kidney disease is soaring. Mental health challenges also take a tremendous toll: depression, anxiety and suicide are all among the top 10 causes of premature death and disability for Californians in the prime of their lives.

These challenges are compounded by pervasive health inequities along racial and ethnic lines. According to the CDC and other sources, African-Americans in California die from cancer, diabetes, heart disease and many other diseases at much higher rates than their white counterparts. 

Governor Newsom’s budget proposals could make real progress in ending inequities and boosting health in California. But national political leaders should also be asking: What forces shape health and well-being—today and in the future? What do Americans really need and want in terms of health? Can we design a healthier future for all of us, not just people with the most money and privilege?

For example, the Los Angeles Times’ Next California series revealed that 58 percent of jobs in the Los Angeles-Long Beach-Glendale area could be lost to automation by 2035. Beyond needing new jobs and training, how will this impact workers and their families? What will these big shifts do to their housing, environment, sense of belonging and health? These are vexing questions that the “single payer v. public option” and “repeal and replace” debates cannot solve.

Seventeen health-focused philanthropies in more than a dozen U.S. states—including the Blue Shield of California Foundation and the Alliance Healthcare Foundation in San Diego—are filling this void. They’ve launched an initiative called FORESIGHT that aims to change the national conversation about health. These forward-looking foundations are challenging corporations, community leaders, policymakers and families from across the country to join them.

First, we’ve teamed up with a group of professional futurists—people who spend their careers researching and scanning what the future could look like. They’ve identified nine game-changing trends that will majorly impact health including the infusion of machines into all aspects of life, the simultaneous rises of authoritarianism and citizen movements, and the breakdown of our environment due to climate change.

Next, we’re talking with people from many parts of the U.S.—particularly people who live on the margins and are most likely to have negative health outcomes because of inequities in our system. We want to know what excites and scares them about the futurists’ predictions and what health should look like in 30 years. In the coming months, we’ll talk to more than 8,000 people across the country, including in the San Diego area. We’ve already heard in initial conversations that people are ready to accept this challenge and meet it head on.

We are confident that we will unearth a new future for health that brings Americans together—because they will see themselves in it. Imagine a different kind of populism, where people from across the country grab hold of a national vision for health they created and put it into action locally. For the first time, Americans will be able to test out new strategies for health informed by the possibilities of the future—rather than reacting to the constraints of the present.

FORESIGHT is an exercise in hope and optimism, and most importantly, it’s the chance to build a different reality for health in the United States. This is the kind of bold health conversation our country needs and deserves. 

Peter Long is senior vice president at Blue Shield of California. Laura Landy is the president and CEO of The Rippel Foundation. They are two co-chairs of the FORESIGHT initiative.

The California Health Report receives funding from the Blue Shield of California Foundation but remains editorially independent.